How to Respond to Confabulation in Dementia

Confabulation is a memory distortion where false information is expressed by an individual to others. The key to understanding confabulation is an awareness that the person is not intentionally being dishonest, but rather attempting to interact with those around him. For example, when seeing an image of the Eiffel Tower, the person describes their visit to it, but they have never been to France.

Confabulation in Dementia and Other Conditions

Confabulation is most common in people who have Korsakoff syndrome (a type of dementia often associated with alcohol abuse), but it also has been observed in cases of Alzheimer's disease and frontotemporal dementia.

Confabulation can also develop in people with other conditions, including a ruptured aneurysm, encephalitis, head injury, subarachnoid hemorrhage, or schizophrenia.

Causes

Theories vary, but some research suggests two explanations of why confabulation may occur:

1. The information was not encoded well enough into the brain. For example, there may have been some distractions while the information was processed that prevented it from correctly or completely inputted into the brain's memory.
2. Over-learned information may be dominant. For example, typical life habits, well-known facts or interesting stories may rise to the forefront in the person's mind, pushing out the specific facts and causing the person to default to inaccuracies rather than the truth.

One reason why encoding and memory are impaired in Alzheimer's is that the hippocampus—an area of the brain associated with memory and encoding—tends to be one of the earlier structures in the brain that is notably impacted by Alzheimer's disease.

Additional research suggests that people with dementia who experience delusions and aggression are more likely to confabulate.

The Difference Between Confabulation and Lying

Family members of people with dementia who confabulate often become frustrated and may feel like their loved one is intentionally being dishonest and deceiving them. It's important to understand that confabulation, although inaccurate, is not an intentional choice, but rather an unintentional effect of dementia, whereas lying involves making a deliberate choice to misrepresent the truth.

Understanding the difference may make it a little less frustrating when confabulation occurs.

A Holistic Approach: Are There Benefits to Confabulation?

It may seem strange to think of confabulation as a good thing, but when we view it in a holistic way, we can see some possible benefits and coping strategies in it. A study conducted by Linda Örulv and Lars-Christer Hyden at Linkoping University outlined three positive functions of confabulation. They include:

• Sense-making: Confabulation can help make sense of the current situation for the person with dementia.
• Self-making: Confabulation can help establish and preserve a sense of personal identity.
• World-making: Confabulation can help the person interact with those around him.

What these three positive functions essentially are saying is that confabulation may help those with dementia feel more positive about themselves and preserve some of their ability to communicate and interact with others.

How to Respond

Often, the best response to confabulation in dementia is to join the person in her reality, rather than attempting to correct and point out the truth. Rarely, if ever, does arguing with someone who has dementia reap any benefits.

Validation therapy recognizes that certain needs, memories and past experiences frequently drive emotions and behaviors, including shaping memories, whether accurately or not. Accepting the person's reality is often more helpful and perhaps may allow them to accomplish some of the benefits identified above.

A Word From Verywell

Although confabulation in dementia may initially be confusing or frustrating, it can be helpful to change the way we view it. Seeing it as a coping response to the cognitive changes in dementia, instead of as lying, can decrease a possible emotional reaction and help caregivers to be able to "go with the flow" and join the reality of their loved one.