One of the most heartbreaking and frustrating aspects of dementia care can be when your loved one insists, with absolute conviction, that there is nothing wrong with them. They may dismiss concerns about their memory, refuse necessary medications, or become angry when you suggest they shouldn’t drive.
This isn’t always simple denial or stubbornness—it is often a profound neurological condition called anosognosia, where the brain is literally unable to recognize its own impairments. Trying to reason, argue, or present evidence only leads to conflict and distress.
But by understanding this lack of awareness as an actual symptom, not a choice, you can learn new ways to connect, communicate, and provide care that reduces conflict and preserves your relationship.
Are They in Denial or is it Anosognosia in Dementia?
Family caregivers often ask, “How do you tell someone they have dementia”? And in some cases, the answer may be that you simply can’t.
Damage in the brain can cause people with Alzheimer’s disease, dementia, stroke, brain tumors, and other cognitive impairments to believe that there’s nothing wrong with them.
When that happens, it’s called anosognosia (pronounced ah-no-sog-NOH-zee-uh, hear it here). The word literally means “to not know a disease,” and it’s much more than being in denial.
We explain what it means when someone has anosognosia and doesn’t believe they have dementia, and why it’s different from denial.
We also share six suggestions for helping someone with anosognosia who doesn’t want assistance, but clearly needs it.
What is Anosognosia in Dementia?
Anosognosia is a condition that causes someone to be unaware of their mental health condition and how it affects them. It’s common in some situations, including dementia.
So, someone who has been appropriately diagnosed with dementia, but has anosognosia, doesn’t know or believe that they have dementia.
However, anosognosia symptoms may vary significantly from person to person, change over time, and might even fluctuate within a day.
The person might sometimes understand what’s happening and other times firmly believe that they’re completely fine.
And depending on their level of self-awareness, other people might only be partially aware that there’s something wrong.
Unawareness of cognitive impairment can affect memory, general thinking skills, emotions, or physical abilities.
They might have occasional difficulty with language, such as finding words, but they can explain it away with excuses like forgetfulness or fatigue.
And even if they forget to bathe, miss appointments, or burn food on the stove, they’re still likely to insist that they don’t need help.
They’ll probably also insist that they’re absolutely capable of living independently – despite clear evidence that things are going wrong.
If someone reminds them of their cognitive impairment, someone with anosognosia may get angry and defensive because, in their mind, they’re 100% convinced that there is no problem.
Anosognosia in Dementia Isn’t the Same as Denial
It’s important to understand that someone who has anosognosia in dementia isn’t just being difficult or in denial – this is something different.
When someone is in denial, they are aware of a fact, but refuse to accept it.
With anosognosia, the damage that dementia is causing in their brain makes it impossible for that person to be aware of what’s happening to them.
6 ways to help when someone has anosognosia in dementia
1. Don’t try to convince them they have dementia
Using reason and evidence to explain or insist that someone has dementia is not going to help.
It will only upset them and likely make them even more convinced they’re right and that you’re wrongly discrediting them.
A more effective strategy is to make discreet changes that help them live safely.
And overall, stay calm and focused on their feelings when expressing your concerns, and keep your comments as subtle and positive as possible.
2. Work with their doctors and care team
When your older adult’s dementia symptoms are interfering with their daily lives, it’s time to start working with their care team – including doctors, relatives, friends, in-home caregivers, or assisted living staff.
Explain the problems your older adult is having and help the team understand that they aren’t aware of their dementia, and why it won’t help to try to convince them logically.
Work together to creatively provide your older adult the support they need with the activities of daily living without waiting for them to ask for help or forcing them to admit there’s a problem.
3. Discreetly make their life as safe as possible
Making your older adult’s everyday life simpler and safer can help prevent someone with anosognosia in dementia from hurting themselves or others.
Some people might try to drive, manage money, cook, or do other activities that could be dangerous because of their cognitive impairment.
Without mentioning dementia as the reason, you may need to make changes such as finding creative ways to stop them from driving, working together to prevent financial problems, making the kitchen safer, or making the home safer overall.
Use a positive approach and present it as removing burdens from their lives so they can do more of what they enjoy rather than doing chores.
