CONFABULATION WITH A SELECTIVE DESCRIPTOR PROCESS IMPAIRMENT

Multinomial models reveal deficits of two distinct controlled retrieval processes in aging and very mild Alzheimer disease

Dual-process models of episodic retrieval reveal consistent deficits of controlled recollection in aging and Alzheimer disease (AD). In contrast, automatic familiarity is relatively spared. We extend standard dual-process models by showing the importance of a third capture process. Capture produces a failure to attempt recollection, which might reflect a distinct error from an inability to recollect when attempted (Jacoby et al. Journal of Experimental Psychology: General, 134(2), 131-148, 2005a). We used multinomial process tree (MPT) modeling to estimate controlled recollection and capture processes, as well as automatic retrieval processes, in a large group of middle-aged to older adults who were cognitively normal (N = 519) or diagnosed with the earliest detectable stage of AD (N = 107). Participants incidentally encoded word pairs (e.g., knee bone). At retrieval, participants completed cued word fragments (e.g., knee b_n_) with primes that were congruent (e.g., bone), incongruent (e.g., bend), or neutral (i.e., &&&) to the target (e.g., bone). MPT models estimated retrieval processes both at the group and the individual levels. A capture parameter was necessary to fit MPT models to the observed data, suggesting that dual-process models of this task can be contaminated by a capture process. In both group- and individual-level analyses, aging and very mild AD were associated with increased susceptibility to capture, decreased recollection, and no differences in automatic influences. These results suggest that it is important to consider two distinct modes of attentional control when modeling retrieval processes. Both forms of control (recollection and avoiding capture) are particularly sensitive to cognitive decline in aging and early-stage AD.

Confabulation in children with autism

Some children with high-functioning autistic spectrum conditions (ASC) have been noted clinically to produce accounts and responses akin to confabulations in neurological patients. Neurological confabulation is typically associated with abnormalities of the frontal lobes and related structures, and some forms have been linked to poor performance on source monitoring and executive function tasks. ASC has also been linked to atypical development of the frontal lobes, and impaired performance on source monitoring and executive tasks. But confabulation in autism has not to our knowledge previously been examined experimentally. So we investigated whether patterns of confabulation in autism might share similarities with neurologically-based confabulation. Tests of confabulation elicitation, source monitoring (reality monitoring, plus temporal and task context memory) and executive function were administered to four adolescents with ASC who had previously been noted to confabulate spontaneously in everyday life. Scores were compared to a typically developing (TD) and an ASC control group. One confabulating participant was significantly impaired at reality monitoring, and one was significantly worse at a task context test, relative to both the ASC and TD controls. Three of the confabulators showed impairment on measures of executive function (Brixton test; Cognitive Estimates test; Hayling Test B errors) relative to both control groups. Three were significantly poorer than the TD controls on two others (Hayling A and B times), but the ASC control group was also significantly slower at this test than the TD controls. Compared to TD controls, two of the four confabulating participants produced an abnormal number of confabulations during a confabulation elicitation questionnaire, where the ASC controls and TD controls did not differ from each other. These results raise the possibility that in at least some cases, confabulation in autism may be less related to social factors than it is to impaired source memory or poor executive function.

Confabulations in schizophrenia

INTRODUCTION

Current theories of confabulation are based primarily on the observation of neurological patients. The present paper evaluates these theories based on evidence from schizophrenia. Schizophrenia is unique in that it presents with a pathophysiology which differs from that of other neuropsychiatric conditions, and yet the candidate's deficits that various theories of confabulation implicate are often simultaneously present in schizophrenia.

METHODS

A selective review of literature on schizophrenic and neurological confabulations was undertaken.

RESULTS

Schizophrenic confabulation differs from neurological confabulation in terms of its characteristic features and association with symptoms, cognition and linguistic functions. Current evidence also suggests that confabulation may be conceptualized as a special class of delusions pertaining to memory phenomena.

CONCLUSIONS

Schizophrenia presents with confabulations that cannot be fully accounted for by the existing theories. It also presents with confabulations with unique features, which have different cognitive correlates and relation to other symptoms of the condition.

Confabulation in schizophrenia: a neuropsychological study

Confabulation has been documented in schizophrenia, but its neuropsychological correlates appear to be different from those of confabulation in neurological disease states. Forty-five schizophrenic patients and 37 controls were administered a task requiring them to recall fables. They also underwent testing with a range of memory and executive tasks. The patients with schizophrenia produced significantly more confabulations than the controls. After correcting for multiple comparisons, confabulation was not significantly associated with memory impairment, and was associated with impairment on only one of eight executive measures, the Brixton Test. Confabulation scores were also associated with impairment on two semantic memory tests. Confabulation was correlated with intrusion errors in recall, but not false positive errors in a recognition task. The findings suggest that confabulation in schizophrenia is unrelated to the episodic memory impairment seen in the disorder. However, the association with a circumscribed deficit in executive function could be consistent with a defective strategic retrieval account of confabulation similar to that of Moscovitch and co-workers, interacting with defective semantic memory.

