In the past several months, as I’ve been doing research, attending classes, support groups and discussions with medical professionals, I’ve heard two words said repeatedly. These two words are ANOSOGNOSIA and CONFABULATION.

I wanted to discuss these two words because in understanding their meaning, I’ve been able to understand some of the actions ( or reasoning behind them) of my father.

Anosognosia

Anosognosia is a lack of knowing that an impairment, deficit or illness exists, in memory, thinking skills (such as language or math), emotions or movement. The term refers to brain cell changes that lead to this lack of self-awareness. IT IS NOT DENIAL. In denial, a person may accept that he is ill, but will avoid dealing with it by not taking his medicine. With anosognosia, the person is not fully aware that there is an illness. This is difficult for caregivers because they are trying to help a person who insists he needs no help. My father repeatedly tells me…don’t be ridiculous, I am NOT an invalid.

When I say “not fully aware”, I mean that there are levels of anosognosia. Some researchers use a rating scale which translates as follows:

1. easily admits memory loss
2. admits (sometimes inconsistently) to small amounts of memory loss
3. not aware of any impairment in memory
4. angrily insists that no memory problem exists

Because many or the dementias are progressive, so will be the level of anosognosia. My father’s dementia is somewhere between stage 2 and stage 3. He is aware that he has “some” memory loss but is not aware of how severe it is. One day, we looked for his keys for over an hour, even though they were in his pocket and even though he found them IN his pocket every 3 minutes. As soon as he placed them in his pocket, he would begin searching again and I would remind him that his keys were in his pocket.

Anosognosia also comes into play when dealing with family members ABOUT an elder with dementia, especially the elderly spouse. They may be aware that he has some “issues” but are not able to realize how severe the issues are…..but that’s a WHOLE OTHER subject.

Confabulation

People who have anosognosia will also often confabulate. This is a tricky process to understand. A person will take pieces of information and link them together in a way that is false. But a confabulation is not a lie. It is an inability to differentiate between what really happened, what didn’t, and when or where it happened. For instance, one of my patients had a bottle of a nationally recognized moisturizing lotion at his side. I made a comment to him that I liked that brand of lotion and he went on to tell me that he had made it himself, how he ground the sesame seeds into oil, and mixed the solutions, etc. I have to admit that I didn’t know what to say.

Typically, confabulation is done in order to answer the question or CONTRIBUTE to the conversation. To those who don’t know the person well or weren’t present during the event (that didn’t take place), the statements may seem perfectly plausible. My father once told a relative that my daughter was flying to Europe for a convention on international business (which was news to both my daughter and me) but since her college major was business, it seemed completely believable that she might do this.

Confabulation can sometimes cause embarrassment or even problems for the caregiver. Dementia patients have been known to confabulate events which might lead to caregivers being questioned about their caregiving practices. “No, she doesn’t feed me and I’ve lost 10 pounds since living there.” But the person who is doing the confabulation believes what they are saying and should be treated with respect and dignity.

Keys to Interacting

The key to interacting with persons who have anosognosia and/or tendencies to confabulate is to use positive approaches.

For instance, instead of saying “The doctor prescribed these pills and you have to take them!”, say “when you take your multi-vitamin, how about taking these “brain vitamins” that the doctor suggested to help keep your memory strong?”  Instead of saying “You’re not paying the bills on time and we’re getting late fees!  I’ll take over the bills from now on” say ” Let’s write out the checks together and after we’re done, we’ll mail them and go out for a nice breakfast”.

Caregiving is difficult, but the more we understand the mechanisms of the disease process and that it IS a disease process, the more we learn how to improve the caregiving process and experience.

For additional assistance with dementia and/or Alzheimer’s questions, please see http://www.alz.org