Focus on allowing them to do as much as they can independently, while you or another caregiver is available to help when needed or observe for safety.
Finding ways to help that still preserve pride will be most effective.
For example, you might say that you don’t enjoy eating alone, or you want to spend more quality time together, so you want to eat dinner with them.
Or, say that you have some fantastic new recipes you need their help to taste-test, so you’ll leave the prepared dishes in their fridge to eat during the week.
Others have found it effective to introduce an in-home caregiver in different ways so it won’t seem like the older adult needs help.
4. Avoid correcting them and having confrontations; pick your battles
When someone has dementia, their brain may experience a different version of reality because of the damage the disease has caused.
Dementia care experts recommend stepping into their reality rather than trying to correct them.
Their brain is losing the ability to process information, and forcing them to join the “real world” only causes confusion, anxiety, fear, and anger.
If something is a serious safety issue, you may have no choice but to insist on doing things your way.
But as much as you can, try to solve problems without them knowing, choose your battles, and let the non-serious things go to avoid conflict as much as possible – stress only makes challenging dementia symptoms worse.
5. Present solutions positively and subtly
The less your older adult feels that they’re being limited for reasons they don’t understand, the less likely they are to become angry or resist help.
Generally, when someone has anosognosia, it helps to be creative and offer solutions in a positive way rather than talking about the problem.
For example, you might say, “It’s a beautiful day outside. Let’s go for a walk together so we can both enjoy the fresh air.”
That’s positive and much easier to accept than if you had said, “ You know you can’t go outside alone, you’ll fall or get lost. I have to go with you.”
Or, offer a compromise with a positive incentive, like “Let’s clean the house together so we’ll be done twice as fast and have plenty of time to watch your favorite show.”
Reminding them to take their medicine can also be done positively.
For example, say “It’s time for both of us to take our medicine. We both need these to keep ourselves in tip-top health.” (If you don’t need any medications at that time, you could “take” mini M&Ms, tiny breath mints, or something else that appears to be a pill, but is harmless. Please keep them in a pill bottle to make them look more real.)
6. Learn more about dementia and dementia care techniques
Many of the most effective dementia care and communication techniques aren’t easy to figure out and might even run counter to our instincts.
Not knowing these helpful techniques can cause added frustration and stress for both you and your older adult. That’s why educating yourself is so important.
Learning as much as you can about the disease helps you solve the top challenges and improve the quality of life for both of you.
Try these helpful resources:
- Alzheimer’s Association
- Alzheimer’s Foundation of America
- 3 Stages of Dementia: What to Expect
- 12 Best Alzheimer’s and Dementia Books for Caregivers
- 14 Caregiver Support Groups on Facebook You’ll Want to Join
- More dementia care articles
Final Thoughts
Navigating anosognosia requires stepping out of a reality-based world and into our loved one’s emotional truth. The goal shifts from making them understand they are ill to making them feel safe, respected, and connected.
Embracing these strategies isn’t about giving in or being dishonest; it’s about practicing a profound form of empathy that prioritizes their emotional well-being over factual correctness.
This path is challenging, so be patient with your loved one as their brain creates its own reality, and be incredibly patient with yourself as you learn this new language of care. You are finding ways to love and support the person they are now, and that is a beautiful and courageous act.
Recommended for you:
- 12 Best Alzheimer’s and Dementia Books for Caregivers
- 3 Stages of Dementia: What to Expect
- Therapeutic Fibbing: Why Experts Recommend Lying to Someone with Dementia
About the Author
Connie is the founder of DailyCaring.com and was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also understands the importance of support, especially in the form of practical solutions, valuable resources, and self-care tips.
