Understanding denial and lack of insight

Dementia, denial and lack of insight

When a person is diagnosed with dementia they may not understand or accept their diagnosis. They may also have limited or no awareness of their symptoms and the difficulties they are having, even when these are obvious to those around them.

This may be because the person is in denial, or because they have what is known as ‘lack of insight’. In either case, it will be harder to talk to the person about their dementia and how to support them.

When a person doesn’t accept their diagnosis of dementia

Every person who is diagnosed with dementia will react to the news in their own way. Many people find it difficult to come to terms with, or adjust to, a diagnosis of dementia. Some people may feel that nothing is wrong and not recognise that they are experiencing any problems.

Others may acknowledge that they are having difficulties doing certain things but believe this is due to a reason other than dementia. For example, they might say their memory loss is because they are getting older. They may avoid talking about their condition by changing the subject if someone mentions it.

Why can't a person with dementia understand or accept their diagnosis?

A person may be unable to acknowledge their diagnosis or symptoms because of denial, or lack of insight. These are different. 

It may also be much harder for people with confusion and memory loss to acknowledge their symptoms, as they may not recognise or remember the difficulties they have.

Why does it matter that a person accepts their dementia diagnosis?

When a person accepts their diagnosis, it can help them to access support and care, as well as plan for the future.

If the person you support doesn’t accept that they have dementia or doesn’t seem to be aware of their symptoms, you might find it frustrating or distressing.

You may feel like they are deliberately avoiding dealing with changes that have become obvious to you and others. However, it is important to remember that this lack of awareness is often outside of the person’s control.

Is it better not to know about a dementia diagnosis?

Sometimes a doctor will decide not to tell a person with dementia about their diagnosis because they believe it’s not in the person’s best interests. For example, if the doctor believes this will cause the person too much distress.

Usually, if a person is not told about their diagnosis, it’s a decision taken by the doctor and the people closest to the person.

Some professionals will avoid using the word ‘dementia’ at all, which can cause further confusion.

For most people, the help and support they could access if they accepted a diagnosis would be judged to outweigh the negative impact of the news.