Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for October 15th, 2010

Confabulation

Posted by Dr. Vollmer on October 15, 2010

    Bella, eighty-six, the mom of Nell, sixty-two, told her daughter that Nell was not invited for Thanksgiving because Nell’s sister Stephanie was mad at her ever since Nell was “too busy” to take Stephanie to get an MRI of her brain. Nell was furious. Stephanie and Nell had a misunderstanding. They cleared the air. Nell called Stephanie immediately, but Stephanie took a while to get back to her, so Nell was stewing on this for days. Ultimately, Stephanie and Nell concluded that Bella made the whole thing up. It is true that Stephanie and Nell “had words.” It is also true that Stephanie was not having Thanksgiving this year. The connection between these two events were woven together in Bella’s mind such that she created a narrative which made sense, but was not true. Confabulation describes what happened to Bella. The mind wants to make sense of events, so when there is confusion, some people, with brain damage (early dementia is possible in the case of Bella), fill in the narrative rather than saying “I don’t know”. Understanding that Bella’s narrative could be an early sign of underlying organic disease is helpful since now Nell knows that everything Bella says must be subject to corroboration. Nell learned the hard way. What if Nell did not understand that confabulation was a sign of brain disease? I imagine so many families with misunderstandings about their elderly loved ones such that heated arguments and frustrations ensue, secondary to attributing blame or maliciousness to these innocent, but hurtful, tales. Brain disease, at any age, is terrifying. Understanding brain decay, as with so much of human behavior, is the first step.

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