Who am I? What am I good at? Where do my weaknesses lie? Those are just some of the questions that self-awareness helps us answer. We all have a view of ourselves but how others view us can differ significantly from this. Accurate self-awareness is important for everyday functioning, because it allows us to match our tasks and goals to our actual abilities. This can prevent possible harm to self and others.
In diseases that affect the brain, like dementia, people often have varying abilities to recognise their own impairments (i.e. impaired self-awareness). Functional impairments can include but are not limited to daily living activities, cognition (i.e. thinking), emotional control, interpersonal abilities and personality. Which of these are affected depends on the disease and which areas of the brain are have been compromised
The anatomical basis of self-awareness is not fully understood but it is thought that both frontal and parietal structures form a larger circuit in the brain that underlies this function (see the image below where these areas are highlighted):
Different types of dementia affect different parts of the brain. Typically in Alzheimer’s disease the parietal lobes are damaged earlier and more severely, as the disease tends to start at the back of the brain and work forward. In Frontotemporal dementia the disease predominantly affects frontal lobe structures, whereas the parietal cortex remains comparatively intact. If and how self-awareness is affected in these different types of dementia depends on two main factors:
Self-awareness in research studies is often measured by comparing the self-rating of the person with dementia to that of a caregiver or researcher. Using this technique, researchers have found the following:
Research has shown that when people gave an inaccurate estimate of their abilities, this tended to reflect their personality prior to disease onset. This means that in some of the functions people were unable to update information on themselves after disease onset
Being unable to accurately assess ourselves has many implications for day-to-day living. Some of these include
It is important to understand that how you view a person with dementia and how they view themselves can be completely different. This does not mean that they have necessarily forgotten who they are or have become a different person; they are simply not as aware of how the disease is changing them. Understanding how dementia affects the brain is a first step to better understanding how the person with dementia is being affected. It has been pointed out that although these biological changes described in this blog play an important role in self-awareness, physical and social interactions are also key. You should therefore never infantilise someone with dementia or treat them as incapable, but instead always treat them with respect and dignity.
All information in this article is based on published research studies. The studies included are listed below: