Hostname: page-component-cb9f654ff-5kfdg Total loading time: 0 Render date: 2025-08-03T23:28:27.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Behaviorally spontaneous confabulation in limbic encephalitis: The roles of reality filtering and strategic monitoring

Published online by Cambridge University Press:  19 August 2010

LOUIS NAHUM ,
RADEK PTAK ,
BÉATRICE LEEMANN ,
PATRICE LALIVE  and
ARMIN SCHNIDER
LOUIS NAHUM
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
RADEK PTAK
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
BÉATRICE LEEMANN
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
PATRICE LALIVE
Affiliation:
Division of Neurology, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
ARMIN SCHNIDER*
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
*
*Correspondence and reprint requests to: Armin Schnider, Service de Neurorééducation, Hôpitaux Universitaires de Genève, Av. de Beau-Séjour 26, CH-1211 Geneva 14 / Switzerland. E-mail: armin.schnider@hcuge.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Behaviorally spontaneous confabulation is characterized by a confusion of reality evident in currently inappropriate acts that patients justify with confabulations and in disorientation. Here, we describe a 38-year-old woman lawyer hospitalized because of non-herpetic, presumably autoimmune, limbic encephalitis. For months, she considered herself at work and desperately tried to respect her falsely believed professional obligations. In contrast to a completely erroneous concept of reality, she did not confabulate about her remote personal past. In tasks proposed to test strategic retrieval monitoring, she produced no confabulations. As expected, she failed in tasks of reality filtering, previously shown to have high sensitivity and specificity for behaviorally spontaneous confabulation and disorientation: she failed to suppress the interference of currently irrelevant memories and she had deficient extinction capacity. The observation underscores the special status of behaviorally spontaneous confabulation among confabulatory phenomena and of reality filtering as a thought control mechanism. We suggest that different processes may underlie the generation of false memories and their verbal expression. We also emphasize the need to present theories of confabulation together with experimental tasks that allow one to empirically verify the theories and to explore underlying physiological mechanisms. (JINS, 2010, 16, 995–1005.)

Keywords

Orbitofrontal cortexLimbic systemReality monitoringRehabilitationParamnesiaCaudate

