Can a person with Alzheimer's have anosognosia (a lack of awareness of their condition) and also be in denial?

First BurnoutGirl and JessieBelle my apologies because this is going to mix your input here and I will just confuse which is which if I try to separate my comments. My mom is also a diabetic so I know your pain. While the diagnosis of dementia/Alzheimer's and type if possible can be helpful, the label I think can be problematic, especially for the generation we are caring for now perhaps. I think we all worry about developing Dementia and Alzheimer's as we age and some are more accepting of having the label than others. Perhaps using a different label would help. Unfortunately my mom had a stroke 1.5 yrs or so ago but I find myself often thinking it was a blessing in some ways. Don't get me wrong it has created many issues and I wouldn't wish it on anyone but we were fortunate in that she had very little motor function affected and really none remaining, what is remaining is aphasia which effects both her speech and cognitive function. We are sure she was showing signs of memory decline, early dementia prior to the stroke so it's often hard to tell what is at play but being able to hear and think about memory and behavioral issues being due to the stoke/aphasia and her brain pathways newly developing is far easier to accept for her I think then saying it's dementia. We have discussions all the time about how her blood sugar plays into it as well because her brain is even more sensitive to her BS levels and proper nutrition now that it's working so hard to rebuilt pathways.

Now I'm not suggesting the situations are the same at all, Mom knows and remembers she had a stroke and knows the difference in her communication abilities so it's very easy to get her to by into the new pathway premise but we have these discussions often because she so often doesn't remember either having them or what was said and honestly I'm not sure she actually remembers some of the time that she pretends she does when I'm reminding her, the truth is I'm never sure whether it's actually the aphasia and stroke damage or Dementia/Alzheimer's at play either. She cared for (lived with) her mother with Alzheimer's for many years and I often recognize similarities. My point being while I am not an advocate of making up lies sometimes little ones feel more humane when dealing with memory loss and brain abnormalities. Do you think it might be easier for your mother to hear/think a different label? Memory issues, blood flow to the brain or brain pathway development, stroke even, IDK. Might it make her more receptive to accepting that she is forgetting things, take the onus off of elderly issues and put them on something that doesn't feel so hopeless. That's part of it I think, things like Dementia and Alzheimer's signify the end to them, people don't "recover" from that, it's a depressing label. The Swiss cheese of it all is so hard for everyone, patient, primary care giver and family to navigate too. I find it can be so hard in the midst of an immediate issue to remember to step back and not take what's being said or not done personally. It's such an energy zapper and there is so much history that ultimately probably doesn't apply but sure feels like it does. We're dammed if we do and dammed of we don't. Sometimes I find myself dropping my point and consoling, other times I use humor to diffuse things and still others I just say fine have it your way and hang up the phone in frustration and tears myself (yes anger too). It's far easier to gain perspective later while not in the heat of whatever hot topic or emergency of the moment, in the end all we can do is muddle through as best we can and try to remember that we are of no use to them if we aren't caring for our own mental health which may mean disengaging for now and it probably wouldn't be so bad if we didn't care so much which means we are coming from the right place.

Might setting out a weeks worth of laxative in one of those week pill holders help? So each day has a days worth and she still has complete control over when and if she takes it. I know she might then take the next day but if indeed it's just a trust and memory thing it at least gives her some private checks that you can of course also see. The other thought I had was maybe the doctor or someone she tends to listen to more could suggest Metamucil or something else either in place of or in addition to the laxative "since it doesn't seem to be working on it's own anymore", something that would give her a crutch that isn't as bad as so much laxative for her. Just a thought, it may be that she's too used to the laxative solving things or because it's just her memory that's the issue it wont help at all or might make things harder for you so no worries ignoring the idea, you know her.

