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Monday, January 28, 2013

Convincing an Alzheimer’s Patient – Why Does this Fail?


Caregivers may find it reassuring that not only the behavioral and cognitive changes, but also the lack of insight, are a direct result of the Alzheimer's disease process.

By Monica Heltemes
Alzheimer's Reading Room


Convincing an Alzheimer’s Patient
Recently, Bob wrote an article about How to Convince an Alzheimer’s Patient.

He and many other readers commented on how difficult, or impossible, it was to convince their loved one that they had dementia or that they needed medication.

As an occupational therapist, I have encountered many patients who deny their deficits and overestimate their current abilities.

“Yes, I take care of my medications” or “Yes, I drive”, I will hear from the patient but then later learn from family that they have not done these activities for years.

Were the patients lying to me when they said they could do these things themselves?

Or, were Bob and the others’ loved ones being unreasonable when they would not accept their diagnosis?

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The fact is that a condition called anosognosia is to blame. Anosognosia is a lack of self-awareness, or insight. The person literally is not aware that they have a disability.

Damage to the brain from the dementia – whether from Alzheimer’s, fronto-temporal dementia, vascular dementia, or other – is the cause.


A 2008 study published in Brain and Cognition studied the phenomena of anosognosia in various types of dementia. What they found is that across conditions, patients had lack of insight into their memory loss and into their behavior changes.

These strong statements taken from the research article underscore the importance of caregivers understanding this:
Study participants “lack of insight into behavioral changes or reduced ability on tests of memory confirms the futility in trying to convince these patients of the extent of such deficits…..Caregiver education is important in mediating this burden in all dementia caregivers, especially when patients exhibit disruptive behaviors. Caregivers may find it reassuring that not only the behavioral and cognitive changes, but also the lack of insight, are a direct result of the disease process, and the patient is not behaving in a difficult, hurtful or indifferent manner on purpose.

So what are caregivers to do? The answer will be unique to each individual.

Perhaps, fiblets – or fudging the truth – may work for the person.

Having a directive from a person in authority, like a physician, might work.

Setting up a situation so the person with dementia feels like they are still doing things (even when the caregiver is doing most of the work) might work.

There is no single answer of what to do when the person with Alzheimer’s or other dementia cannot be convinced – except to know that it is the disease doing the irrational talking.

Monica Heltemes
Monica Heltemes is a practicing occupational therapist and owner of MindStart™.

Individuals with dementia may stop participating in activities and blame it on alternate reasons, such as not being able to see or not being interested. But often it is truly due to the person having difficulty with doing traditional activities. MindStart designs adapted hobby-style items, such as games and puzzles, specifically for individuals with memory loss. They keep individuals with dementia active, while giving support to caregivers, and are quick and easy to use. Visit MindStart to learn more.
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Original content the Alzheimer's Reading Room