Information

Type
Symposia
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 6 , November 2010 , pp. 995 - 1005
Copyright
Copyright © The International Neuropsychological Society 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Anderson, N.E., & Barber, P.A. (2008). Limbic encephalitis - A review. Journal of Clinical Neuroscience, 15, 961–971.Google Scholar
Benson, D.F., Djenderedjian, A., Miller, B.L., Pachana, N.A., Chang, L., Itti, L., et al. . (1996). Neural basis of confabulation. Neurology, 46, 1239–1243.CrossRefGoogle ScholarPubMed
Berlyne, N. (1972). Confabulation. British Journal of Psychiatry, 120, 31–39.Google Scholar
Bonhoeffer, K. (1901). Die Akuten Geisteskrankheiten des Gewohnheitstrinkers. Eine klinische Studie. Jena: Gustav Fischer.Google Scholar
Bonhoeffer, K. (1904). Der Korsakowsche Symptomenkomplex in seinen Beziehungen zu den verschiedenen Krankheitsformen. Allgemeine Zeitschrift für Psychiatrie und psychisch-gerichtliche Medicin, 61, 744–752.Google Scholar
Burgess, P.W., & McNeil, J.E. (1999). Content-specific confabulation. Cortex, 35, 163–182.Google Scholar
Burgess, P.W., & Schallice, T. (1996). Confabulation and the control of recollection. Memory, 4, 359–411.CrossRefGoogle ScholarPubMed
Butter, C.M. (1969). Perseveration in extinction and in discrimination reversal tasks following selective frontal ablations in Macaca mulatta. Physiology and Behavior, 4, 163–171.CrossRefGoogle Scholar
Conway, M.A., & Tacci, P.C. (1996). Motivated confabulation. Neurocase, 2, 325–339.CrossRefGoogle Scholar
Crovitz, H.F., & Schiffman, H. (1974). Frequency of episodic memories as function of their ages. Bulletin of Psychonomic Society, 4, 517–518.Google Scholar
Dalla Barba, G. (1993). Confabulation: Knowledge and recollection experience. Cognitive Neuropsychology, 10, 1–20.Google Scholar
Dalla Barba, G.F. (2002). Memory, consciousness and temporality. Boston: Kluwer Academic Publishers.Google Scholar
Dalla Barba, G., Cappelletti, J.Y., Signorini, M., & Denes, G. (1997). Confabulation: Remembering ‘another’ past, planning ‘another’ future. Neurocase, 3, 425–436.Google Scholar
Damasio, A.R., Graff Radford, N.R., Eslinger, P.J., Damasio, H., & Kassel, N. (1985). Amnesia following basal forebrain lesions. Archives of Neurology, 42, 263–271.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (1987). California verbal learning test: Adult version. San Antonio, TX: The Psychological Corporation.Google Scholar
Flament, J. (1957). La fabulation dans le syndrome de Korsakov d’étiologie traumatique. Considérations cliniques, psycho-pathologiques et neuro-pathologiques à propos d’une observation de fabulation à caractère mythopathique. Acta Neurologica Belgica, 57, 119–161.Google Scholar
Fotopoulou, A., Conway, M.A., Tyrer, S., Birchall, D., Griffiths, P., & Solms, M. (2008). Is the content of confabulation positive? An experimental study. Cortex, 44, 764–772.CrossRefGoogle ScholarPubMed
Gilboa, A., Alain, C., Stuss, D.T., Melo, B., Miller, S., & Moscovitch, M. (2006). Mechanisms of spontaneous confabulations: A strategic retrieval account. Brain, 129, 1399–1414.Google Scholar
Gilboa, A., & Moscovitch, M. (2002). The cognitive neuroscience of confabulation: A review and a model. In Baddeley, A.D., Kopelman, M.D., & Wilson, B.A. (Eds.), Handbook of memory disorders (2nd ed). London: John Wiley and Sons.Google Scholar
Gundogar, D., & Demirci, S. (2006). Multiple sclerosis presenting with fantastic confabulation. General Hospital Psychiatry, 28, 448–451.CrossRefGoogle ScholarPubMed
Hirst, W., & Volpe, B.T. (1982). Temporal order judgments with amnesia. Brain and Cognition, 1, 294–306.Google Scholar
Howard, D., & Patterson, K. (1992).Pyramids and palm trees: A test of semantic access from pictures and words. Bury St Edmunds: Thames Valley.Google Scholar
