When a loved one with dementia shares stories or recounts events that appear untrue, it can be unsettling. These narratives represent how the brain processes information when affected by neurological changes. This behavior is an involuntary response, highlighting the internal experience of someone living with cognitive decline.
What is Confabulation
Confabulation refers to the unintentional creation of false or distorted memories, beliefs, or explanations, and it is a known neuropsychiatric phenomenon. The individual genuinely believes the information they are sharing, even though it may range from subtle inaccuracies to fantastical fabrications. It is not a conscious act of deception but rather an unconscious effort by the brain to fill in gaps in memory.
For example, a person might recall going on a grand trip when they have not left their home, or remember speaking with someone they never encountered. The fabricated accounts can sometimes be coherent and internally consistent, making them seem plausible to others. The person confabulating typically remains unaware that the information is inaccurate and often shows no concern even when errors are pointed out.
Why Confabulation Occurs in Dementia
Confabulation in dementia arises primarily from damage to specific brain regions that support memory retrieval, executive functions, and reality monitoring. Memory loss, particularly of episodic memory (memories of specific events and experiences), creates voids that the brain attempts to fill. The brain compensates for these deficits by unconsciously producing fabricated details to create a coherent narrative, even if it is incorrect.
Damage to areas like the basal forebrain, which is involved in producing acetylcholine (a neurotransmitter affecting information transmission between brain cells), can contribute to confusion and memory distortion. The frontal and medial temporal lobes are also implicated, as damage to these regions disrupts normal memory processing and retrieval. This impairment of complex neural circuits, particularly between the right prefrontal cortex and mediotemporal regions, can lead to the tendency to confabulate. Some theories suggest that confabulations are true memories displaced in time, or an attempt to recollect information from a deficient memory system.
Responding to Confabulated Stories
When a person with dementia confabulates, a compassionate approach by family members and caregivers is beneficial. Directly confronting or correcting the individual’s false memories can cause distress, agitation, and confusion. Instead, focusing on the emotions behind the statements and providing reassurance can be more effective. For instance, if a person expresses a desire to visit a deceased relative, one might respond by acknowledging their feelings without reinforcing the inaccurate memory.
Validation therapy is a technique that recognizes the underlying needs and emotions driving behaviors, including confabulation. Engaging with the person’s perceived reality can reduce their anxiety and help them feel understood. Gently redirecting the conversation to familiar and positive topics can shift focus away from the confabulated narratives. Maintaining consistent routines and creating a supportive, familiar environment with personal items can also provide a sense of security and potentially minimize instances of confusion, helping to stimulate accurate memories.
Confabulation Versus Intentional Untruths
It is important to distinguish confabulation from deliberate lying. Confabulation is an unintentional memory error where the individual genuinely believes the false information. In contrast, lying is a conscious act of deception, typically involving an intent to mislead. Individuals with dementia generally do not possess the cognitive capacity for intentional deceit.