CogBlog – A Cognitive Psychology Blog

There are small lies and there are large lies, and then there are a range of lies that fall in between- not too unbelievable, but just shy of complete plausibility. We’ve all committed a few little white lies, telling mom or dad that yes, of course our homework is done, of course the dishes have been washed, and of course we cleaned our rooms. We grow older and the lies get larger and a bit more complicated- of course we’re out of town, too sick to make it, too tired to meet up. Of course it was a business trip, of course we were at the office late. Then you have the lies that Mr. A, who could be seen as your respectable grandfather, tells about the staff at his nursing home. A likeable business man until a stroke two years ago, and now he’s going around making up stories and claiming that all the aides are sleeping with him (Chlebowski, Chung, Alao, & Pies, 2009).

https://www.motivateyourself.co.uk/podcast-114/

But can it really be considered just a lie? There’s no evidence of anything going on between Mr. A and the nurses, but is he really just a troublemaker, making up the lies for fun? Or rather are the accusations an example of false memories (untrue or distorted real memories)? Then, take note of the fact that Mr. A had a stroke before these “lies” arose. Confabulation is the term for a memory disturbance, where false or erroneous memories are formed involuntarily and are fully believed to be true, seen with amnesia and Alzheimer’s disease (Bajo, Fleminger, Metcalfe, & Kopelman, 2016; Lee, K. Meguro, Hashimoto, M. Meguro, Ishii, Yamaguchi, & Mori, 2007). Mr. A, then, could vehemently believe in the truthfulness of his statements, despite their complete fabrication. There is still research going on to figure out what confabulations really are and what causes them, but here we can look into what’s been done to tell us (1) why confabulations occur and what they entail, (2) what confabulations actually look like, and (3) how confabulations differ between amnesic and Alzheimer’s patients.

Why exactly do confabulations occur? Unfortunately there is still no complete agreement on the causes and prerequisites for confabulation, but there is a growing consensus that confabulations arise when executive dysfunction and frontal lobe damage are added to deficits in memory (Bajo et al., 2016). Executive dysfunctions simply refer to difficulties with your abilities to think, feel, or behave, and your frontal lobe is the part of your brain directly behind your forehead that deals with your personality, learning, and other voluntary activities. Confabulations, then, are linked to brain damage, as we saw with Mr. A, who suffered that stroke before his confabulations began.

There are other theories of confabulation though, like the idea that confabulations are simply a problem of context memory confusion, where a confabulator gets memory traces mixed up, thinking that something that he or she saw or heard was actually a part of a different memory. Thus, a false memory can be formed where you, as the confabulator, commit a misattribution error (misattribution). You might remember your friend telling you about this insane concert he went to where a person sitting next to him was dragged kicking and screaming out of the venue by a squadron of police officers. But then you misattribute the story to a concert you went to years ago, causing you to claim this experience happened to yourself, when really it happened to your friend. Bajo et al. (2016) performed a study looking into temporal text confusion (TCC), which is a mix up in memory in time, very similar to the context memory confusion and misattributions we just discussed. If you see a tiger running around at the park, and then go to the mall, and later say that you saw a tiger running around at the mall, you have committed temporal text confusion. It turns out that TCC is more common in confabulators than non-confabulators. Also, greater autobiographical memory and more executive impairments (those abilities to think, feel, and behave) are more prominent in people with severe confabulation (TCC). Both the theories discussed earlier are supported then, in that confabulations are most likely caused by executive dysfunction in cases when memory is already impaired, but TCCs are also a great example of confabulations being caused by context memory confusion. Perhaps both theories could be combined to describe confabulations correctly.

A quick summary so far: confabulations are essentially involuntary false memories that confabulators believe to be true. They are likely linked to brain damage, but could also be a problem of context memory confusion, which would cause the source confusion of confabulators’ false memories.

http://positivemed.com/2014/06/03/false-memories/

Now we can observe what confabulations really look like. The only visual example of confabulation that we have is imagining someone like our grandfather (patient Mr. A) telling everyone he’s sleeping with the staff at his nursing home. There are a few different variations of confabulation, though, that we can look at through case studies. Recollection refers to the process of setting up retrieval cues, or guides, to help pull out memories, and creating an acceptable representation of a past experience (La Corte, Serra, George, Pradat-Diehl, & Dalla Barba, 2016). Sometimes confabulations only affect certain recollections, which we can see in these case studies of real-life confabulators:

• Female patient IG just had surgery to clip an aneurysm and get rid of a hematoma. Now she is showing amnesic and confabulatory symptoms by not being able to recall having any memory impairment whatsoever, and she is completely unaware of her memory issues. She is unable to recall impersonal information from her past, present, and future.
• Male patient TA suffered from an accident at work and developed lesions on different parts of his brain. He is disoriented about the time and place and again is unaware of his memory issues. He can’t recall personal information from his past, present, or future.
• Female patient CM has a brain tumor and is showing some mild amnesia and confabulatory symptoms, and again is unaware of her memory problems. She only confabulated with past knowledge, both personal and impersonal.