Jacoby, L.L. (1991). A process dissociation framework: Separating automatic from intentional uses of memory. Journal of Memory and Language, 30, 513–541.CrossRefGoogle Scholar
Janowsky, J.S., Shimamura, A.P., & Squire, L.R. (1989). Source memory impairment in patients with frontal lobe lesions. Neuropsychologia, 27, 1043–1056.CrossRefGoogle ScholarPubMed
Johnson, M.K., O’Connor, M., & Cantor, J. (1997). Confabulation, memory deficits, and frontal dysfunction. Brain and Cognition, 34, 189–206.Google Scholar
Johnson, M.K., & Raye, C.L. (1998). False memories and confabulation. Trends in Cognitive Sciences, 2, 137–145.CrossRefGoogle ScholarPubMed
Kaplan, E.F., Goodglass, H., & Weintraub, S. (1983). The Boston naming test (2nd ed.). Philadelphia: Lea & Febiger.Google Scholar
Kopelman, M.D. (1987). Two types of confabulation. Journal of Neurology, Neurosurgery, and Psychiatry, 50, 1482–1487.Google Scholar
Kopelman, M.D., Stanhope, N., & Kingsley, D. (1997). Temporal and spatial context memory in patients with focal frontal, temporal lobe, and diencephalic lesions. Neuropsychologia, 35, 1533–1545.CrossRefGoogle ScholarPubMed
Kopelman, M.D., Wilson, B.A., & Baddeley, A.D. (1989). The autobiographical memory interview: A new assessment of autobiographical and personal semantic memory in amnesic patients. Journal of Clinical and Experimental Neuropsychology, 11, 724–744.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1886). Ueber Erinnerungsfälschlungen (1/3). Archiv für Psychiatrie und Nervenkrankenheiten, 17, 830–843.Google Scholar
Kraepelin, E. (1887). Ueber Erinnerungsfälschlungen (2/3. Fortsetzung). Archiv für Psychiatrie und Nervenkrankenheiten, 18, 199–239.Google Scholar
Mandler, G. (1980). Recognizing: The judgment of previous occurrence. Psychological Review, 87, 252–271.CrossRefGoogle Scholar
Metcalf, K., Langdon, R., & Coltheart, M. (2007). Models of confabulation: A critical review and a new framework. Cognitive Neuropsychology, 24, 23–47.CrossRefGoogle Scholar
Milner, B. (1971). Interhemispheric differences and psychological processes. British Medical Bulletin, 27, 273–277.CrossRefGoogle ScholarPubMed
Moscovitch, M. (1989). Confabulation and the frontal system: Strategic versus associative retrieval in neuropsychological theories of memory. In Roedinger, H.L., & Craik, F.I. (Eds.), Varieties of memory and consciousness: Essay in honor of Endel Tulving. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Moscovitch, M. (1995). Confabulation. In Schacter, D.L. (Ed.), Memory distortion, Cambridge: Harvard University Press.Google Scholar
Moscovitch, M., & Melo, B. (1997). Strategic retrieval and the frontal lobes: Evidence from confabulation and amnesia. Neuropsychologia, 35, 1017–1034.Google Scholar
Nahum, L., Ptak, R., Leemann, B., & Schnider, A. (2009). Disorientation, confabulation, and extinction capacity: Clues on how the brain creates reality. Biological Psychiatry, 65, 966–972.CrossRefGoogle ScholarPubMed
Pick, A. (1905). Zur Psychologie der Confabulation. Neurologisches Centralblatt, 24, 509–516.Google Scholar
Ptak, R., & Schnider, A. (1999). Spontaneous confabulations after orbitofrontal damage: The role of temporal context confusion and self-monitoring. Neurocase, 5, 243–250.Google Scholar
Regard, M., Strauss, E., & Knapp, P. (1982). Children’s production on verbal and nonverbal fluency tasks. Perceptual and Motor Skills, 55, 839–844.Google Scholar
Rosenkilde, C.E. (1979). Functional heterogeneity of the prefrontal cortex in the monkey: A review. Behavioral and Neural Biology, 25, 301–345.Google Scholar
Rosenkilde, C.E., Bauer, R.H., & Fuster, J.M. (1981). Single cell activity in ventral prefrontal cortex of behaving monkeys. Brain Research, 209, 375–394.Google Scholar
Schacter, D.L., Norman, K.A., & Koutstaal, W. (1998). The cognitive neuroscience of constructive memory. Annual Review of Psychology, 49, 289–318.Google Scholar
