Do confabulators really try to remember when they confabulate? A case report

Abstract

Since Korsakoff's (1889/1955) first descriptions of confabulation at the end of the 19th century, all attempts to understand this neuropsychological disorder have focused on memory dysfunctions. Although the precise mechanisms underlying confabulation are still a matter of debate, the prevalent view is that confabulation is the output of a faulty recollective process. In the present paper we raise doubts about this undemonstrated assumption, arguing that confabulators are not necessarily attempting to recall when they confabulate. We describe a patient (M.L.) who floridly confabulated after a ruptured aneurism of the anterior communicating artery. The patient was administered a range of verbal tasks that required either memory recollection or other kinds of cognitive processes not involving memory. We conclude that the memory dysfunction exhibited by our patient represents one of many manifestations of a more general underlying disorder characterized by an inability to select the cognitive process that matches the task requirements in conjunction with a compulsion to provide verbal responses.

Keywords:

• Confabulation
• Frontal lobes
• Memory
• Utilization behaviour

Acknowledgments

We wish to thank Umberto Sabbadini for help with the evaluation of M.L.'s neuroimages.

Notes

¹ As we noted in the case history, M.L.'s spontaneous speech did not reveal any obvious semantic deficits; however, they may have been masked by a general lack of logical coherence. Also, since spontaneous speech is obviously a less demanding task than picture naming, it is possible that a subtle semantic deficit becomes more evident in the latter task.