Awareness and confabulation

Objective: A single case study with control and normative data of a 74-year-old retired businessman with amnestic mild cognitive impairment, who had spontaneous confabulations concerning fantastic exploits and magical powers as well as déjà vécu experiences. Methods and Results: His neuropsychological profile showed episodic memory impairment including deficits of recent episodic autobiographical memories and of recognition, but performance was within normal limits on tests assessing source memory for words, the ability to suppress irrelevant items on a continuous recognition memory task, and the detection of stimulus frequency. There were discrete impairments in an ad hoc test measuring his ability to detect and discriminate the source of a range of material including information derived from personal and public events, invented material, and episodes culled from his personal reading. Although his source memory for autobiographical information was normal, he attributed 20% of the invented material and personal readings and 15% of the public events either to his own experience or to that of someone he knew personally or to someone else. Conclusions: This evidence suggests that none of the current theoretical accounts of spontaneous confabulations is sufficiently explanatory. Instead, an argument is developed that both fantastic confabulation and déjà vécu arose from a more fundamental disorder of awareness.