Confabulation+(False+Memories)

CONFABULATION (DELUSIONAL & FALSE MEMORIES) Confabulation is a form of lying. However, a confabulator is not purposeful liar, as the lies they make up are delusional and bizarre. Even so, the patient often believes their lies, even when confronted with evidence that the lie has no basis in reality. Instead, they make up yet another bizarre lie and then another and another.

-Exceedingly bizarre -Delusional -Fantastical -Loosely associated ideas become organized and anchored around fragments of an experience.
 * When secondary to right (or bilateral) frontal damage, speech may become **

-Disinhibition -Difficulties monitoring responses -Withholding answers -Utilizing external or internal cues to make corrections -Accessing appropriate memories -Maintaining a coherent line of reasoning -Suppressing the flow of tangential and circumstantial ideas
 * Frontal lobe confabulation seems to be due to **

<span style="color: #000000; font-family: Times New Roman,serif;">That is, since the right frontal lobe can no longer regulate information processing and the flow of perceptual and ideational activity, information that is normally filtered out and suppressed is instead expressed. In consequence, the Language Axis of the left hemisphere becomes overwhelmed and flooded by irrelevant, bizarre associations, leading sometimes to the expression of false memories, which the patient (that is, Broca's area) repeats.

<span style="font-family: 'Times New Roman',serif; font-size: medium;">**Example:** 24 y/o store cleark who received a gunshot wound (during the course of a robbery) which resulted in destruction of the right inferior convexity and orbital areas, attributed his hospitalization to a plot by the government to steal his inventions. He claimed he was a famous inventor, had earned millions of dollars and had even been on TV. When it was pointed out that he had undergone surgery for removal of bone fragments and the bullet, he pointed to his head and replied, "that's how they are stealing my ideas."

In right inferior parietal lobe injury a person may deny that body parts on the left side of the body belong to them and may be perceived to belong to someone else. It is possible that when the language dominant left hemisphere denies ownership of the left extremity it is in fact telling the truth. That is, the left arm belongs to the right not the left hemisphere. The parietal lobe is in part an evolutionary derivative of the hippocampus (which also contains neurons that code for the position of the body and objects in space), not just a body image and the body in space, but the memory of the body is maintained in this tissue. Memories are sometimes unilaterally stored; i.e. the left hemisphere maintains a somesthetic-memory image of the right half of the body, the right cerebrum maintaining perhaps bilateral representations. In this regard, the left brain may in fact have no memory regarding the left half of the body.
 * <span style="font-family: "Times New Roman",serif; font-size: medium;">Inferior Parietal Lobe and confabulation **

Inevitably, in order for an individual to confabulate, erroneous information must become integrated in some fashion so that the confabulated response can be expressed.

//Frontal lobe confabulation:// Much flooding of the association and assimilation areas with tangential and irrelevant information much of which is amplified completely out of proportion to more salient details. Consequently, salient and irrelevant, highly arousing and fanciful information are expressed indiscriminately. The normal filtering process is disrupted. //Parietal lobe damage:// rather than flooding, there is a disconnection and information received in the Language Axis is incomplete and riddled with gaps.

Assimilation of input from diverse sources is a major feature of left and right inferior parietal activity. Hence, when this area is damaged errors abound in the assimilation of perceptions and ideas as the language axis can no longer access all necessary information. \When no message is received and when the language axis is not informed that no messages are being transmitted, the language zones instead rely on some other source even when that source provides erroneous input; substitute material is assimilated and expressed and corrections cannot be made (due to loss of input from the relevant knowledge source). The patient begins to confabulate.

In these instances delusions and confabulatory responses occur as a result of an attempt by the Language Axis to fill the gaps in the information received with associations and ideas which are in some manner related to the fragments available and while erroneous, can contain some accurate elements around which erroneous, albeit related, ideations are anchored. Hence, a patient may see his left leg or arm and then state it belongs to the doctor.

//Regions Affected/Involved:// In general, these disturbances occur most frequently when the right frontal or right parietal lobe is damage. However, neglect, denial, and delusional confabulation may also infrequently result from left parietal injuries.

<span style="color: #000000; font-family: Times New Roman,serif;">In some respects injuries involving the orbital frontal lobes can result in symptoms similar to those with right frontal injuries, including the production of confabulatory ideation. However, in contrast to right (or bilateral) frontal injuries which may result in the production of fantastical spontaneous confabulations where contradictory facts are ignored or simply incorporated, confabulatory responses associated with orbital injuries tend to be more restricted, transitory, and in some cases must be provoked.
 * <span style="color: #000000; font-family: Times New Roman,serif;">Differential Dx: **