Confabulation: Benign Memory Mix-Ups or Early Signs of Cognitive Impairment?
Memory is imperfect. Certain information may be harder to recall at one time or another. Details can become fuzzy, and at times, a memory can become jumbled by events and information that are either fictitious or borrowed from other memories.
Mixing up memories or inserting imaginary events or circumstances into your memory is called confabulation. It’s a common aspect of age-related changes in thinking skills, but it also can develop as a result of conditions such as Alzheimer’s disease or traumatic brain injury.
What’s especially important to understand is that confabulation isn’t the same as lying or trying to be deceitful. You could say it’s an honest mistake. “Confabulation happens when gaps in a person’s memory are unintentionally filled with incorrect, misinterpreted, or distorted information that the individual believes to be accurate,” says Massachusetts General Hospital psychiatrist Jennifer Gatchel, MD, PhD. “In short, there is a confusion of imagined things with real memories. When an individual confabulates, his or her mind is attempting to cover up for a memory that has been lost without them being aware they are doing this.”
Confabulated information is drawn from some aspects of the person’s memory and current or past experiences. “The information may be plausible or seem unrealistic or farfetched,” Dr. Gatchel says.
“As an example of a provoked confabulation that might occur in aging, an individual might be asked how he or she came to acquire a certain item, such as a scarf. The individual may not remember but might confabulate a story to explain buying the scarf during a prior vacation trip that actually happened.”
Causes of Confabulation
While confabulation is sometimes associated with disease states—including memory disorders (mild cognitive impairment and dementia), traumatic brain injury, Wernicke-Korsakoff syndrome, and psychiatric or substance use disorders—it may also occur as a part of normal aging, Dr. Gatchel explains.
“Indeed, with aging, there may be a decrease in correct memories and an increase in false memories,” she adds.
She notes that no one area of the brain is responsible for confabulation, though it has been linked to abnormalities in the frontal lobe (responsible for higher-level executive functions, expressive language, and more) and the corpus callosum—a thick bundle of nerves that allows both sides of the brain to communicate with each other.
“Confabulation also may occur because of overlearning, in which some information is very strongly encoded and crowds out other memories,” Dr. Gatchel says. “It canalso occur because of poor encoding of new experiences due to a variety of factors, such as divided attention, false memories—the distortion of memories due to a number of factors—and memory loss, where there are progressive gaps in memory that a person is attempting to fill. Or it can be a combination of these factors.”
Types and Treatment
There are two main types of confabulation: provoked and spontaneous.
Provoked confabulation is much more common and usually occurs when a person is asked a question. The answer might include a mix of true and false information or a completely fabricated story that, in the moment, seems true to the person experiencing confabulation.
Spontaneous confabulation occurs when a person volunteers a story that may include some accurate and inaccurate (or imagined) information.
Both types of confabulation can include mild mix-ups that are based on true information, or “memories” that have little or no basis in fact. Mild moments of confabulation can be difficult to recognize.
If you suspect you are starting to conflate memories more frequently or insert made-up details into stories, talk with your doctor. Similarly, if you notice that a loved one may be experiencing confabulation, you may want to attend a doctor’s visit with that individual to discuss the matter. Family accounts of confabulation can be very helpful, as a health-care professional may not be able to discern accurate memories from confabulated ones.
“It can be difficult to detect confabulation, but if suspected, a medical and neurological evaluation should be sought to determine the cause or rule out possible causes,” Dr. Gatchel says. “The mainstay of treatment is identifying and addressing the underlying cause(s) if possible.”
Dr. Gatchel explains that if confabulation occurs as part of normal aging, it may be difficult to treat it or to fully stop it. Some approaches that can be helpful are psychotherapeutic interventions, such as cognitive behavioral therapy, which helps individuals become increasingly aware of memory errors in the safe context of therapy and with a trained therapist.
“Individuals may be coached to question how confident they are in certain memories and to gain awareness of instances when they may be confabulating,” she adds, noting that there are many helpful such strategies. “They can be encouraged to say
‘I don’t know’ in instances when they are unsure. In some instances, keeping a diary can also be helpful.”
Confabulation and the Family
As with any change in a person’s cognitive health, mood, personality, or behavior, confabulation can be frustrating and troubling for family members to observe.
“It is important to provide support to the individual and to recognize that what they are doing is not based on manipulation or deceit, but may reflect changes in brain function or aging,” Dr. Gatchel says. “It will be important for family to accompany the individual to events where correct information is very important, or to provide collateral information, such as during a medical appointment or a business or legal transaction.”
Dr. Gatchel also cautions against being impatient in correcting someone who may be confabulating memories. While there are times when a gentle reminder or explanation of the facts is essential, such as relaying medical history, many stories can pass without comment. If necessary, you may be able to pull someone aside who heard a confabulated story to provide a more accurate version of events.
“In the moment, it is often not helpful to assume an argumentative or confrontational stance with someone about the accuracy of a memory,” Dr. Gatchel says. “This often will not serve a purpose and may exacerbate the situation. A better approach would be to provide support and acceptance, while ensuring safety, and pursuing other approaches to make sure the facts are known to those who need that information.”
Dr. Gatchel says it’s important to understand that confabulation is not intentional. She notes, “Frustration may be mitigated and compassion increased by bringing to mind that confabulation is an unconscious coping mechanism the person is using for something that can be very scary—not remembering.”
The post Confabulation: Benign Memory Mix-Ups or Early Signs of Cognitive Impairment? appeared first on University Health News.
