Confabulation: After brain injury, what’s it mean?

Confabulation: After brain injury, what’s it mean?

Thomas Novack, Ph.D.

When the survivor says things that are not accurate and is unaware that statements are untrue, families and caregivers are often confused and frustrated. Confabulation is related to changes in memory after a brain injury. But it is often misunderstood and the survivor is accused of lying. This tip card helps individuals, families and caregivers understand what causes confabulation, what to do about it and how to help the survivor. Author Dr. Tom Novack explains that confabulation is often a recollection of events that occurred in the past; however, they are not being recalled fully or in the proper time frame or sequence.
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Full Description

Confabulation is often associated with an injury to the frontal area of the brain. This area focuses attention, directs and organizes thoughts and behaviors, and controls impulsiveness. Confabulation occurs when the frontal areas do not provide direction and organization to the memory system. Too often, confabulation is mistakenly perceived as the person lying or having delusional thoughts. By better understanding how information is stored in memory and later retrieved, users gain an understanding of what happens when this system breaks down. As a consequence, a person who is confabulating will recall events out of sequence, mismatch people and events, and give too much information.

This tip card is an excellent tool to help families, caregivers and clinicians understand the causes and consequences of confabulation after brain injury. It provides strategies to use at home and in the community to help the survivor correct errors and use memory aids and tools.

Details
Item CONF
Pages 8
Year 2012

Authors

Thomas Novack, Ph.D.

Dr. Novack is a neuropsychologist and Professor of Physical Medicine and Rehabilitation at the University of Alabama at Birmingham. He is also Director of the Traumatic Brain Injury Model System.

Contents

What is Confabulation?

  • Is confabulation the same as lying?
  • Is confabulation the same as being delusional?
  • Why does confabulation occur?
  • Why is direction and organization important for memory?

    • Example of encoding with similar information
    • Example of time tagging an event
  • What about severe memory disorders?
  • Why does the person not think things through before speaking?

What Do You Do about Confabulation?

  • Be patient
  • Ask the person to think about what was just said and if it is on target.
  • Match dates with memories
  • Focus on self-awareness
  • Use memory aids
  • Use a date book
  • Stay calm

Final Thoughts

Excerpts

What is Confabulation?

Of the many problems that individuals can have with thinking skills after a brain injury, confabulation is among the most troubling to family members. The person with an injury says things that are simply not accurate, and seems to have no awareness that what is being said is untrue.

"Frank says that he spoke with his mother yesterday. She passed away seven years ago, but he insists that he has spoken with her.”

“Emily keeps saying that she has been at work, when she hasn’t been working since her injury. She also says she has been driving. It isn’t true! People believe her and think she is doing great.”

"As we were going into the grocery store, I asked David what we needed to buy, to see if he could remember. Out of the three things we needed he remembered two, but he also added 3 things that weren’t on the list!”

Let’s take a moment to consider what confabulation is, why it occurs, and what to do about it.

Is confabulation the same as lying?

The answer is, no. Confabulation does not include an ulterior motive of trying to mislead people. Unlike lying, there is no gain to be achieved. The injured person is not aware of the inaccuracy of what is being said. This is not to say that people with brain injury are incapable of lying. Any of us can lie. The point is, with confabulation there is no conscious attempt to mislead people to the benefit of the injured person.

Rather than lying, confabulation is often a recollection of events that occurred sometime in the past; however, they are not being recalled fully or in the proper time frame or sequence.

From the examples above, there is no doubt that Frank spoke with his mother—it just did not occur yesterday. Emily has worked and driven in the past, but she is not doing those things now. David recalled things that can be purchased in a grocery store, but not the specific items needed on this trip.

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