|memorylossonline.com, opgeslagen 14-09-2014,
by Daniel Pendick
The Truth About Confabulation|
The rupture of a tiny blood vessel in the brain can produce distorted or
If someone asked you what you did yesterday, you would probably recite a list of
mundane facts: what time you woke, what you ate for breakfast, when you left for
work. You would know these facts to be true simply because you remember them.
But what if the day-to-day facts of your life proved to be utterly erroneous?
This is the predicament faced by many of the patients seen by neuropsychologist
John DeLuca, Ph.D., director of neuroscience research at the Kessler Medical
Rehabilitation Research and Education Corporation in West Orange, New Jersey. Dr.
DeLuca studies people for whom the line between fact and fiction can sometimes
become obscured. These patients suffer from a disorder called confabulation,
which produces inaccurate memories ranging from "subtle alternations to bizarre
fabrications," DeLuca says.
The patients that DeLuca works with confabulate because of a rupture in a tiny
blood vessel in the brain called the anterior communicating artery (ACoA). The
rupture of this tiny artery temporarily cuts off the normal flow of oxygenated
blood to areas of the brain that are essential to the proper recall of memories.
The damage caused by an ACoA rupture can vary from one person to another, both
in the location and the degree of damage. And the symptoms are also diverse: the
person can suffer memory impairment alone, or memory impairment accompanied by
When the ACoA balloons into an aneurysm and bursts, part of the frontal lobe–the
region of the brain behind the forehead–is starved of oxygenated blood. This
condition, known as hypoxia, can lead to the death of brain cells. An area at
the bottom of the brain, the basal forebrain, can also suffer damage. For
reasons not entirely clear, damage to the basal forebrain can impair the ability
to form lasting memories from recent experiences, a condition known as
Confabulation in ACoA patients takes two forms. One involves distortions of when
a particular remembered event actually occurred–what DeLuca calls its "temporal
context." The other type of confabulation is marked by distortions in what
actually occurred–the actual content of a memory.
For instance, when asked what he did the previous weekend, one of DeLuca's ACoA
patients said that he spent time with an old friend, visited New York City, and
stopped by his store. Then the patient mentioned that the store was no longer in
operation, contradicting himself. Furthermore, since the man had not left the
hospital in the previous three weeks, much less traveled to New York City, the
whole story was a confabulation. He had distorted both the when and the what of
Yet this patient was totally unaware of the errors in his memory of the weekend.
This reflects an aspect of confabulation known as impaired self monitoring.
"Normally we're able to filter out what doesn't fit with the context of what
we're doing or saying," DeLuca says. "But apparently, people who confabulate are
having a breakdown in that. The system that tells them it's not right isn't
working. That’s the frontal lobes."
The frontal lobes are important to the "executive" functions of the mind,
including self monitoring, or awareness of one’s own behavior. In confabulation,
self monitoring is crippled. This is what allows a confabulating ACoA patient to
recall impossible or improbable events without realizing it.
The picture of human memory emerging from research on confabulation doesn’t
match the popular misconception of memory as a computerlike system that simply
stores and retrieves information. Instead, DeLuca emphasizes, memory is a
"reconstructive process" that pieces together rough drafts of an event based on
a lifetime of experiences and perceptions. And being imperfect, human memory
needs something to check up on it: call it the executive within. Deprived of
this executive within, the confabulating patient mixes fact and fiction and the
order of particular events.
DeLuca is quick to emphasize, however, that ACoA patients who confabulate are
not deliberately attempting to deceive anyone. Some psychiatrists, he says,
still assume that confabulation is an amnesic patient’s way of filling in lost
details to save face. However, DeLuca sees little evidence for that in his
research. "They really believe with conviction that what they're saying is
absolutely true," he says.
At the Kessler Medical Rehabilitation Research and Education Corporation, where
DeLuca and his colleagues conduct their research, neuropsychologists,
physicians, and therapists help people with confabulation to become aware that
some of the memories they recall, believe, and even passionately defend are
inaccurate. As awareness of the confabulation grows, the person confabulates
less. Just how and why this happens is unknown. But gradually, over a period of
weeks to months, most patients stop reporting inaccurate memories. The amnesia
generally persists, but the executive within has returned to his desk.
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