Repost: How Big was that Fish?

This week I wanted to repost a great article Dr. Shandera did last year about confabulation with memory loss, or the brain "making up information" that is not true when the real memory is not there.  I think it is so important for our relationships with someone with memory loss to understand the difference between willful "lying" and neurologic confabulation.  Thanks Dr. Shandera!

The original link is here.

How Big was that Fish?  When Memory Loss Changes the Story

Mild Cognitive Impairment (MCI) often affects memory. When memory fails, the brain sometimes compensates by attempting to fill in the gaps on its own. The technical term for this is confabulation. Confabulation might be the creation of “memories” for discussions or events that never actually happened, or it might be a distortion or elaboration of things that did happen. Sometimes, the confabulated story sounds very reasonable, while other times the gaps get filled in with outlandish or bizarre content.

Isn’t that lying?

Confabulation is not the same as lying. The person with memory loss truly believes what he or she is saying, as it feels like a real memory. The process happens automatically. For those close to the person with MCI, confabulation can be surprising or even scary at first. Spouses or adult children may feel embarrassed when it is obvious to others that the person with MCI is saying something that is not true. The person with MCI, in turn, may feel angry or humiliated when a family member corrects his or her version of a story.

Some examples

Sometimes, confabulation is a mix of what the person with MCI has seen or heard in “real life.” It might be triggered by reading a story in the newspaper or watching a program on television. Imagine this scene: Gene has Mild Cognitive Impairment. Gene and his wife, Marge, are watching a television nature program about sharks, and shark attacks on humans. The next day, Marge overhears her husband on the telephone with their daughter, explaining that they cannot come to visit her in Florida as planned because last time they were there they were attacked by a shark.

Other times, confabulation happens when a situation does not make sense to the person with MCI due to memory difficulty. For example, Irene recently had to change the passcode for her cell phone. However, she forgot she did this, and now she keeps getting locked out of her phone for repeatedly typing in the wrong code. Her brain may try to help fill in the gap in her memory by coming up with the explanation that someone came into her apartment and changed the passcode for her cell phone. She may start to repeat this story to anyone who will listen, and will likely feel upset about it.

What helps

• Don’t argue. This is unlikely to result in anything more than frustration on both sides. Remember, for the person with MCI, this feels like a real memory.
• Try re-orienting to reality. If a confabulated story sticks around and seems upsetting to the person with MCI, loved ones may try to gently present another explanation. This is where a memory notebook system can really come in handy. In the case of Irene, her husband could show her where she made a note of her new passcode in her notebook – “maybe you changed it? Let’s look in your notebook together to see if that’s what happened.” Stay neutral and helpful, be an ally. Avoid statements that put the person with MCI on the defense, such as “I bet you forgot” or “That’s not what happened, how many times do I have to remind you?”
• Wait and see. For example, when Gene told his daughter they’d have to cancel their trip to see her because of the shark attack, his wife and daughter might say “okay, good point, we can get together another time.” Then, a few days later, his wife might try bringing up the trip again, to see how Gene responds. Sometimes the confabulation is forgotten soon afterward, and there’s no need to do anything about it.
• Just go with it. Sometimes, a confabulated story sticks around, and there’s not much you can do about it. If it’s upsetting to the person with MCI, just nod your head, and provide reassurance and validation of the feelings he or she is experiencing. “I know the situation with your cell phone is so frustrating, I’m sorry that happened.” Then change the subject and redirect the conversation.

Chime in! What tricks and tips have you used to help cope with confabulation?