Alzheimer's Foundation of America

Foundation of America


It is a common concern among family caregivers—offering help to a loved one with Alzheimer’s, only to be rebuffed and told “I don’t need help.” They can no longer manage their personal finances or drive safely. Personal hygiene might become less important. Medication remains untaken. Dementia can bring memory problems, confusion, behavioral changes, and impaired judgement.

It seems obvious to others when a loved one needs help. Why would a loved one not only refuse help but refuse to recognize that help is even needed? Or that there are self-care steps they need to take?

One possibility is a medical condition called anosognosia, where individuals genuinely cannot recognize their own impairment. Because of changes in the brain, they are unaware that they need assistance; the ability to understand their own impairment is affected. This is not the same as denial.

Those with Alzheimer’s disease or other forms of dementia, as well as traumatic brain injury, stroke, bipolar disorder, and schizophrenia, can truly believe there is nothing wrong with them. According to Anosognosia by Aninda Achary and Juan Carlos Sánchez-Manso, 81% of individuals with Alzheimer’s disease and 60% of individuals with Mild Cognitive Impairment (MCI) exhibit signs of anosognosia. To compound the difficulty, there can be varying degrees of self-awareness. Common responses to this condition are rationalizing impairments, disbelief that there is an impairment, and anger. Because a loved one must be cared for and kept safe, intervention is needed. Remember that
strategies need to keep evolving as the illness progresses, and finding solutions is often a process of trial and error.

Tips for helping a person who is experiencing anosognosia

  • Consult with your medical provider for advice.
  • Understand that your loved one truly believes there is nothing wrong with their functioning.
  • Don’t take things personally. Your person has an illness.
  • Offer choices so that some autonomy is maintained.
  • Let your loved one do what they can (e.g., If they want to pay bills, have dummy checks made. If they enjoyed homemaking, let them fold laundry or set the table).
  • If your person can no longer drive, you drive to their destination, reminding them that it is to “give them a break.”
  • Find activities close to things they once did but simplify them.
  • Take an individual approach; use your best judgement. If one approach does not work, try another.
  • If a Power of Attorney is needed for medical and/or legal affairs, say it is being done “in case anything ever happens to you.”
  • Join a caregiver support group for feedback and resources.

Contact the AFA Helpline at 866-232-8484 to speak with a licensed social worker specifically trained in dementia care for support.

This article originally appeared in Alzheimer’s TODAY, Volume 16, Number 1, published by AFA. View the entire issue here.