Abstract
Confabulations, also known as false memories, have been associated with various diseases involving mainly the frontal areas, such as Wernicke–Korsakoff syndrome or frontal epilepsy. The neuropsychological dysfunctions underlying mechanisms of confabulation are not well known. We describe two patients with memory impairment and confabulations at the onset speculating about neuropsychological correlates of confabulations and self-awareness. Both patients, a 77-year-old woman and a 57-years-old man, exhibited confabulations as first symptom of cognitive decline. She later developed memory impairment without awareness of her memory deficits and her cognitive and imaging profile suggested an amnesic mild cognitive impairment due to Alzheimer’s disease (AD). Unlike her, he developed a prevalent involvement of frontal functions despite a clear consciousness of his cognitive deficits. However, the clinical diagnostic hypothesis of behavioral variant of frontotemporal dementia was not supported by imaging findings, which suggested AD. Both patients underwent neuropsychological evaluation including the Confabulation Battery. Despite that the exact anatomical correlation of confabulations is still not defined, imaging data shown by our patients is consistent with recent theories according to which at the origin of confabulatory tendency in AD there is an impairment of the connections between crucial hubs in frontal and mediotemporal areas, mainly involving the right hemisphere. Besides, it would be reasonable to hypothesize that self-awareness and confabulations should not be considered as necessarily associated dimensions.
Highlights
Confabulations are defined as actions and verbal statements unintentionally incongruous to the patient’s history, background, and present and future situation (Dalla Barba and Decaix, 2009)
We describe the cases of two patients with an unusual neuropsychiatric presentation at disease onset speculating about the possible anatomical and neuropsychological correlates of confabulations and self-awareness
At T3, the Confabulation Battery (CB) was administered to detect provoked confabulations, while spontaneous confabulations were both anamnestically reported by relatives and produced during medical visits
Summary
Confabulations are defined as actions and verbal statements unintentionally incongruous to the patient’s history, background, and present and future situation (Dalla Barba and Decaix, 2009). Confabulations are commonly distinguished in provoked, if produced in response to direct questions, and spontaneous, if independent from any external stimulus (Kopelman, 2010). Spontaneous confabulations have been linked to frontal lobe pathology such as in Wernicke–Korsakoff syndrome, subarachnoid hemorrhage due to the rupture of anterior communicating artery aneurysms, and frontal lobe epilepsy (Fujikawa et al, 2016). According to the “temporality theory,” confabulations, spontaneous ones, are true memories displaced in time, resulting from the mind failure to recognize the correct temporal order of memories. On the other hand, according to the “strategic retrieval hypothesis” confabulations, provoked ones (Schnider et al, 1996) result from the attempt to recollect information from a deficient memory (Gilboa et al, 2006)
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