My mother is 70 and has rheumatoid arthritis, In the last two to three years her mental stability has been getting worse. She won’t see her doctors, she won’t get her shots, she won’t take her medicine, she is falling, she can’t open her hands to do anything for herself. My dad has done everything he can to protect her and care for her. He has taken over all responsibilities and made life as simple as possible. He has given up all of his simple enjoyments and even friends due to her mean disposition, paranoia, and the need to be right beside him at all times. He has used some therapeutic fibbing, some coercion, bargaining, and pleading. I am afraid I am more direct, like you have to take a bath/shower to go to your grand daughter’s play or at least let us wash your hair. I even offered to take her to a mother/daughter nail spa day, so she would let someone cut her nails that are three times too long. Her rheumatiod arthritis is worse and she has fallen a few times. My dad sometimes has to help her off the toilet or out of bed. Other times, she is following him around the house. They have stairs and she won’t let us put a lift in. I am terrified she will fall down the stairs since there are times she can barely walk. She is down right hateful to me since she sees me as a threat to my father’s attention. My 12 and 13 year old girls don’t even want to go over to my parents’ house because of how mean she is to me and sometimes even them. There has always been a level of mental illness with my mother (undiagnosed of course), but now it is so much worse. She used to be sharp as a tack and never forget anything. She can’t remember how to do basic things in her own home. She doesn’t remember what she has done from one minute to the next. The worse part is that she doesn’t think anything is wrong. Now she is sleeping in and wearing the same clothes. It has been two weeks. No matter what my dad or I try, she will not change clothes. She has also gone from 130 pounds two years ago to 80 pounds. Her face is terribly broken out. We need help, but she won’t go to the doctor. We don’t know how to help her when she won’t even let her spouse of 50 years help her. Something has got to give because my dad is not well. He really should not be taking on this much stress and 24/7 care of my mom. It is affecting his health. She won’t let anyone else stay with her or help her with anything when my dad is not around. We have considered calling a social worker or getting a doctor to come to the house. My dad just doesn’t know what else to do, but he is finally realizing that things can’t keep going the way they are; bad to worse.
We’re so sorry to hear about this very challenging situation. Unfortunately, with the severe weight loss, limited mobility, and personal hygiene issues, it sounds like your mom may no longer be able to use good judgement to keep herself healthy. It may be time for your dad (and you) to change the situation, possibly without her agreement. First, it would be a good idea to have a doctor come to the house to see if they can detect any cognitive issues that could be treated. But if she refuses to be examined, it may be time to insist that she must choose between getting the care she needs at home (proper medical care and hygiene) or perhaps moving somewhere where a staff can give her the care she needs in order to protect both her and your dad’s health.
More info here:
– 7 Treatable Health Conditions with Dementia-Like Symptoms https://dailycaring.com/7-treatable-health-conditions-with-symptoms-similar-to-dementia/
– 8 Treatable Diseases That Mimic Dementia https://dailycaring.com/8-treatable-diseases-that-mimic-dementia/
Michael, It sounds like you are fully aware of your cognitive decline and I can see how you need a more direct communication. My husband thinks he is fine. As his wife of 48 years and his right hand person, the last few years have been a struggle for him and me. Since he doesn’t recognize his cognitive decline, being direct is sometimes more hurtful to him and causes angry responses. Each family living through LBD or other types of dementia have unique ways to deal. I wish peace for you. Take care.
Way too fluffy. You paint lovely word pictures, and that’s just not the way it is. I believe there’s far too much emphasis placed on the demented person, and not nearly enough on the sleep deprived, mentally and emotionally tortured care giver. I have Lewy Body Dementia, and while I still have some semblance of my faculties, I would be angered by such obvious, patronising manipulation. Too many poor people are living bitter lives of quiet despair because of this saccharine emphasis on “care givers” doting on “loved ones” when many are simply not up to the task. I am demented. My brain is dying, and no amount of spin will ease the burden on those who love me. Just let me go.
It’s helpful that you’re already clear on what you want and how you do and don’t want to be cared for. If you make your wishes known to your family, it will help them treat you in the manner that you’ve chosen.
Nice article. Calm solutions.
I’m afraid it didn’t help much in our case though. Mother flat refuses assistance of any kind or a move to a skilled nursing facility. She has been hallucinating, running out into the busy highway, and yelling hurtful things at her relatives. It is against the law to lock her inside her house and she can’t afford sitters. I have had to ask the state to attempt guardianship. After two years of stress and depression, I’m walking away to rescue my own life.
We’re so sorry to hear that nothing has worked to help your mother accept the assistance she needs for her health and safety.
Two years. You did well. I’m in your mother’s situation, just not as bad yet, and from this side of the equation, I think you are doing the right thing.
Lovely and caring