Spontaneous confabulations and behavioral and cognitive dysexecutive syndrome

We have examined and diagnosed confabulation in a 20-year-old woman who had suffered severe traumatic brain injury (TBI) when she was 12. Spontaneous confabulations were associated with dysexecutive behavior involving perseveration and impulsiveness. The patient was amnesic during neuropsychological tests but did not present intrusion, confabulation or false recognition. She could evoke self-constitutive autobiographical events accurately and without fantasizing. The only difference between her false and true recollections is that the patient could never envision herself as an actor in a scene involving confabulation. She succeeded, albeit slowly, in carrying out the classic executive tests: Stroop, Trail Making A and B and Wisconsin Card Sorting (WCST). She showed particularly slow reaction time and was impulsive and hurried in her performance of the D2 attention test, the errands (Martin) test and the chocolate cake test. Her working memory was significantly impaired. A peculiar inability to inhibit the generation of fictional constructions may reflect a problem in control of short-term memory. Diagnosis of the confabulation phenomenon has had three clinical consequences: 1) information has been given to the patient, her family and other people close to her; 2) reeducation by means of voluntary memory control prior to speaking has been proposed; 3) reporting on the case has been improved.