The sugar craving and sneaking, a couple of ideas. First it might be worth consulting her doctor and getting a blood work up as well as a medication review to make sure there isn't some physiological issue, something she isn't getting or absorbing or a side effect going on that is making her crave sugar. Getting the sugar craving under control might help. Then reminding her that this type of sugar affects her memory and ability to do something she cares about. She probably wont remember this conversation for long but if you keep reminding her perhaps it will slip in and it gives you a way to express your concern, frustration without sounding like your accusing her of knowingly doing something wrong or trying to "control" her, maybe without such a heated argument. At the very least you are getting it out in a healthier way for you. Hope I'm making some sens here, not sure I'm explaining this well. If they don't find any underlying causes for sugar cravings there are ways you can try through diet and other natural things to help not just for the sugar cravings, though that could also be related to the afternoon crash...but for calming her down or leveling her mood through the day. Sometimes it's helpful to get a review of things like medication from someone other than her regular doctor too, new eyes or a different experience/training sometimes picks up on things.

Hi Burnout Girl,

Have you looked into Sun downing? You say she is doing strange things. My mom goes through sun downing every night but she doesn't splurge on sweets, etc. Every day around 4 p.m. she starts getting really confused about everything. Before I had to move her into a MC unit I would call her around 3 p.m. to let her know I was bringing her dinner over. Right on the dot of 4 p.m. she would call several times before got there to ask if I was bringing dinner. When I took her dinner over at 6 p.m. she would slowly get worse and by 8 p.m. she couldn't even remember her own name. If your mom is gorging on sweets before 3 p.m. I'm not sure that is sun downing. I may be wrong, but I was under the assumption that sun downing started at around 4-5 p.m.

I suggest that you read "The 36 Hour Day" that SueC recommended. I've read it and it explains a lot of things. It's a great resource. I wish you the best of luck in taking care of your mom.

SueC1957 ...Thanks... I had a feeling that both denial and lack of awareness is possible...Mom seems to see her Alzheimer's dementia on one level, and deny it...but sometimes the make-believe memories don't figure in... this is such a complicated disease... my niece described the Alzheimer's brain as Swiss cheese... sometimes things stick, and sometimes they go thru the holes, and you never know which....
Thanks again, all. Thank goodness for this site.

Wish it would work. My mother still has enough wits about her to be able to trick her. She would know if something wasn't her pills. I did sneak and substitute lower strength laxatives that will be easier on her system. The laxative thing has been a big fall-out point between the two of us, since it is asking me to compromise my own ethics to give her something she really doesn't need.

My mother also says that she could live here by herself if I decide to leave. I know that she can't handle much of anything anymore, so we stayed painted in a corner waiting for a big change.

HI BOGirl,
Yes, they can have a lack of awareness and be in denial at the same time-isn't that crazy? If you're in denial, then you wouldn't acknowledge you have a problem, therefore you don't HAVE a problem.

Denial is a powerful emotion. You can "believe" yourself out of anything but still have the problem. I had a patient that was HIV positive absolutely deny that she had the disease, even though the results were on the paper in front of her!

Alzheimer's is such a complex disease. It's really hard to know what's affected and what isn't. When I talk to mother about her memory, she says, " I can't remember anything anymore." but will then vehemently deny she has dementia.
Some sentences make sense and others are 'off the wall'. It's hard to wrap your (sane) brain around what parts work and what other parts are totally broken. It's like the disease is selective as to what memories, functions and responses to take and what to leave.

My mother will tell you she could live alone in her previous apartment in SF. (No way) She tells me she's leaving to go back there tonight. "How will you get there?", I ask. "Well, you"ll take me." "So, you can cook and clean the house and wash clothes again?" After a moment she says, "oh forget it."

Dawg gone, they can be stubborn about what they believe is right. Mother asks for a pill for her headache multiple times a day. She won't accept the answer that she already got one. So I put TicTacs in an empty pill bottle and give her one when she wants it.
JessieBell, could you get away with that with the laxative?

Thank you, Burnoutgirl. This is so relevant to showtiming, too. People with dementia can showtime to people who aren't around too long, so they appear to be okay. They are able to compensate until the dementia gets to a late stage. It makes us look like we're the ones who are nuts if we bring up something they are doing. They look so sweet and almost normal to doctors or visitors who drop by for a few minutes.

