What is Anosognosia?
Anosognosia is a type of mental health condition where a person is not aware, or in denial of their physical limitations or health issues without realizing it. This condition was first brought to light by a French neurologist named Joseph Babinski, in 1914. He noticed it in patients who didn’t acknowledge the fact that they were unable to use the left side of their bodies. Anosognosia can occur in people with various types of psychological and neurological disorders. It is most commonly seen when there is damage to the right side of the brain due to a stroke. Also, this term is used in psychiatry to define a patient’s unawareness of their condition.
What Causes Anosognosia?
Anosognosia typically occurs as a result of damage to the right parietal lobe in the brain, a condition often seen after an injury. However, it’s not always linked to this specific part of the brain; it can also occur with damage to other areas like the temporoparietal regions, thalamus, basal ganglia, or even in mental health conditions.
The exact cause of anosognosia is not yet known, but it’s assumed to be linked to disruptions in the parts of the brain responsible for consciousness and the awareness of deficits. It’s believed that a brain injury causing anosognosia might disrupt certain areas responsible for higher-level thinking, linked to areas of the brain referred to as “secondary integration areas”.
Specifically, researchers are looking into the role of some areas of the brain. One is the prefrontal cortex, which helps us with tasks like memory, self-monitoring, and organizing. Another is the insular cortex, which plays a role in processing emotions, recognizing mistakes and directing our attention to important things. The third is called the default mode network, which involves connections between the prefrontal cortex and other areas. Damage to these regions could make a person unaware of their loss of cognitive abilities or motor skills.
Risk Factors and Frequency for Anosognosia
Anosognosia, or a lack of awareness about one’s health condition, can happen after a brain injury like a stroke or trauma. But it can also occur with no identified brain injury. In stroke patients with partial paralysis, about 10% to 18% experience anosognosia. This term is also used when referring to certain psychiatric conditions where the person may not realize or acknowledge their symptoms.
- It’s estimated that between 50% and 90% of schizophrenia patients and 40% of bipolar disorder patients exhibit anosognosia or a severe lack of insight.
- In cases of neurological cognitive diseases, around 60% of those with mild cognitive impairment and up to 81% of people with Alzheimer’s dementia appear to show some form of anosognosia – often denying or minimizing their memory problems.
Signs and Symptoms of Anosognosia
Anosognosia, a condition where patients are not aware of their symptoms, is usually diagnosed by healthcare professionals through patients’ discussions about their understanding of their own symptoms. Some patients come up with somewhat logical reasons why they can’t perform certain tasks, making the condition difficult to notice immediately. In cases where the patient has dementia, they often don’t recognize or minimize their memory problems. When anosognosia occurs in conjunction with mental illness, patients frequently come up with excuses for unusual behavior or symptoms of their psychiatric illness and often make up stories combining real and imagined information without realizing it.
Testing for Anosognosia
Anosognosia, or lack of self-awareness about being ill, can often be linked to physical damage in certain areas of the brain. Typically, medical brain scans reveal damage in the right parietal or right temporoparietal sections of the brain. In less frequent cases, damage might be found in the thalamus, basal ganglia, or left parietal region of the brain.
In terms of dementia, brain scans often reflect a more generalized shrinkage of the brain. For individuals dealing with mental health disorders, brain scans usually don’t provide specific insights.
There’s even a rating scale to assess the unawareness level among dementia patients. The scale ranges from patients who easily admit their memory loss to those who get angry at the mere suggestion of having any memory problems.
Treatment Options for Anosognosia
There isn’t a particular cure for anosognosia, however, it appears that stimulating the balance system in the ear can provide temporary relief. This method seems to temporarily raise awareness of the side the person has been ignoring. If anosognosia continues, cognitive therapy could assist patients in better recognizing and adapting to their limitations.
What else can Anosognosia be?
Anosognosia is a condition that is different from denial. Denial is a mental strategy where people do not accept or avoid information they find stressful or painful. In denial, an individual might know they have an issue but downplay its impact and avoid seeking treatment. However, Anosognosia is different and should not be confused with severe mental impairments such as encephalopathy, which causes problems with being awake and attentive. It also differs from other problems like vision loss or cognitive difficulties, which may prevent people from recognizing their own difficulties.
What to expect with Anosognosia
Anosognosia, a condition where a person is unaware of their illness, can be caused by both physical changes in the brain or mental and dementing illnesses. When caused by a physical change in the brain, it generally improves over time, though it can occasionally last for a long time. However, when anosognosia is due to mental or dementing illnesses, the condition might stick around and can lead to a patient not following their medication routines properly.
Possible Complications When Diagnosed with Anosognosia
Anosognosia, or a lack of awareness about a personal health issue, can hinder the healing process. This is because patients who have anosognosia often don’t participate as much in rehabilitation therapy, which is needed to address their neurological problems. On top of that, patients with this condition are more prone to falling due to their unawareness of their limitations. This means healthcare providers might need to implement additional safety measures to prevent these patients from getting injured.
Recovery from Anosognosia
Recently, A.R. Egbert outlined a moral structure to involve patients with anosognosia, a lack of awareness or denial of a health condition, in their rehabilitation treatments. It’s important for rehabilitation specialists to always keep this condition in mind, as it could influence the results of their treatment plan.
Preventing Anosognosia
Teaching patients and their family members how to handle and prevent problems associated with anosognosia, a dysfunction where a person doesn’t recognize their own illness, is very important. This is because those who have anosognosia often don’t cooperate as they fail to acknowledge or underestimate their condition. Things like driving, handling money, and walking without assistance could become points of dispute.
Ensuring the safety of these patients is vital to prevent any injuries. This involves assessing their environment thoroughly. Helping them manage tasks by making them simpler, keeping a positive attitude, showing care and understanding, and creating a well-structured environment can be very beneficial. These strategies aim to prevent any negative outcomes and assist in their overall wellbeing.