Strategic retrieval, confabulations, and delusions: theory and data

Based on Moscovitch and Winocur's "working with memory" framework, confabulation is described as a deficit in strategic retrieval processes. The present paper suggests that only a confluence of deficits on multiple memory-related processes leads to confabulation. These are divided into three categories. Core processes that are unique to confabulation and required for its evolution include: (1) an intuitive, rapid, preconscious "feeling of rightness" monitoring, (2) an elaborate conscious "editor" monitoring, and (3) control processes that mediate the decision whether to act upon a retrieved memory. The second category is deficits on constitutional processes which are required for confabulation to occur but are not unique to it. These include the formation of erroneous memory representation, (temporal) context confusion, and deficits in retrieval cue generation. Finally, associated Features of confabulations determine the content "flavour" and frequency of confabulation but are not required for their evolution. Some associated features are magnification of normal reconstructive memory processes such as reliance on generic/schematic representations, and positivity biases in memory, whereas others are abnormal such as perseveration or source memory deficits. Data on deficits in core processes in confabulation are presented. Next, the apparent correspondences between confabulation and delusion are discussed. Considering confabulation within a strategic memory framework may help elucidate both the commonalities and differences between the two symptoms. Delusions are affected by a convergence of abnormal perception and encoding of information, associated with aberrant cognitive schema structure and disordered belief monitoring. Whereas confabulation is primarily a disorder of retrieval, mnemonic aspects of delusions can be described as primarily a disorder of input and integration of information. It is suggested that delusions might share some of the associated features of confabulation but not its core and constitutional processes. Preliminary data in support of this view are presented.

The cognitive neuroscience of constructive memory: remembering the past and imagining the future

Episodic memory is widely conceived as a fundamentally constructive, rather than reproductive, process that is prone to various kinds of errors and illusions. With a view towards examining the functions served by a constructive episodic memory system, we consider recent neuropsychological and neuroimaging studies indicating that some types of memory distortions reflect the operation of adaptive processes. An important function of a constructive episodic memory is to allow individuals to simulate or imagine future episodes, happenings and scenarios. Since the future is not an exact repetition of the past, simulation of future episodes requires a system that can draw on the past in a manner that flexibly extracts and recombines elements of previous experiences. Consistent with this constructive episodic simulation hypothesis, we consider cognitive, neuropsychological and neuroimaging evidence showing that there is considerable overlap in the psychological and neural processes involved in remembering the past and imagining the future.

Multiple sclerosis presenting with fantastic confabulation

Multiple sclerosis (MS) is the most common inflammatory, demyelinating disease of the central nervous system. Besides neurological signs and symptoms, the disease may be associated with various psychiatric manifestations, and uncommonly, psychiatric manifestations may be the presenting symptom. On the other hand, confabulation is defined as falsification of memory occurring in clear consciousness in association with an organically derived amnesia or as spontaneous narrative reports of events that never happened. We report an unusual association of confabulation with MS. A 23-year-old man was admitted to a hospital, telling unusual stories. After evaluation and a detailed workup, the patient was given the diagnosis of MS with fantastic confabulations. Neuropsychological evaluation revealed mild frontal lobe dysfunction. Confabulation has been reported after frontal lobe lesions and is also hypothesized to be associated with a deficit primarily in the retrieval of more than one of the following: encoding, consolidation or storage. Clinicians' awareness of this kind of rare association may further enlighten the neural basis of confabulation.

The cognitive neuroscience of memory distortion

Memory distortion occurs in the laboratory and in everyday life. This article focuses on false recognition, a common type of memory distortion in which individuals incorrectly claim to have encountered a novel object or event. By considering evidence from neuropsychology, neuroimaging, and electrophysiology, we address three questions. (1) Are there patterns of neural activity that can distinguish between true and false recognition? (2) Which brain regions contribute to false recognition? (3) Which brain regions play a role in monitoring or reducing false recognition? Neuroimaging and electrophysiological studies suggest that sensory activity is greater for true recognition compared to false recognition. Neuropsychological and neuroimaging results indicate that the hippocampus and several cortical regions contribute to false recognition. Evidence from neuropsychology, neuroimaging, and electrophysiology implicates the prefrontal cortex in retrieval monitoring that can limit the rate of false recognition.