All three patients have suffered brain injuries and are confabulating as a result (2016. Case Studies). Here’s where the difference in confabulations comes in though: if you talk to IG, she might tell you that Smokey the Bear was the president of the United States in 1952 and that Tony the Tiger is running in the 2020 election and full heartedly believe it. While those are impersonal confabulations, both past and future, TA would never confabulate in such a manner. Instead, he might tell you that he was fending off the British at Valley Forge in the 1700s, or that he’s going to be jetting off to Mars in a few weeks. TA confabulates personally in the past, present, and future, but then CM only will confabulate with past knowledge, both personal and impersonal, so she might tell you that she had a secret marriage to Prince Charles that lasted three weeks, or that the Cold War never happened. So three patients, all similarly injured, but their confabulations are all different!

Now we have looked into what confabulations are (those involuntary, yet thoroughly believe, false memories), a few theories on what cause them (brain damage, context memory confusion), and here we just observed how varied confabulations are. They can be impersonal, personal, past, present, or future. Any combination is possible, which makes studying different cases of confabulation so interesting.

To cover our last point of how confabulations differ between amnesic and Alzheimer’s patients, we’ll look into Lee et al.’s (2007) study on confabulations within Alzheimer’s patients. Patients with Alzheimer’s disease have more false memories, which again are made up of erroneous memories, because the brain deteriorates and causes memory errors and deficits (2007). Within patients with Alzheimer’s disease though, those suffering from delusions were seen to confabulate more than those without delusions. A delusion in this case would be if you thought someone was blaming you for something, like cheating at a rousing game of checkers, so you become accusatory or malicious in defiance. Alzheimer’s patients who have those delusions show stronger episodic memory, or memory of personal events, confabulations than those without delusions, but there’s no difference in confabulations with semantic memories, or fact based knowledge (2007). Because episodic and semantic confabulations don’t always occur at the same time in people, there are probably different mechanisms that cause confabulations between semantic and episodic memories, but we don’t know what they are yet. Like with amnesic patients, there are differences in impersonal (semantic) and personal (episodic) knowledge confabulations, but delusions are the key aspect of Alzheimer’s confabulations that we did not see in amnesic patients.

https://carra-lucia-books.co.uk/2015/05/20/false-memory-syndrome-is-it-possible/

There’s a thin line between truth and lie, and confabulations fall somewhere in between. They can’t be lies if the confabulator is convinced that they’re true, but they can’t be truth if they never even happened! It’s a great scapegoat if you ever get caught in a lie- just say that you’ve suffered from some injuries to your executive brain functions, and now you’re prone to a bit of confabulation. Except those case studies we talked about say that you realistically wouldn’t even know about the brain injury or your memory problems… So maybe just stick to telling the truth for as long as you can, until you (hopefully never) undergo brain injury and memory loss.

References

Bajo, A., Fleminger, S., Metcalfe, C., & Kopelman, M. D. (2016). Confabulation: What is associated with its rise and fall? A study in brain injury. Cortex: A Journal Devoted To The Study Of The Nervous System And Behavior, 8731-43. doi:10.1016/j.cortex.2016.06.016

Chlebowski, S. M., Chung, C., Alao, A., & Pies, R. W. (2009, May 26). Confabulation: A Bridge Between Neurology and Psychiatry? Psychiatric Times.

La Corte, V., Serra, M., George, N., Pradat-Diehl, P., & Dalla Barba, G. (2016). Different patterns of recollection impairment in confabulation reveal different disorders of consciousness: A multiple case study. Consciousness And Cognition: An International Journal, 42396-406. doi:10.1016/j.concog.2016.04.013

Lee, E., Meguro, K., Hashimoto, R., Meguro, M., Ishii, H., Yamaguchi, S., & Mori, E. (2007). Confabulations in Episodic Memory Are Associated With Delusions in Alzheimer’s Disease. Journal Of Geriatric Psychiatry And Neurology, 20(1), 34-40. doi:10.1177/0891988706292760