ANOSOGNOSIA - WHEN YOUR BRAIN DENIES REALITY

Medically Reviewed by Dr. Sony Sherpa, (MBBS) - September 23, 2024

Anosognosia is a condition that affects a person's ability to recognize their illness or disability. It is a complex neurological disorder that can occur in various forms and have different causative factors.

In this article, we will explore what it is, its types, symptoms, potential causes, and how it can be treated.

What is Anosognosia?

Anosognosia is a Greek term that translates to "without knowledge of disease." It is a neurological disorder in which a person suffers from a lack of insight regarding their illness or disability.^[1]

The condition was discovered by French-Polish neurologist Joseph Babinsky in 1914^[2]. Babinsky observed that some left hemiplegic patients believed that they could move their paralyzed limbs. Those with hemiplegia are paralyzed on one side of their body.

The lack of awareness of this condition is not due to extreme denial. It is rather a neurological deficit that impairs the patient's ability to recognize their condition.

It is most commonly linked to:

• Neurological disorders, such as traumatic brain injury, stroke, or dementia.
• And mental conditions, such as schizophrenia or bipolar disorder.

In some cases, it can also be a defense mechanism for the brain to cope with a traumatic event.

Types of Anosognosia

There are different types of anosognosia, depending on the area of the brain that is affected. The most common types are:

• Motor anosognosia affects a person's ability to recognize their paralysis or hemiplegia.
• Cognitive anosognosia is the inability to recognize one's cognitive deficits.
• Affective anosognosia occurs when someone does not recognize their own emotional or mood disturbances.
• Sensory anosognosia affects a person's ability to recognize their sensory loss, such as deafness or blindness.
• Anton's syndrome is a rare type that creates the inability to perceive or denial of blindness. It is also known as visual anosognosia.

In psychiatric illness, the condition does not necessarily present as one of these types. It is commonly seen as the inability of the patient to be aware of their delusions, symptoms, or mental illness.

How Common is Anosognosia?

The prevalence varies. In stroke patients, the condition commonly occurs in the early stages, roughly affecting anywhere between 10-44% of patients.^[3]

50-90% of schizophrenic patients are likely to be affected. Up to 40% of those with bipolar disorder may have the condition as well.

While it can occur in other mental health conditions, the prevalence is not well established.

Symptoms of Anosognosia

The most common symptom of anosognosia is a lack of awareness or insight into one's condition. This can manifest in a variety of ways, depending on which type a person has.

Some common symptoms include:

• Denial of illness or disability
• Lack of concern for their condition
• Refusal to seek treatment or follow medical advice
• Inability to recognize or acknowledge their limitations
• Lack of awareness of their behavior or actions
• Difficulty understanding or accepting their diagnosis
• Emotional distress due to being in denial

Unlike ordinary denial, facts or evidence to disprove the patient's belief cannot shake their incorrect perceptions.

Not every person with anosognosia will experience it in the same way.

Challenges Faced by Those With Anosognosia

Those with the condition are prone to living with the following challenges:

1. Lack of Awareness: Not recognizing the condition makes it difficult to seek treatment or get support.
2. Strained Relationships: Denial can lead to strained relationships, especially with loved ones and caregivers.
3. Treatment Difficulties: People with the condition may refuse to take medications, stick to protocols, or attend consultations.
4. Impact on Daily Life: It often causes the person to be dependent on others due to an inability to perform some daily tasks.

Early intervention may help to ease the burdens of a person who denies their symptoms or disabilities.

How Long Does It Last?

Anosognosia can last for varying lengths of time. The duration depends on the underlying cause and individual circumstances.

It can be a temporary condition that improves over time with treatment or a chronic condition that lasts indefinitely.

The specific type can affect the outcome as well:

• If related to stroke or traumatic brain injury, it may improve as the brain heals and recovers.
• If associated with degenerative neurological disorders, like dementia, it may progressively worsen over time.

Early intervention, therapy, and medication can improve insight and awareness, leading to better long-term outcomes.

If you or someone you know is experiencing symptoms, promptly seek anosognosia assessment and treatment from a healthcare professional.

Causes of Anosognosia

The exact cause is unknown.

It likely involves disruption of specific areas of the brain that affect cognitive and sensory functions. These regions form part of the frontal lobe, prefrontal cortex, insular cortex, and default mode network. They are responsible for working memory, self-monitoring, emotional processing, and error awareness.

Anosognosia can be the result of a traumatic brain injury, stroke, or degenerative neurological disorders, such as dementia and schizophrenia.

Denial as a Defense Mechanism: In some cases, it is seen as a defense mechanism, allowing the brain to cope with a traumatic event. The brain may block out awareness of a disability or illness to protect the person from the emotional distress they went through.

Risk Factors for Anosognosia include the conditions it is associated with and risk factors for those conditions, such as:

• Injuries or accidents
• Unhealthy diet and lifestyle choices
• Post-Traumatic Stress Disorder or severe life stress
• Delirium

The risk can be reduced by following a healthy lifestyle and maintaining open lines of communication with loved ones. The more communicative one is, the quicker a diagnosis and treatment are likely to be.

Diagnosis of Anosognosia

Diagnosis can be challenging, as it requires a thorough evaluation and someone else to be aware of the condition.^[4]

A doctor may use various tests and assessments to determine if a person has the disorder, including:

• Neuropsychological testing
• Brain imaging scans
• Vestibular stimulation tests
• Anosognosia-specific questionnaires

Anosognosia Treatment

There is no specific treatment for anosognosia, as it is a neurological condition that cannot be cured. However, there are ways to manage and improve a person's awareness of their condition.

One of the most effective treatments is vestibular stimulation therapy.

Vestibular Stimulation Therapy^[5]: This therapy involves stimulating the vestibular system, which regulates balance and spatial orientation. By stimulating this system, it can help improve a person's awareness and perception of their own body and surroundings.

Treating the Underlying Condition: In addition to therapy, medication can also be used to manage symptoms. These include antipsychotics for people with schizophrenia or mood stabilizers for people with bipolar disorder.^[6]

Supportive Therapy: For some, talking to a highly skilled psychotherapist or an occupational therapist can help them cope with the condition.

Cognitive behavioral therapy (CBT) and metacognitive reflection and insight therapy (MERIT) are effective in managing anosognosia and enhancing self-awareness.

Environmental Modifications

In addition to treatment, a person's home environment may need to be changed to promote safety. Examples include:

• Removing hazards
• Ensuring clear pathways
• Installing safety features
• Improving lighting
• Simplifying the environment
• Using visual cues
• Implementing a daily routine

How to Help Someone With Anosognosia

If you know someone who has this condition, it can be challenging to understand their lack of awareness and acceptance.

Here are some tips on how to help someone with anosognosia:

• Educate yourself about the condition and its symptoms
• Be patient and understanding
• Encourage them to seek treatment and follow medical advice
• Avoid arguing or trying to convince them of their condition
• Provide support and assistance when needed
• Seek support from a therapist or support group for yourself

Takeaways

Anosognosia is a complex neurological condition that impacts a person's ability to recognize their illness or disability. It can occur in different forms and can be caused by various factors, such as brain damage or mental illness.

While there is no specific treatment for it, there are ways to manage and improve a person's awareness of their condition. With patience, understanding, and support, people with anosognosia can learn to manage their condition and live a fulfilling life.

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