symptoms

Dementia - Confusion, Misunderstanding and Confabulation

Joseph Community Member February 09, 2010
  • In the later stages of dementia, a person gets details mixed up and sometimes fabricates things from fragmented memories.  In the field of Psychiatry there is a name for this mental process called "confabulation", which is defined as: Filling in memory gaps with a falsification that a person believes to be true.  The dementia afflicted person absolutely believes without question, that this memory is complete and intact.  Sometimes these "memories" are plausible explanations that sound reasonable and other times, they are absolutely preposterous.  Because the belief in these is absolute, it makes no difference that they are illogical, impractical, or even impossible.

     

    Visitors of the person with dementia may have a perfectly normal conversation without ever becoming aware that a confabulation has been verbally expressed to them.  They can be hard to spot even when you are aware of them and are expecting them.  My mother may tell me that she went on a scenic bus ride on Sunday and describe it in some detail, when in fact she hasn't taken a bus trip for several weeks and hasn't left the assisted living building since that occasion, either.  It makes for challenging conversations and awkward circumstances sometimes.  This is not to be confused with delusions, which can seem very similar.  In this instance, she intended to go on the bus ride, but missed it and did something else, later forgetting what she did instead.  She probably spoke to someone later who did go on the bus ride and learned some of the details which then became her own memories of the trip.

     

    It's natural to want to question comments that don't ring true and suggest alternative possibilities to correct a memory.  It rarely helps to clear anything up and actually adds more confusion for the person having the memory trouble.  When these confabulations are harmless falsifications, it is best to ignore them and accept them as though they are factual.  The person telling the story absolutely recalls every detail of it as a fact and clearly remembers doing whatever their brain fabricated to complete the story.  They aren't lying, because they are relating the truth as they recall it.  They will argue if challenged about these memories.  That is another good reason to just let it go. 

     

    When a confabulation isn't harmless, it can cause all kinds of problems.  Perhaps one of the worst examples is when a confabulation involves a caregiver in a sexual situation with the dementia patient.  In this scenario, the person telling the story absolutely believes every detail and can be very convincing if they are telling the story to another resident in the assisted living community.  An innocent caregiver can be characterized as an opportunistic sexual partner and that can lead to abuse allegations or create fear in the other residents.  These confabulations absolutely must be addressed delicately, but directly, and it will be an awkward head-on confrontation.  It will take a multiple person intervention to try and purge this error in memory.  It may never be completely eliminated, but you may get the person to stop talking about it.  In time the false recollection may fade away and be forgotten.

  •  

    It seems that confusion is ever-present in later stage dementia.  The ability of the brain is so impaired that information isn't processed or interpreted correctly in many instances.  A distant conversation between two hearing impaired individuals speaking loudly, may be interpreted as an argument or a fight.  This will sometimes lead to a new false belief that the individuals don't get along with each other.  In populated surroundings like a dining room, overheard bits of conversation can become merged into a myriad of strange thoughts.  Those peculiar thoughts may then become confabulated into a new false belief about the people in the room.  These are difficult issues and they can become quite problematic.

     

    Aside from reducing the stimulus of multiple voices (crowds) and reducing exposure to radio and television voice broadcasts (other than music), little can be done to prevent the confusion and false beliefs.  They are as real as any genuine memory that the dementia patient has.  The notion that it's just a casual mistake that should be corrected is wrong.  These circumstances are not careless errors, but are a byproduct of the illness.  They are a symptom of dementia, nothing more.  Like a rash, the symptom comes and goes.  It must be allowed to resolve itself whenever possible.  Treating the symptom won't cure the illness and may exacerbate the problems further, causing agitation in some individuals.  This can lead to the four A's, "agitation", "anxiety", "anger" and "aggression".  A better approach is to seem agreeable and change the subject to something else that is more comfortable for all involved.  Staying calm and understanding is the best approach, even if it's difficult.     

3 Comments
  • NC
    NC
    Feb. 09, 2010

    Hi Joe,

     

    Thanks for the post. This is exactly what my father-in-law has been doing for almost 5 years now. It started in 2006 when he thought his lady friend's old neighbor was her mother (she liked to entertain neighbors and he was there too.) Then he thought of her as 2 persons: one at work and the other one as the former wife of his colleague. She...

