Confabulations: definition, causes and frequent symptoms.

A phenomenon that distorts the perceived reality. We explain why it occurs.

The phenomenon of human memory is one of the most studied cognitive functions throughout the history of science, since in addition to being extremely complex it is also treacherous to a great extent.

One of the phenomena that distort people's reality are the confabulationsunderstood as false products of memory.

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What are confabulations?

The confabulations constitute a curious phenomenon and of difficult explanation. First of all, they could be defined as a kind of false memory due to a retrieval problem in the memory..

But there are differences between false memories and confabulations, and the latter go beyond the category of normal; either because of the high frequency with which they appear or because of their strangeness.

On the other hand, the person who suffers from them is not aware of it, coming to take these memories as genuine and not doubting their veracity. The content of the confabulations varies greatly from one person to another, ranging from stories related to the patient's or other people's experiences, to genuine constructions completely invented by the patient.

Moreover, the degree of credibility may also vary from one person to another. They can contain from the most ordinary stories (telling that one has gone to buy bread), and therefore credible, to the most absurd and disproportionate stories (telling that one has been abducted by aliens).

Classification of conspiracies: Kopelman vs. Schnider

Throughout history confabulations have been classified according to four criteria:

• ContentContent: differentiated in limits of true or false, probability of occurrence, positive or negative, etc.
• Mode of occurrenceprovoked or spontaneous.
• Terms in which they are manifestedAutobiographical, episodic, general semantic or personal semantic.
• Clinical syndrome in which it appears.

However, the most accepted classification by the scientific society is the one made by Kopelman. He considered that the most relevant thing to take into account was the way in which they arose; distinguishing two types. They are the following.

1. Spontaneous confabulations

These are the least frequent and are usually related to another amnesic syndrome integrated with another dysfunction.

2. Provoked confabulations

These phenomena are much more frequent in amnesic patients and are observed during the administration of a memory test. They are similar to the errors that a healthy person may present when trying to memorize something with a prolonged retention interval, and may represent a habitual response according to an altered memory.

Another classification was proposed by Schnider, who classified them into four genera according to the different production mechanisms. Although these groupings do not enjoy unanimous validity by the scientific community, they may help the reader to understand what they are about.

3. Simple provoked intrusions

This term includes distortions that appear when the person is pressured to remember the details of a story. An example would be when the person tries to remember a list of words and introduces, unconsciously, new words that are not in it.

According to Schnider, this type of intrusion does not correspond to a specific recovery mechanism.

4. Momentary confabulations

These refer to false statements that a patient makes when prompted to make a comment in a conversation. In comparison with other confabulations of more fantastic content, these may be completely plausible and credible on the part of the listener, although they may be incompatible with the person's current state and circumstances.

For example, the patient may relate that he or she is going on a trip abroad when, in fact, he or she is in the hospital.

Momentary confabulations are the most common of all, but they are not yet fully understood and it is not clear whether they have a mechanism of their own.

5. Fantastic confabulations

As the name implies, these confabulations have no basis in reality; and they are frequent in patients with paralytic dementia and psychosis.

These confabulations are absolutely inconceivable from the logical point of view and lack any sense. Moreover, they are not accompanied by the behavior that corresponds to them.

Causes

Usually the account of confabulations is typical of patients with damage in prefrontal areas of the brain, namely the basal forebrain.specifically the basal forebrain; including here the orbitofrontal and ventromedial areas.

The disorders and diseases with the highest number of confabulations are the following:

• Wernike-Korsakoff syndrome.
• Brain tumors
• Herpes simplex encephalitis
• Frontotemporal dementias
• Multiple sclerosis
• Anterior communicating cerebral artery infarcts

On the other hand, from a neuropsychological point of view, three hypotheses can be distinguished, which differ in the degree to which memory impairment affects confabulations. These are the hypothesis focused on memory dysfunction, the hypothesis focused on executive dysfunction, or the dual hypothesis.

1. Memory dysfunction

This first assumption is based on the idea that amnesia is a necessary condition for the patient to be able to confabulate. At the time, confabulations were considered a different form of amnesia. This belief is still maintained today, since confabulations appear predominantly in neurological disorders that lead to memory impairment.

From this hypothesis it is insisted that confabulations are a way of "filling in" the gaps left by amnesia.

2. Executive dysfunction

Executive function includes internally self-directed and goal-directed cognitive abilities.. These functions direct our behavior and our cognitive and emotional activity.

Therefore, this hypothesis states that confabulations are the result of problems in this executive function. The evidence supporting this theory is that confabulations decrease when executive functioning improves.

3. Dual hypothesis

The third and final hypothesis holds that the production of confabulations is due to a joint involvement of deficient procedures both at the level of memory and executive functioning. both at the level of memory and executive functioning.

Explanatory models of confabulations

The difficulty of defining confabulations concretely, explaining them as false memories that are completely true for the patient, makes it necessary for researchers to develop explanatory models.

During the early research on confabulations, models insisted that they arose from the patient's need to compensate for memory gaps. However, although emotional aspects are taken into account, this model has been superseded today.

On the other hand, from neuropsychology there are several suggestions to explain this phenomenon.. These are grouped between those that define confabulations as a problem of temporality, and those that give greater relevance to the recovery process.

1. Temporality theories

This theory supports that a confabulating patient suffers from a distorted sense of chronology. In this sense patients are able to remember what happened but not the proper chronological order.

The temporality theory is supported by the observation that most confabulations can find their origin in a true but misplaced memory.

2. Retrieval theories

Human memory is considered a reconstructive process, and confabulations are a great example of this.

According to these theories, confabulations are the product of a deficit in the memory retrieval process. The strongest evidence is that it affects both distant memories and those acquired once the deficit is installed.

Even so, retrieval of memories is not a unique process, so it would be necessary to determine whatIt would therefore be necessary to determine which specific aspects are impaired.