Comprehension, encoding, and monitoring in the production of confabulation in memory: a study with schizophrenic patients

INTRODUCTION

The aim of the present study was to test the hypotheses proposed by Nathaniel-James and collaborators (Nathaniel-James & Frith, 1996; Nathaniel-James, Foong, & Frith, 1996) to account for the cognitive deficits involved in the production of confabulations in schizophrenic patients: impairments in comprehension, memory encoding, and memory monitoring.

METHOD

Five patients were investigated in this multiple single-case study. Comprehension abilities were investigated in several tests in which a memory bias was avoided. The encoding deficit hypothesis was tested by manipulating cues at encoding and/or retrieval. "Memory monitoring" abilities were examined in two tasks: the Hayling test for all patients and an AB-AC word pairs learning task for two patients.

RESULTS

Four of the patients produced an abnormal level of confabulations in story and fable learning tests. All patients exhibited encoding deficits and specific comprehension difficulties. However, some demonstrated preserved memory monitoring abilities. Across different tests, it was observed that the more the confabulations occurred, the more severe were the comprehension difficulties.

CONCLUSION

The results are in favour of the hypothesis that verbal comprehension difficulties lead to the production of confabulation. They are inconsistent with the idea that memory monitoring impairment is necessarily involved.

A positive emotional bias in confabulatory false beliefs about place

Some neurological patients with medial frontal lesions exhibit striking confabulations. Most accounts of the cause of confabulations are cognitive, though the literature has produced anecdotal suggestions that confabulations may not be emotionally neutral, having a ('wish-fulfilment') bias that shapes the patient's perception of reality in a more affectively positive direction. The present study reviewed every case (N = 16) of false beliefs about place reported in the neuroscientific literature from 1980 to 2000, with blind raters evaluating the 'pleasantness' of the patient's actual and confabulated locations. In each case the confabulated location was evaluated as more pleasant. This striking finding supports the claim that there may be a systematic affective bias in the false beliefs held by neurological patients with confabulation.

The contribution of executive processes to deceptive responding

We measured behavioral responses (RT) and recorded event-related brain potentials (ERPs) when participants made truthful and deceptive responses about perceived and remembered stimuli. Participants performed an old/new recognition test under three instructional conditions: Consistent Truthful, Consistent Deceptive and Random Deceptive. Compared to Consistent Truthful responses, Consistent Deceptive responses to both perceived and remembered stimuli produced the same pattern of less accurate, slower and more variable responses and larger medial frontal negativities (MFN). The MFN is thought to reflect activity in anterior cingulate cortex, a brain area involved in monitoring actions and resolving conflicting response tendencies. The Random Deceptive condition required participants to strategically monitor their long-term response patterns to accommodate a deceptive strategy. Even compared to the Consistent Deceptive condition, RTs in the Random Deceptive condition were significantly slower and more variable and MFN activity increased significantly. MFN scalp distribution results revealed the presence of three different patterns of brain activity; one each for truthful responses, deceptive responses and strategic monitoring. Thus, the data indicate that anterior cingulate cortex plays a key role in making deceptive responses.

When is schematic knowledge used in source monitoring?

Source monitoring involves judgments regarding the origin of information (M. K. Johnson, S. Hashtroudi, & D. S. Lindsay, 1993). When participants cannot remember the source in a source-monitoring task, they may guess according to their prior schematic knowledge (U. J. Bayen, G. V. Nakamura, S. E. Dupuis, & C.-L. Yang, 2000). The present study aimed at specifying conditions under which schematic knowledge is used in source monitoring. The authors examined the time course of schema-based guesses with a response-signal technique (A. V. Reed, 1973), and multinomial models that separate memory and guessing bias. Use of schematic knowledge was observed only when asymptotic old-new recognition was low. The time course of schematic-knowledge retrieval followed an exponential growth function. Implications for theories of source monitoring are discussed.

Introspective physicalism as an approach to the science of consciousness

Most 'theories of consciousness' are based on vague speculations about the properties of conscious experience. We aim to provide a more solid basis for a science of consciousness. We argue that a theory of consciousness should provide an account of the very processes that allow us to acquire and use information about our own mental states - the processes underlying introspection. This can be achieved through the construction of information-processing models that can account for 'Type-C' processes. Type-C processes can be specified experimentally by identifying paradigms in which awareness of the stimulus is necessary for an intentional action. The Shallice (1988b) framework is put forward as providing an initial account of Type-C processes, which can relate perceptual consciousness to consciously performed actions. Further, we suggest that this framework may be refined through the investigation of the functions of prefrontal cortex. The formulation of our approach requires us to consider fundamental conceptual and methodological issues associated with consciousness. The most significant of these issues concerns the scientific use of introspective evidence. We outline and justify a conservative methodological approach to the use of introspective evidence, with attention to the difficulties historically associated with its use in psychology.