    RHMLucky777

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    Hi Joe,

     

    Thanks for the post. This is exactly what my father-in-law has been doing for almost 5 years now. It started in 2006 when he thought his lady friend's old neighbor was her mother (she liked to entertain neighbors and he was there too.) Then he thought of her as 2 persons: one at work and the other one as the former wife of his colleague. She did his upper denture and so that confused him a lot.
    Well, he got worse obviously in 2008 when he forgot his elder son unless he calls on the weekends. Then he flirted and treated all women like a mate or future wife/girlfriend wanting to marry them or go to bed with them (whoever was or is closer to him via caregiving or phone calls/visits.)

    For the last 2 times in the hospital stay overnight, he invented the story that the hospital people are trying to kill him. The reason is probably that he used to work on research using cats in the lab. and also he saw how dogs/cats were put down in the shelter. His late wife died in hospice due to cancer. So these experiences naturally support his thoughts about the hospital staff, not to mention he would pull off the iv and tubing...

    This confabulation has been going on forever. We just ignore him and don't bother to explain except that we told him once in 2009 that we cannot kill him. The funny part is After he refused to be killed in the hospital, he would come home saying he wanted to die thinking we can put him down. (I think if it is under his control so it is dffierent to die at home or something.)

     

    All we can do is calm him down and ignore the subject by sort of agreeing with him. No arguing with him. One time in late 2008, we told him there is no work for him. He has thought his son, my husband, can work with him in the same field as professors. But it is not possible as they are never in the same field anyway and my FIL has lost his ability to work and write/read. His reaction is if he cannot work, he does not exist. Ok, so what can we do? We continue to pretend this game that he can work with my husband. Now he often tallks about his own work for a very short time and forget about it later. He still thinks my husband works in the same stuff that he does. I think he knows my husband is not in the same field all the time, but he insists that my husband talks to him about his own old interest, in which my FIL can no longer makes sense out of it anymore.)

    The other time he told me the neighbor can give him money as he mixed it up with the condo committee and the houses in the same block. But she has her own house and he has his own house. Of course, he has no idea that he paid for his own house already.

     

    This is so common to us now. Everyday I wonder what the story is he going to tell.

     

    Sometimes a sense of humor helps, so I don't get too upset now by his stories anymore.

     

    Nina

    • Joseph
      Feb. 09, 2010

      Hi Nina,  It sounds like you have adapted well to your FIL's mysterious confabulations and have learned how to handle them.  After 5 years of this behavior, you are probably quite used to it and have even come to expect it.  I'm sure that it was troubling for your family in the early years.  It's never easy to deal with the false beliefs,...

      RHMLucky777

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      Hi Nina,  It sounds like you have adapted well to your FIL's mysterious confabulations and have learned how to handle them.  After 5 years of this behavior, you are probably quite used to it and have even come to expect it.  I'm sure that it was troubling for your family in the early years.  It's never easy to deal with the false beliefs, especially when the loved one's personality changes, as a result.  I'm glad that you are handling it well and understand it enough that you can approach it with a sense of humor.  That's about all that you can do.  I hope that your FIL can get past the idea that the hospital wants to kill him.  That's a tough one.  Thanks for the reply!  --  Joe   

    • NC
      NC
      Feb. 10, 2010

      Hi Joe,

       

      The first time we realized my FIL was not right in his mind was when my husband asked his lady friend about her mother. Well, she said her Mom died 14 years ago. So the person that my FIL was referring to was the old neighbor. We believed it was her mother! When he thought the lady is 2 persons (he tried to chase her and didn't work...

      RHMLucky777

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      Hi Joe,

       

      The first time we realized my FIL was not right in his mind was when my husband asked his lady friend about her mother. Well, she said her Mom died 14 years ago. So the person that my FIL was referring to was the old neighbor. We believed it was her mother! When he thought the lady is 2 persons (he tried to chase her and didn't work out), my husband tried to tell him it is not true and explain why she was in Chicago and yet was at home after work as well. That didn't work out because he tried to walk out at night to find her and the caregiver called back to ask us to calm him down by agreeing with him. Actually when my husband agreed with him, my FIL said he felt better that he agreed with him!! This was the first time we realized he really has something wrong.

       

      Whenever a new story was told by my  FIL, we still attempted to modify it or explain it to him differently but gradually we can no longer do that. When I told him the neighbor does not have money for us, he told me to shut up if I don't understand and he wanted to tell my husband to get money from the neighbor!!

       

      As my FIL  got sicker, the fantasy got bigger. Now we just deal with it when it comes - the best we can do is to explain to his friends that he was not in his right mind. Sometimes people may believe his story!

       

      Take care,

      Nina