JessieBelle... your answer got me to thinking about underlying mental issues... my daughter had noticed signs of narcissism and said that maybe there are things that are showing up now that Mom can't compensate.... Someone had said in passing that Alzheimer's is like giving the patient too much to drink... their inhibitions disappear... I have found this to be rather profound, actually... not only inhibitions, but it becomes hard to cover up mental illness...
I found this interesting, and maybe you all will, too.
http://www.amcneurology.com/blog/2011/04/01/alzheimer%E2%80%99s-disease-co-morbidities/

"Alzheimer’s disease is a chronic, progressive neurodegenerative brain disorder that affects patient’s memory, language, and judgment, decision making, planning and organizing.
Alzheimer’s disease (AD) remains the most common cause of dementia. There are currently 5.3 million Americans affected by the disease, and as the number of aging population increases without a disease modifying treatment, it is projected to be 15 million by 2050.
AD is a complex disease; hence the treatment can at times be complicated and often challenging to the treating physicians. Successful treatment of patients with AD requires a thorough understanding of the patient and the family dynamic. AD like any other chronic condition may have other medical and psychiatric co-morbidities that need to be addressed. Treating the AD with anti-dementia drugs is a small part of the comprehensive management of AD. The discussion of medical co-morbidities are beyond the scope of this article, however, the psychiatric co-morbidities such as depression, anxiety, delusions, hallucinations, agitation and aggression will be discussed. Some patients may have an undiagnosed personality disorder that resurfaces as the patient’s ability to compensate diminishes." .......

I didn't understand your note to me. Ask what? My mother and I rarely have confrontation because I walk away. She has long-standing mental issues now coupled with dementia. It makes her very mean to her daughter, so it is best to walk away. This isn't a new thing -- I also did a lot of walking away growing up. Maybe she has a hard time recognizing the dementia because she spent a lifetime not tending to mental illness beyond taking sedatives. It is very important to her that other people not see her as crazy.

Burnoutgirl, this is not an easy road. Keep in mind, it is the disease. Not your moms fault. My mom would buy a bag of little snickers or milky ways, they went from the fridge to hiding them in room. I found if when I removed the majority of the candy bars out of the bag. without her knowing. Keeping her with 4 in the bag in her room. .She wouldn't gorge.
Leaving the trash and not remembering is the disease, don't take it personal. It can be a challenge to let things go. Clean it up, throw it away. Don't ask her. Sorry she is not going to remember. My mom gets very upset when it is time to pay them. She enjoys the company. Could use advice on how to get past that one.
JessieBelle, totally understand. I quit asking. It can cause confrontation, which is going to make you both miserable. Stay strong ladies.

Read the book: The 36 Hour Day by Nancy Mace and Peter Rabins MD. Very comprehensive book , explains every thing you could possibly want and need to know on Alzheimer's and other dementias. Available on Amazon, (about $15.)

To JessieBelle, I read your comment and I thought to myself that I could have wrote your comment!

I go through this every day. It is hard to live with someone with dementia when they think nothing is wrong with them. My mother will forget that she had a bowel movement, then ask for a laxative because she is all stopped up. When I say she went to the bathroom, she'll get angry and abusive, yelling at me to just give her a laxative.

She'll check her blood sugar and find it is high. I'll say it's because she ate snack crackers. She'll deny that and say it is genetics. If I don't buy crackers, there is h3ll to pay. If I do buy them, she'll sneak them, then forget (or deny) she ate a lot of them, though the packaging is in the trash. She is diabetic, so I have to decide whether to let her have her crackers or not. Hard decision, since she is 91 and nearing death.

There is so much that I could write all day on my mother's not realizing anything is wrong with her. She is really nasty to me, so I've had to learn to avoid her. Today I wouldn't give her a laxative, so she ordered some from the pharmacy when I went to the grocery store. She's waiting for the delivery now, though she's probably forgotten and won't recognize the doorbell when it rings. I don't want to be involved in any way with this, but what to do when the doorbell rings??

I wish she realized something was wrong. It would be a lot easier to say it was the dementia playing tricks on her mind. She gets very angry if someone even hints that something is not right with her brain.