What Are Confabulations and Why Do They Occur?

Confabulations are difficult to treat. It is, however, possible to improve the quality of life of people afflicted by them. Let's see what they are and how to deal with them.
What Are Confabulations and Why Do They Occur?

Last update: 24 March, 2021

It’s important to know that confabulations originate from the distortion of memories to understand what they are. This is because memory is one of the most studied within the range of human cognitive processes. It remains a complex subject though.

Events in your memory aren’t exact restructurings of events. Every person can remember an event in a different way and assure it’s just how it happened. It’s a deformation of reality due to the loss of information.

A clear example occurs in older people who present major neurocognitive disorder (senile dementia). They’re convinced they’ve experienced something in a completely different way than the actual events.

Types and classification

Confabulations are a cognitive phenomenon that’s difficult to typify, taking into account they can take manifest in several ways. However, there are five criteria to classify these cognitive alterations.

Let’s take a look at them.

1. Spontaneous confabulations

This first type of confabulation is short. It’s a fanciful idea affirmed as real by a given person, in a clear-cut way. This usually occurs in patients with Korsakoff’s syndrome.

2. Provoked confabulations

In this case, what happens is the memory fails to evoke something accurately. It’s common in people with amnesia. Something similar happens when a healthy person tries to retain some information in a forced manner for long periods of time.

For example, studying for an exam in a textual manner can lead to failures in recall memory. Some concepts may be interchanged and asserted as true at the time of the test, even though they don’t correspond to reality.

A person confabulating.
Older age increases the risk of experiencing senile dementia, usually associated with the elaboration of memories that never happened.

3. Simple provoked intrusions

These distortions appear when a person has to remember information in detail. Let’s imagine for a moment that you forget the shopping list and try to remember what it said. You might unconsciously buy something that wasn’t on your list and yet you’re convinced it was.

4. Momentary confabulations

This type of memory failure is the most common type of confabulation and the stories may be fantastic but perfectly credible.

Furthermore, these are easier to detect. For example, when a patient talks about their plans in all detail but these aren’t feasible at all. It’s common in nursing homes when some older adults claim they’ll go visit their childhood friends, even though they may be already deceased.

5. Fantastic confabulations

This type of confabulation is the most intense due to the high detachment of reality these people present. As the name indicates, these are fantastic stories that are only credible to the patient. Also, these alterations of reality are common in psychotic patients and those with paralytic dementia.

Another classification

This classification of the five types seen above is proposed by Kopelman and is the most accurate for determining the intensity and frequency of confabulations. Another method used over the years is the one proposed by Schnider, which consists of four criteria:

  • Content. Establishing how plausible the account can be using limits ranging from true to false.
  • The mode in which they appear. Are they spontaneous or provoked?
  • The terrain in which they appear. Are they episodic, autobiographical, general semantic, or personal semantic?
  • The clinical syndrome in which they occur.

The symptomatology of confabulations varies depending on which underlying disorder is causing them. For example, the most characteristic symptoms of Alzheimer’s disease are cognitive deficits, mental decline, and memory problems.

Let’s see what others may appear depending on the neurological disorder:

  • Dementia is about memory impairment with nervousness
  • Schizophrenia is a thought disorder, acoustic hallucinations, and paranoia
  • Korsakoff’s syndrome is the loss of recent memory, mania, and repetitive behavior
  • Asomatognosia is the inability to integrate one’s own body parts or to recognize them, there are false sensations associated with the loss of a limb

The possible causes of confabulations

The causes of the memory failures that produce confabulations in patients are the result of damage to the frontal area of the brain. In particular, the affected area is the basal anterior, where the orbitofrontal and ventromedial areas are.

There are three theories that try to explain the reasons why confabulations occur. We’ll now review which ones they are. This is because it’s important to know about those hypotheses that come from a neuropsychological perspective.

1. Memory dysfunction

This theory states that confabulations are a form of amnesia. Moreover, the main postulate holds that failures in recall memory are a way of making sense of incomplete memories one can retrieve. There’s overall approval for this hypothesis.

2. Executive dysfunction

This theory states that memory failures that give rise to confabulations occur when there are severe mental limitations in terms of planning and setting concrete goals.

3. Dual hypothesis

In this hypothesis, the approach doesn’t rule out any of the previous postulates. In fact, it maintains that confabulations are due to a deficit in executive processes (higher functions of consciousness), in addition to memory failures.

Find out more about The Five Best Memory Exercises

Treatment

Confabulations after brain damage.
Brain injuries can cause the consequence of confabulations, as an associated medium-term complication.

Confabulations are considered an untreatable sequela, although there’s an approach capable of improving the quality of life of patients who confabulate after sustaining a brain injury. For this reason, this neuropsychological procedure is based on confrontation as a means of cognitive stimulation.

Researchers at the University of Granada designed this treatment. It consists of showing a series of images to patients. The sequence of the series may vary in content and then the researchers ask them to recall what they saw. Confabulations occur when these people try to remember and this is when the specialists interpellate.

They must emphasize to their patients that the memory they claim to be true isn’t and then they show them the images again. Of course, they explain to them that their memory is faulty, referred to as feedback in neuropsychology. One can expect an improvement in about nine weeks.

What to do if you know someone who confabulates

The best thing to do is not to insist abruptly that a person is mistaken if you know someone who may be confabulating. You must keep in mind that these facts are real to them, so show empathy and avoid stressing them further.

The next thing to do is consult a specialist who can evaluate them and determine the intensity of the damage in order to establish the path to follow. Some patients stop confabulating after a while and don’t require hospitalization.

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