When Insight Fades, Risk Rises
What happens when a person with dementia can no longer see what others see?
Anosognosia, a neurological condition in which individuals lose awareness of their own cognitive challenges, is one of the most complex and often misunderstood symptoms of dementia. Unlike denial, which is psychological, anosognosia is caused by brain changes that impair self-awareness. The result? A person may insist they’re fine, even when facing clear safety risks.
They may attempt to cook despite forgetting how to operate a stove. They may try to drive after getting lost and agreeing the week before they would no longer drive. They may refuse help with medications, finances, or mobility, believing that no help is needed. And they may genuinely not understand why you’re worried.
Anosognosia isn’t stubbornness. It’s not resistance. It’s a condition that requires skill, structure, and deep compassion to manage safely.
TheKey’s Clinical Leadership
Our SVP of Clinical Excellence and Quality, Dr. Shadi Gholiadeh, recently co-authored a chapter on anosognosia in the Pathways to Well-Being with Dementia manual, a national resource published by the Dementia Action Alliance. This free guide offers practical, evidence-based strategies for families and professionals navigating the emotional, cognitive, and safety complexities of anosognosia. Download here
At TheKey, we bring these insights into the home—where risk is real, emotions are high, and compassion must guide the plan.
What Anosognosia Looks Like in Daily Life
Anosognosia often fluctuates from day to day. In one moment, a person might accept support; in the next, they may reject it, firmly believing they don’t need help.
Common signs include:
- Insisting “I don’t have dementia” even after a formal diagnosis
- Overestimating abilities (e.g., refusing a walker despite recent falls)
- Denying memory loss, medication needs, or safety limitations
- Arguing against care plans, appointments, or caregiver presence
This disconnect can place both the person and their care partner at risk—physically, financially, and emotionally.
How TheKey Supports Clients and Families
At TheKey, we train our caregivers and Client Success Managers to recognize the signs of anosognosia and respond with dignity and clinical precision. Our approach includes:
- Care planning built around preserved strengths, not confrontation
- Structured routines that enhance safety without provoking resistance
- Environment modifications like automatic stove shutoffs or removing car keys
- Functional assessments to understand what the person can do vs. what they believe they can do
- Support for families navigating high-conflict or high-risk scenarios.
Why This Matters Now
An estimated 60–80% of people with moderate dementia experience some level of anosognosia. But it’s often missed (and rarely discussed) until a crisis occurs.
We believe early recognition and proactive support can prevent unnecessary ER visits, reduce financial risk, and dramatically ease family stress.
Our goal isn’t to “convince” the person. It’s to support them safely, respectfully, and with the understanding that their insight may come and go.
Free Download: National Resource on Anosognosia
We encourage families and professionals to download the Pathways to Well-Being with Dementia manual, including the chapter on anosognosia co-authored by TheKey’s clinical leadership team. It’s filled with strategies to reduce risk and build trust. Go to the Dementia Action Alliance website for a link to download.
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