Schnider, A. (2003). Spontaneous confabulation and the adaptation of thought to ongoing reality. Nature Reviews. Neuroscience, 4, 662–671.CrossRefGoogle ScholarPubMed
Schnider, A. (2008). The confabulating mind: How the brain creates reality. Oxford, New York: Oxford University Press.CrossRefGoogle Scholar
Schnider, A., Bonvallat, J., Emond, H., & Leemann, B. (2005). Reality confusion in spontaneous confabulation. Neurology, 65, 1117–1119.CrossRefGoogle ScholarPubMed
Schnider, A., Guggisberg, A., Nahum, L., Gabriel, D., & Morand, S. (2010). Dopaminergic modulation of rapid reality adaptation in thinking. Neuroscience, 167, 583–587.Google Scholar
Schnider, A., Gutbrod, K., Hess, C.W., & Schroth, G. (1996). Memory without context. Amnesia with confabulations following right capsular genu. Journal of Neurology, Neurosurgery, and Psychiatry, 61, 186–193.CrossRefGoogle Scholar
Schnider, A., Mohr, C., Morand, S., & Michel, C.M. (2007). Early cortical response to behaviorally relevant absence of anticipated outcomes: A human event-related potential study. Neuroimage, 35, 1348–1355.CrossRefGoogle ScholarPubMed
Schnider, A., & Ptak, R. (1999). Spontaneous confabulators fail to suppress currently irrelevant memory traces. Nature Neuroscience, 2, 677–681.Google Scholar
Schnider, A., Ptak, R., von Daniken, C., & Remonda, L. (2000). Recovery from spontaneous confabulations parallels recovery of temporal confusion in memory. Neurology, 55, 74–83.Google Scholar
Schnider, A., Treyer, V., & Buck, A. (2000). Selection of currently relevant memories by the human posterior medial orbitofrontal cortex. Journal of Neuroscience, 20, 5880–5884.Google Scholar
Schnider, A., Treyer, V., & Buck, A. (2005). The human orbitofrontal cortex monitors outcomes even when no reward is at stake. Neuropsychologia, 43, 316–323.Google Scholar
Schnider, A., Valenza, N., Morand, S., & Michel, C.M. (2002). Early cortical distinction between memories that pertain to ongoing reality and memories that don’t. Cerebral Cortex, 12, 54–61.Google Scholar
Schnider, A., von Daniken, C., & Gutbrod, K. (1996a). The mechanisms of spontaneous and provoked confabulations. Brain, 119, 1365–1375.CrossRefGoogle ScholarPubMed
Schnider, A., von Daniken, C., & Gutbrod, K. (1996b). Disorientation in amnesia: A confusion of memory traces. Brain, 119, 1627–1632.Google Scholar
Snodgrass, J.G., & Vanderwart, M. (1980). A standardized set of 260 pictures: Norms for name agreement, image agreement, familiarity, and visual complexity. Journal of Experimental Psychology: Human Learning & Memory, 6, 174–215.Google ScholarPubMed
Tewes, U. (1991). HAWIE-R. Hamburg-Wechsler Intelligenztest für Erwachsene - Revision. Bern: Huber.Google Scholar
Thurstone, L.L., & Thurstone, T.G. (1963). Chicago test of primary mental abilities. Chicago: Research Associates.Google Scholar
Treyer, V., Buck, A., & Schnider, A. (2003). Subcortical loop activation during selection of currently relevant memories. Journal of Cognitive Neuroscience, 15, 610–618.CrossRefGoogle ScholarPubMed
von Cramon, D.Y., & Säring, W. (1982). Störung der Orientierung beim hirnorganischen Psychosyndrom. In Bente, D., Coper, H., & Kanowski, S. (Eds.), Hirnorganische Psychosyndrome im Alter (pp. 42–50). Berlin: Springer.Google Scholar
Wechsler, D. (1945). A standardized memory scale for clinical use. Journal of Psychology, 19, 87–95.Google Scholar
Wechsler, D. (1987). WMS-R. Wechsler memory scale - Revised. San Antonio, TX: The Psychological Corporation.Google Scholar
Wernicke, C. (1900). Grundriss der Psychiatrie in klinischen Vorlesungen. Leipzig: Thieme.Google Scholar
Williams, H.W., & Rupp, C. (1938). Observations on confabulation. American Journal of Psychiatry, 95, 395–405.CrossRefGoogle Scholar
Supplementary material: File

Nahum supplementary material

Nahum supplementary material

Download Nahum supplementary material(File)
File 42.5 KB