Confabulation, Delusions, and Intentional Lying in Dementia: What's the Difference?

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody. Welcome back to another brand new episode of The Truth, Lies Alzheimer's Show. And I'm your host, Lisa Skinner. And today I'm going to be talking about something that you may have never heard of before. I'm going to be discussing confabulation, and you're probably wondering, all right, what the heck is confabulation? Well, hang in there, don't go away, because I'm going to tell you in just a minute. But first, I really wanted to take a moment to acknowledge that September is World Alzheimer's Month. And for those of you who have not heard of World Alzheimer's Month, the goal is for it to be an international campaign that takes place every September to raise awareness about Alzheimer's disease and dementia. And to challenge the stigma associated with it. And any of you out there who are currently going through this in your family have probably realized that those stigmas really do exist out there. And, you know, dating back 50 years when my grandmother was first diagnosed with what they called back then senile dementia. They didn't even refer to it as Alzheimer's disease. That was back in the '70s. My grandmother was called a nutcase by the police because she was calling for help. So obviously there was a stigma attached to brain disease back then. And then, as most of you know, I have been working professionally in this industry for 30 years, and I really have not seen a lot of movement or change in people's beliefs about it or their paradigm about it. So I think this all ties into the goal of World Alzheimer's Month, and for us to keep chipping away at changing people's mindset about this disease. So I feel the more we talk about it and the more education and awareness that we can provide about what living with Alzheimer's disease is really like, and it's different from what most people believe, then we can start to move forward and start to slowly but surely lift those stigmas from the disease. So, I just wanted to take a moment to reflect on that. And now I'm going to discuss what confabulation is. So it's actually a condition that accompanies Alzheimer's disease and dementia. So what it is, it's, it's a cognitive phenomenon where a person creates false memories without the intention to deceive. So this is different than flat-out lying. Confabulation involves the fabrication of memories, often filling in gaps in a person's memory with incorrect information. Unlike lying, confabulation is not a conscious effort to mislead individuals because they genuinely believe in the accuracy of these memories. It's commonly associated with various neurological conditions, including Korsakoff's condition, which is often due to alcohol abuse, leading to memory deficits. Of course, Alzheimer's disease, memory loss resulting in attempts to reconstruct past events, TBIs, or traumatic brain injuries. Damage to brain areas involved in memory formation. And then, uh, there's a mental illness out there that we have all heard of called schizophrenia, and confabulation occurs with that. Some people may experience confabulated memories as part of that condition. So there are several types of confabulation. One is called provoked confabulation, and what that means is it occurs in response to questions or prompts where gaps in memory lead to incorrect but plausible answers. So somebody, if they're probed with a question, their response could be confabulated because they're just really trying to fill in the blanks. It— there's also, uh, what's called spontaneous confabulation, and this arises without external prompts, often in individuals with severe memory impairment. It's also a memory error characterized by the creation of false memories without the intent to deceive. Individuals do genuinely believe in the accuracy of these memories. Confabulation often occurs where there are gaps in memory due to cognitive impairment, and what happens is the brain attempts to fill these gaps in with fabricated details. The process involves the brain's reconstructive memory systems where existing memories are combined or altered to create a coherent narrative. Now, currently there are no specific treatments for confabulation itself. However, managing the underlying conditions can help. Techniques to improve memory function and reduce confabulation incidence and through cognitive rehabilitation and also through supportive therapy. So for both individuals and families to cope with the challenges of memory disorders, they can seek supportive therapy or cognitive rehabilitation. Confabulation often results from the brain's attempt to reconstruct memories where actual memories are missing or distorted. It can involve various memory systems, including episodic, which are a person's personal experiences, and semantic, which is, um, the general knowledge part of our memory. It's often associated with damage to the fronto the frontal lobes, which are crucial for executive functions and memory retrieval, and the hippocampus, vital for forming new memories. Diagnosing confabulation involves observing the individual's memory patterns and discrepancies in their recounting of events. These can help differentiate between confabulation and other memory disorders such as delusions or lying. So unlike delusions, and this is important, unlike delusions, which are strongly held false beliefs despite evidence to the contrary, confabulated memories are not consciously fabricated and are often less fixed in belief. Increased awareness about confabulation can improve social interactions and reduce stigma for those with memory disorders. Disorder. So just a couple examples here. Common in individuals with chronic alcohol abuse, confabulation often occurs due to significant