What to know about Dementia and Confabulation

What is Confabulation?

According to The Alzheimer’s Society, “When someone with dementia unknowingly invents a story – which is called confabulation – it may be a coping strategy to make sense of the world around them.” Living with dementia can be confusing and disorienting at times, and if someone is struggling to recall a particular memory they may fill the gap with a false or distorted memory, otherwise known as a confabulation. This isn’t a deliberate deception, their brain is creating or distorting their memory as a result of the dementia.

Examples of confabulation can be when someone remembers part of something they did, such as getting on and off a bus, but have no recollection of what happened in-between. Their brain could then fill that gap with an appropriate ‘memory’ that didn’t actually happen, such as who they saw on the bus or what they talked about. Our dementia care can help.

This is when misunderstandings can occur because the person may insist that what they remembered is exactly what happened and challenge another person if they say it couldn’t have done. Confabulations differ from delusions in that they are memories rather than beliefs, with delusions usually more apparent in psychiatric disorders such as schizophrenia.

The Distinction Between Lying and Confabulation

For someone living with dementia, confabulation is a memory error, something their brain does without their conscious input, and not something that is done to deliberately deceive others. Lying, on the other hand, could be said to be a conscious action that is done to obscure the truth, whether for positive or nefarious reasons. “Some psychologists call confabulation “honest lying” because those who confabulate stories genuinely believe what they’re saying. In this sense, the message is honest, even if untrue.” A person living with dementia may tell a story about an event in their life that never actually happened, although for the person telling the story, it did and was very real. This is different to someone concealing the truth about a story deliberately and changing the details to benefit their situation better. Therefore, the way others react to the story told is key to the person’s continued wellbeing, as accusing them of ‘lying’ or contradicting their story may be quite damaging, and cause them additional grief, confusion or anguish.

Dementia UK recommends a careful approach to how caregivers react to their version of events. “(Confabulations) feel very real to the person with dementia. They may become angry or upset if you challenge them, which can make it hard to care for them.” There are approaches that can be made to help the person make more sense of what’s around them, such as explaining the reality of what they think happened but without correcting or challenging them. It can be difficult for the caregiver not to get frustrated if caring for the person on a daily basis is sometimes challenging, but not getting into heated discussions and knowing when to leave a subject will benefit both parties. It can be upsetting if the person living with dementia is adamant something has happened, especially if it involves accusing a loved one, but the way the subject is handled will make all the difference. If the person has accused someone of ‘stealing’ a piece of their property or ‘losing’ it, the temptation is to challenge and argue, however that will just cause upset on both sides. Instead, distracting away from the subject can often work well, as the person may quickly forget what they’d said and the implications of it, alternatively, responding in a non-accusatory way will keep tempers in check. For instance, if the person living with dementia claims that someone close to them has stolen their purse, instead of arguing and saying, “they’d never do that”, it would be better to say something along the lines of “the thought of that happening is very distressing. Let me see if I can find it for you in case it’s been misplaced in the house somewhere.” While this may not pacify the person immediately it will certainly keep tempers in check and provide some time to look for the item in question.

What Causes Confabulation in Dementia

Confabulation is most often caused by types of dementia that affect the memory. These include – but are not limited to – Alzheimer’s disease and frontotemporal dementia. It can also be caused by Korsakoff’s syndrome, a type of dementia that is caused by excessive alcohol consumption.

Other conditions that can cause confabulation include:

Brain aneurysm

Brain damage

PTSD

Multiple Sclerosis

Schizophrenia

Amnesia

What are the signs of Confabulation?

Different types of confabulation can have different signs and symptoms, but some of the more common include:

Provoked confabulation

When someone is asked a question and they create a false memory to answer it. Not to be confused with consciously lying, their brain is simply doing it as a result of being prompted.

Momentary confabulations

These are created as a response to a discussion, or like provoked confabulation, when asked a question.

Recollective confabulation

Similar to experiencing déjà vu constantly, the person may feel they’ve experienced something before, when they haven’t.

Fantastic confabulation

Sometimes dream-like memories that are completed invented, rather than ‘fantastic’ meaning ‘wonderful’. This means the memory hasn’t been distorted as it never actually existed.

Responding to Confabulation in Dementia

Some people not living with dementia may have experienced confabulation without even being aware of it. Distorting memories of actual events or trying to implant false memories is something that some professions use as a tactic to gather information. For instance, when a journalist wants a particular story, they may ‘lead’ someone’s memories to fit their narrative, or a lawyer in court may do the same to fit their client’s claims. Other people may try and convince someone that their memory of an event is not how it happened, for their own benefit. Consequently, this should give us an understanding of how to support another person who is living with confabulation.

Correcting them

While usually to be avoided, correcting someone living with dementia may be necessary if the false memory they are experiencing could cause them to act to their own detriment.

Examples include if someone is convinced a friend or loved one has wronged them and they isolate themselves because of it, or if they are sure an event is happening on a certain day and may put themselves in a vulnerable position if they turn up at the wrong time.

Validating them

While agreeing with a false memory isn’t always helpful, as it can cause additional anxiety when someone is experiencing hallucinations or delusions, validating a pleasant memory that someone believes is true may be a good thing. For instance, if they are recalling a holiday that they took to another country and the memory is giving them pleasure, even if you know they’ve never been there, it may be better to let them experience it. Telling them they’ve never been there and that they’re ‘mistaken’ may make them feel belittled and will almost certainly cause bad feeling. If the situation began to cause embarrassment or awkwardness then distracting away from it is often an effective way of managing it.

How Helping Hands Can Help With Your Dementia Care

Helping Hands have been supporting our customers living with dementia since we were established in 1989, meaning that we have decades of experience helping people to live well. We believe that supporting people to live their best quality life in the home they love is a privilege, and a responsibility we take extremely seriously. We promote independence above all else, believing that to remain in control of your own life as much as possible contributes positively to both physical and emotional wellbeing. Our experienced dementia carers will support every aspect of your life at home, on either a visiting or live-in care basis, so that you and your loved ones can be reassured that you’re safe, comfortable, and cared for always.

If you would like to learn more about dementia care across England and Wales you can talk to your local branch team, whose details you’ll find here, or you can chat to our central customer care advisors who are available seven days a week, via our website or over the phone.