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The 5 A's of Alzheimer's Disease: Agnosia

Posted by Monica Heltemes on 4/15/2015

There are five A symptoms seen with patients with Alzheimer's disease: Anomia, Apraxia, Agnosia, Amnesia, and Aphasia. This is part three of five about these symptoms and discusses Agnosia, which can cause the person to be unable to recognize objects or faces.

Agnosia - Trouble with Identifying Objects and Faces in Alzheimer's Disease

The symptom, agnosia, is complex and has different types.  This article describes this symptom in general terms and how it usually applies to Alzheimer's disease.

Agnosia happens when the person has difficulty interpreting information from the five senses. For example, what the person "sees" can be affected. In agnosia, the person's eyesight is not the factor but rather the way the brain interprets what the eye sees is incorrect.  Therefore, the person may mistakenly try to eat with the knife instead of the fork.

It can also affect other senses, such as when a ticking clock sounds like something different to the person or even when the feeling of a full bladder is no longer recognized as the time to make a bathroom trip.

Agnosia can also cause affect the ability to recognize faces. The person may mistakenly think a granddaughter is their daughter or may not recognize the person at all.

The brain can no longer properly
integrate perception, memory, and identification.

Agnosia is due to damage to the parts of the brain that integrate perception, memory, and identification.  As I said, a complex condition!  Some real life examples you might see in the person with Alzheimer's include:

  • The person does not recognize the shaver in front of him when you ask him to shave, so does not do the task.
  • The person mistakes a medication pill for a piece of candy.
  • The person mixes up or does not recognize family members.
  • The person thinks a bottle of colored cleaning solution is a bottle of colored juice.
  • The person misses a wrong way or one way traffic sign when driving

Anosognosia, a form of agnosia, is when the patient does not even recognize his or her own deficits.  Normal self-awareness is gone, so patients deny anything is wrong, both to themselves and to others.  Not all patients have this lack of self-awareness, but many do. This is often why family members and friends do not realize there is a problem until long after mild symptoms have started.  It is also what can cause big safety risks when letting the person continue to do things that are no longer truly safe for him or her.

So how can a caregiver help the person who is experiencing agnosia? Try these tips:

Set up the environment and cue the person

-Hand the person the razor when you ask him to shave, even demonstrate how to do it, to get him started.
-Give only a spoon at meal times, if the person mixes up silverware.
-Avoid having similar looking items in close proximity - for example, toothpaste tubes and denture cream tubes. 
-Lock away things that could potentially be hazardous if the person mistakenly ingested them, such as cleaning solutions, dishwashing and laundry detergents, and other chemicals or sprays.
-Tell the person your name and who you are when you come to visit, if identifying faces is difficult- even if you are the son who visits dad everyday. Never ask the person, "Do you know who I am?", which can cause anxiety and distress.  You might even bring pictures of yourself when you were a child, as the person might remember that and then better be able to place you.  You might even hear some interesting stories from your childhood that you had never heard before!

Be aware the person might truly not be aware of their own mistakes
Be aware of things that don't seem quite right with the person, even if the person says there is nothing wrong.  For instance:
  • Forgetting important dates or events that the person usually remembers without trouble
  • Medications not taken or food that is not eaten or is spoiling.  Also, spatters or evidence of burned food in the kitchen.
  • Dents in the car from misjudgement mistakes when parking or driving.
  • Increasing clutter in the home or the person being more isolative.
Although these signs do not automatically mean the person has Alzheimer's disease, they are red flags to be aware of and to monitor. If multiple signs are present and not getting better, seek medical consult, even phrasing it as "the doctor called and wants to do a check-up", if the person is defensive . Remember if the person truly does not recognize they have a problem due to brain damage, trying to reason with the person will not work and will lead to conflict.

With this better understanding of the symptom of agnosia in Alzheimer's disease, caregivers can better manage it, plan for it, and minimize safety risks that can arise.

Read about the first 'A' symptom of Alzheimer's disease: Anomia

Read about the second 'A' symptom of Alzheimer's disease: Apraxia

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