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Confabulation and Dementia



I've been CONFABULATING!


Recently, I've noticed that my recall has become increasingly unreliable.


I'll relate a tale in conversation only to find that I have got the details muddled or incorrect on reflection or when gently corrected by my wife, Pam.


This doesn't happen often, but it is incredibly embarrassing.


Anyway, I was sufficiently worried that I engaged in a little research, and I'd like to share what I found with you because I find the whole topic fascinating and relevant.


What is confabulation?


The dictionary says that:

"Confabulation in dementia involves the spontaneous creation of fabricated or distorted information, often related to personal experiences, events, or facts. These false memories are not intentionally deceptive but result from memory impairments and cognitive deficits associated with dementia".

People with dementia may confabulate to fill in gaps in their memory or to make sense of their surroundings.


Confabulations are not the same as delusions, which occur in people with psychiatric disorders like schizophrenia, and are beliefs rather than memories. For example, a delusion would be someone believing that their neighbour is poisoning their roses at night, while a confabulation would be a false memory of seeing them do so.


Confabulation is most common in people who have Korsakoff syndrome (a type of dementia often associated with alcohol abuse), but it also has been observed in cases of Alzheimer's disease and frontotemporal dementia.


It seems that these false memories can often appear in the early stages of dementia and may be a mechanism for coping with memory loss.


Two main types of confabulation are sometimes seen in people with dementia.

  • Provoked confabulation occurs when individuals with dementia provide incorrect information in response to a question or a specific cue. They might fill memory gaps with plausible-sounding but false details.

  • Spontaneous confabulation involves the unprompted generation of false memories or narratives without any specific external cue. It often occurs when individuals attempt to make sense of their surroundings or recall past events.

The exact causes of confabulation in dementia are not fully understood. However, it appears that several factors contribute to its development, including:

  • Memory impairments which affect various aspects of memory, including episodic memory (memory of personal experiences). Confabulation may arise as a compensatory mechanism to fill memory gaps caused by the deterioration of brain regions involved in memory processing.

  • Frontal lobe dysfunction. The brain's frontal lobes are responsible for executive functions, such as monitoring and controlling one's thoughts and behaviours. Damage to these areas in dementia can disrupt the ability to inhibit or correct false information, leading to confabulation.

  • Retrieval errors, Dementia can interfere with retrieving accurate memories, making distinguishing between actual and imagined events difficult. This retrieval deficit contributes to the creation of false memories or the fusion of different memories.

How can confabulation be managed?

Although it's probably not possible to eliminate confabulation, according to the experts, the following strategies can help manage and reduce its impact:

  • Validation and empathy: Rather than correcting or arguing with the person, it is often more beneficial to validate their feelings and experiences while redirecting the conversation to a more positive or neutral topic.

  • Creating a supportive environment: Reducing stress, providing familiar cues, maintaining consistent routines, and minimising potential triggers can help reduce confabulation episodes.

  • Reminiscence therapy: Engaging individuals with dementia in activities that encourage reminiscing about their past, such as looking at photo albums or listening to familiar music, can provide positive experiences and potentially decrease confabulation.

  • Involving professionals: Healthcare professionals experienced in dementia care can provide guidance on managing confabulation and offer support to both individuals with dementia and their caregivers.

So. in a nutshell:

  • Be aware of the possibility of confabulation

  • Be patient

  • Keep the confabulator engaged and in a calm, stress-free environment

  • Steer the person gently back on track

  • Seek guidance.

What are the implications?

As you can imagine, If one accepts that there is a chance of encountering confabulation when interacting with a person living with dementia, there may be several consequences:

  • Communication difficulties: False or distorted information can make conversations challenging, as the person with dementia may provide inaccurate responses or contradictory accounts.

  • Emotional distress: Individuals with dementia may become frustrated, confused, or upset when confronted with inconsistencies in their memories or when others challenge their confabulations.

  • Caregiver challenges: Caregivers and family members may find it difficult to understand and respond appropriately to confabulation, leading to frustration or misunderstandings.

Imagine the difficulties for police officers taking statements that may later provide evidence for conviction or acquittal. A person who is confabulating is not lying or being deliberately obstructive, but this may be the perception of an interrogator.


Yet a diagnosis of dementia is currently not a valid reason to be excused from jury service in a UK court of law!


Conclusion

Everything I've read points to the fact that our understanding of confabulation is far from complete, and there is a rich vein of research to be mined.


I suspect most people, like me, had only vaguely heard of the word. And, if we had, we probably associated it with delirium.


So come on, academics! Get cracking and explore the phenomena of confabulation. We can't really tackle it until we understand it.


Meanwhile, I'll try to be alert to my own confabulation, and curb it.

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5 Comments


This is a great explanation Pete- thank you. Your lived experience makes it so much more valuable. You have described it so well but you have also described the impact it has on you. So helpful. As always great work! 👍🏼

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michele.adamson
michele.adamson
Jun 30, 2023

thank you again for your insightful explanation.. it is such a mindfield to navigate and your writing is really helpful. I wish you much love and gratitude x x x

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Peter Middleton
Peter Middleton
Jun 30, 2023
Replying to

Thank you for your kind words Michelle. A little feedback goes a long way !

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I totally agree and always tell it has it is but I will watch out for it

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Peter Middleton
Peter Middleton
Jun 30, 2023
Replying to

Thanks Pete!

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