Unawareness in dementia is often viewed as a ‘symptom’ that is wholly or primarily the product of biological factors. While neurological damage may be sufficient to produce unawareness in some disorders, it is argued that this is not generally the case in early-stage dementia. Instead, it is suggested that the apparent degree of awareness is an expression of adaptive psychological responses constructed in a social situation in the context of neurologically based cognitive impairment. Drawing on examples from detailed interviews with people who have dementia and their partners, the contribution of psychological and social factors to the expression of awareness is explored. It is further argued that, because evaluations of awareness are constructed in dialogue through the interpretative activity of the researcher or clinician, reflexivity is essential in considering awareness.
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