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to Grips as the Memory Fades, Part II Ė The Three Biggies
most people immediately go to memory loss as a primary deficit of dementia,
there are other issues which can create havoc for coping be it the affected
person or support persons. Chief among those other issues are anosognosia,
confabulation and disinhibition.
is the condition of the person lacking awareness of their own deficit. This is
quite different from denial. Denial is seen as a psychological defense mechanism
to distance oneself from the emotional challenge of accepting oneís issues. In
denial, the person does have an awareness of the deficit, but hasnít come to
accept it. Anosognosia is truly the absence of awareness of the issue or
deficit. When applied to the issue of memory loss, the person in denial will
likely become angry or agitated when confronted by others about losing an
object. The person may even become agitated or angry with him or herself. As for
the person with anosognosia if confronted on the issue of memory loss, this
person may be apt to not even understand the problem as originating with
themselves, but may more believe someone is playing a mean trick on them.
Whereas counseling can help a person in denial address the emotional impact of
their situation, counseling for the person with anosognosia will likely prove
futile. In lieu of counseling the person with anosognosia, counseling is better
directed to those who support the person.
may be best understood as the mind filling in the gaps for not perceiving things
as they really are. With confabulation a person may be seen as accusatory,
blaming others on the basis of misunderstandings or simply making things up in
order to make sense of their distorted view of personal experiences. For
instance, a person may blame their partner of having an affair when they try to
put together broken elements of their perception, knowing the other is out, not
knowing where and perhaps catching a piece of a message about a meeting. While
the story of an affair seems to make sense to the affected person, it strays far
from the reality of the situation where the other person may have simply been
out shopping with a friend. Confabulation is often combined with anosognosia.
Not realizing what one may miss, one constructs a distorted view that only makes
sense to that person. Arguing and counseling are typically not of value to the
affected person, but again, counseling can be of particular value to those who
support the affected person.
is when the brakes fail to control our normal impulses. While everyone has had
the experience of wanting to do or say something that may be deemed
inappropriate, we typically have a set of internal controls that keep us from
doing so. The disinhibited person has a faulty set of those internal controls
and as such may say or do things inappropriate to the situation. These persons
appear to lack social judgment and their behavior or comments may be
inappropriately humorous to rude to hurtful to harmful to dangerous.
together, anosognosia, confabulation and disinhibition can create havoc in the
life of the person with dementia and those who provide for their support or
care. Counseling the affected person about these issues will have little to no
impact and may actually create more turmoil and upset for everyone. Rather than
counseling the affected person, it is the support or caring persons, very often
the family members and friends who require counseling and education. Education
is best directed to explaining these conditions and offering strategies for
management. Those strategies include learning when not to argue and how to
redirect to more socially acceptable conversation and behavior. These can be
challenging strategies to learn and role play may be helpful with instruction.
the end, most family and friends are upset not only for the management
challenges but also for the compromised dignity of the affected person. Family
and friends may feel shame or embarrassment for the affected person or
themselves. It is important to address those feeling as well as learning
effective management strategies so that the dignity of the affected person may
be better protected by loved ones and friends. To that end, loved ones and
friend may have to confront their own denial and challenges in accepting the
affected personís dementia. Protecting oneís dignity begins by acknowledging
the dementia so that problems arising are not seen as a reflection of the
affected person, but can be viewed compassionately as an outcome of a disease
and education for loved ones and friends are often the best way to help the
person with dementia.
Direnfeld, MSW, RSW
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