Confabulation: False memories

Confabulation in dementia, or false memories in dementia, can make a person remember things that didn’t happen. It’s a confusing and sometimes frightening part of the condition.

What is confabulation?

Confabulation is when gaps in memory are subconsciously filled with false or distorted memories. This memory is called a confabulation.

For example, somebody might correctly remember getting on a bus and getting off it at their stop, but have lost their memory of being on the bus. Confabulation could then fill that gap in with a fabricated memory, such as they may falsely remember seeing their friend on the bus and having a conversation with them. Or, they may have spoken to somebody on the bus but recall the conversation very differently from how it really was.

The person experiencing confabulation really believes the memory is the true course of events.

Confabulation is often a symptom of a bigger memory problem, such as dementia or amnesia. These illusions do not necessarily have to be recent. It has been known for people with dementia to have confabulations about events decades prior.

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 damaging their car at night, while a confabulation would be a false memory of seeing them do so.

Types of confabulation in dementia

Provoked confabulation

This is when somebody creates a false memory after being asked a question. Again, they aren’t lying or consciously inventing a story, their brain is creating or distorting their memory.

Interestingly, provoked confabulation can happen in healthy brains that do not have memory problems. Suggestive questioning can distort people’s true memories, a technique that can be used by defence lawyers or journalists to distort a witness’s recollection of events. Gaslighting, a form of psychological abuse when the abuser manipulates their victim into doubting their own memories, is an example of provoked confabulation in a healthy person.

Momentary confabulations

Similar to provoked confabulations, these false memories are created on the spot, in response to a question or as part of a discussion. The recaller may believe that a long-forgotten memory has come back to them, ignited by the discussion, when in fact it is confabulation.

It is believed that provoked and momentary confabulations are caused by a different mechanism of the brain than other types, but research is still being done on this.

Fantastic confabulations

The word ‘fantastic’, here, means a fantasy rather than wonderful. Fantastic confabulations are completely invented memories, rather than a distortion of true events. They are often illogical and can even be dream-like in their narrative. It is most likely to occur in a person experiencing delirium or advanced dementia.

Behaviourally spontaneous confabulation

This is when somebody acts on their false memory. These could be harmless actions, like putting the bins out on the wrong day, to more significant ones. For example, somebody could have distorted memories of conversations with friends and believe that their friends have shouted at them. They may even repeat things their friends supposedly said, when no such words left their mouths. They then act on these memories by refusing to speak to their friends and isolating themselves.

Recollective confabulation

This is when a person believes what they are experiencing has happened before, when in fact it hasn’t. It has been compared to consistent déjà vu. An example could be a person goes on holiday to Italy, and believes they have been many times before, when in fact they never have. They may even recall stories from previous holidays there or people they met, but none of it is real.

What causes confabulation?

Confabulation is usually caused by conditions that affect memory. These could include:

• Dementia, particularly Alzheimer’s disease and frontotemporal dementia
• Brain aneurysms and other forms of brain damage
• Korsakoff syndrome. Sergei Korsakoff was the first scientist to detail confabulation (although the term was coined later by Karl Bonhoeffer), after noticing its prevalence in patients with chronic alcoholism, as a result of the damage that alcohol does to the brain
• Anosognia. This is when somebody is ill but does not believe it. They may recall doing activities that they could not possibly have done due to their illness. An extreme form of this is Anton’s syndrome, when somebody is blind but believes they can see. People with this may vividly remember seeing things like anybody else, when it cannot be so
• PTSD
• Multiple Sclerosis
• Schizophrenia
• Amnesia
• A tumour in the frontal lobe of the brain

Is confabulation treatable?

Confabulation can be a temporary affliction that disappears on its own. If it’s caused by alcohol misuse, sobriety can dramatically reduce confabulations or stop them happening altogether. If it’s confabulation in dementia, which has no cure yet. it may not be treatable. However, treatments can help people to recognise when they are confabulating and act accordingly.

Treatments include:

• Neuropsychological treatment. This can teach people strategies to help manage their memory and confabulations. These include keeping a memory diary, avoiding stressful situations which provoke confabulations, reality-monitoring techniques and self-monitoring techniques.
• Treating underlying mental health conditions. If the confabulations are caused by schizophrenia or PTSD, treating these can in turn treat the confabulation. Mental health conditions that carry overconfidence or excessive self-belief can also lead to confabulation, such as Narcissistic Personality Disorder, which can be treated with psychotherapy.
• Treating physiological conditions. Some physical causes of confabulation can be treated or will naturally improve over time. Many brain tumours are operable, while effects of brain injuries and inflammations often decrease gradually after treatment.

How to respond to confabulation or false memories in a person living with dementia

Knowing how to respond to somebody who experiences confabulations can be tricky, particularly if the false memories cause them distress or to act inappropriately.

It’s best to be pragmatic when a loved one experiences a confabulation. For each situation, you can usually take one of two paths:

Validate them

This doesn’t mean confirm that their memory is true, but to engage with it as if it is, and validate the feelings they are having because of it. If they are recalling a fond memory that you know never happened, but it makes them happy, it can be best to just go with it. There is even such a thing as validation therapy, that looks at the emotions behind memories and memory issues. 

For example, if your loved one has dementia and falsely believes that they achieved their dream of being a famous artist, there may be unresolved emotions behind never having achieved that ambition, and the reasons they didn’t. You could ask them about why they enjoy painting and how it makes them feel, rather than correcting them or asking which famous paintings were theirs.

Another example might be that they believe they saw someone in their garden, when in fact there was nobody there. While the memory is false, their feelings of disquiet and fear are real, so you could help them to secure their doors and windows and plan with them what they should do if they see the person again.

Correct them

Correcting someone with dementia is rarely productive but if their false memory is detrimental to them, it can be the best action. If you do correct them, make sure to be gentle and show them the true course of events if possible.

Examples of situations where it may be best to correct them could be if they have got the date of an event wrong and risk turning up two days early, or they mistakenly believe that somebody has treated them badly.

Helplines

If you suspect that you or a loved one is experiencing confabulation, it’s best to visit your GP. The following helplines can also provide somebody to talk to about it, and advice.

Admiral Nurse Dementia Helpline	0800 888 6678	helpline@dementiauk.org
Age UK	0800 169 2081
Mind	0300 123 3393	info@mind.org.uk
Headway	0808 800 2244
The Brain Tumour Charity	0808 800 0004	support@thebraintumourcharity.org
Alcoholics Anonymous	0800 9177 650	help@aamail.org