memory gaps. With Alzheimer's disease, many people may exhibit confabulatory behavior as their condition progresses. And then in people with a traumatic brain injury, they may experience confabulation as a result of memory impairments. So I'm going to give you now some specific examples of confabulation so you kind of get an idea of what it might come across as, what it might sound like when somebody is actually confabulating versus having a delusion or flat-out lying. So a person might claim to have attended a family event that never occurred, filling in memory gaps with fabricated details about the gathering. An individual might confidently recount a vacation that they never took, describing places they have seen in photos but they actually have never visited or been there. A person might confuse recent events, claiming they had a conversation with a friend last week when it actually happened months ago, blending memories from different times. A person might create elaborate stories about past experiences that never happened. But they believe them to be true, such as claiming to have been a famous actor. An adult reflecting on childhood may unintentionally mix real memories with details from stories that they've heard, leading to inaccurate recollections of events. Now, after a stroke, that affects memory areas, a person might describe a family holiday that never took place, elaborating on imaginary details like the activities they did or the people who were there with them. An individual might insist that they were a doctor, narrating experiences and achievements in a medical career that they actually never had. Filling in gaps in their memory. A person could recount a traumatic event with altered details, mixing different memories or creating new elements that feel real to them. A child might confidently assert that they have a pet that they never owned, perhaps influenced by stories about friends, pets, or cartoons, blending imagination with memory. So we see confabulation in children. An elderly person might believe they attended a historical event like a famous concert, even though they really didn't, recalling vivid details from media coverage instead of personal experience. An individual recovering from substance abuse might recount past drug experiences with embellished stories, believing them to be true while mixing real and imagined events. And the reason why I'm including, um, people recovering from substance abuse, because don't forget, alcohol abuse can cause what's called alcohol dementia. It is one of the reversible dementias, not always, but it can be. So confabulation can and does occur with damage done from substance abuse. A depressed individual may believe they have failed at numerous life events, recounting specific absences, or perceived failures that really never occurred. Continuing on, individuals often use confabulation as a cognitive strategy to maintain a coherent narrative, helping them make sense of their experiences despite their memory gaps. Confabulated memories can evoke strong emotions. As individuals may feel genuine joy, sadness, or nostalgia when recalling these false events. Confabulation can lead to misunderstandings and conflicts in relationships, as family and friends may struggle to reconcile false memories with reality. So one of the differentiations between confabulation versus false memories is, well, they both involve inaccuracies, but confabulation is unintentional, whereas false memories may arise from suggestive questioning or misinformation. And then there are age-related changes. Aging and Memory. Older adults may experience confabulation more frequently due to cognitive decline, leading to a mix of real and imagined memories. So that is a pretty detailed description and information between what confabulation delusions and actually somebody flat out lying is. And I have to say that most of the stories that I've heard over the last 30 years from people suffering from Alzheimer's disease and related dementia, their stories are confabulated. They are not intentionally trying to lie. They are trying to fill in the gaps of their memory loss with information because they may have been asked a question and they want to answer the question and they can't remember. There's a disconnect between what they remember actually happened related to that question, and then there's a disconnect. They can't remember the rest of it. So their mind just fills in those gaps with details that are not accurate, but they're not intentionally trying to deceive anybody. So next time your loved one or the person that you care for tells you some whopping story about something, now you know all about confabulation. So please don't think that they're just, you know, intentionally making this up. That they're lying to you, that they're having a delusion. It's really their brains filling in the gaps to the memories that they don't have anymore. So hopefully that raises your awareness that confabulation is a real part of living with dementia and Alzheimer's disease, and that you understand the difference between them. And I would say that probably more times than not, the stories that you're going to hear are confabulated stories. So hopefully this helps in your day-to-day experiences caring for people with dementia, having loved ones with dementia, and that it just really kind of helps explain some of the elaborate stories that you hear along the way. So thank you again for tuning in with me again today. I really appreciate you taking the time to be here with me every week. And once again, I will bring you another new episode of the Truth, Lies Alzheimer's show next week. Until then, take good care of yourselves and your loved ones and the people that you care for. And have a great week.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.