Confabulation

Confabulation in dementias [and several other neurological conditions as well] is the tendency of the brain to fill in the gaps for a faltering memory.  Last week, Dad's was in full bloom.  We went to the neurology clinic at the V.A. for a routine exam.

Dad has been extremely angry at the dentist-- specifically at the receptionist.  Several of the fake teeth had departed from his partial plate, necessitating that it be brought to the dentist office for repair.  Because the repair required welding, the broken partial and the separated "teeth" had to be sent out to the lab.  Because the whole mess had to be sent out to the lab, there was a charge of $160 dollars.  I was able to return the repaired partial to Dad four days later.  Things got dicey after that.

Dad's view on bills-- excepting his rent at assisted living-- is easily summed up by the words, "I don't owe them anything."  Occasionally for variety's sake, the words change to, "I can't afford it."  Dad's words concerning the dental bill were, "That should have been free.  I ain't paying it."  Dad's anger at the receptionist in particular has been of epic proportions.  He wants to tell me about it at length pretty much every time I see him.  Dad wants the partial to be fitted better to his mouth which translates to he wants to go to the dentist.  I have to find him a new dentist.  Although our dentist is still willing to see Dad, I can envision disaster happening.  Dad showing up at the dental office would not make for a pleasant surprise to the receptionist that he screamed at over the phone.

I prompted Dad to tell the neurodoc about the incident.  In actuality, Dad had called the dentist's office [because unfortunately some days he can dial phone numbers] about the bill.  This particular call quickly evolved into a one-sided screaming match.  Words on Dad's end of the call were things like, "I did not have the partial for four years,"  "I don't owe you that,"  "I'm not paying it," finishing with "Who are you to decide how much I have to pay?"  

In Dad's version of events to the neurodoc, it was clear that he did not remember how much the bill was for.  "Forty dollars," he told her.  He did explain that the receptionist somehow had set the price of how much he should pay.  Naturally, since I had described his anger as bordering on the psychotic range of things, Dad was perfectly calm when talking with the neurologist.

Prior to talking about his partial, I prompted Dad to tell the neurologist about his pants.  Or rather, his imposter pants.  Because the pants that Dad insists upon wearing every day are in actuality his pants which were purchased for him several years ago.  Dad explained to the neurodoc why he insists upon wearing only the one singular pair of pants which are ripped and now growing a hole in a most inappropriate place.  "A man that used to live at the home stole my pants.  He died.  The staff gave me his pants.  His pants are too big for me.  This was the guy that died before the last guy who died."  The neurodoc had to check, "Does he have other pants?" she asked me.  "Oh yes."  Not only that, they are still decent looking from lack of constant wear.  Dementia-- what a wonderful drug. 

My dad was always a sharp dresser.  He still tries to be.  But things don't work out that way anymore.  It takes more effort now for Dad to remember how to do things.  His co-ordination is not what it used to be.  Thus, achieving the well put together look now escapes him.  And he absolutely will not ask for help with anything at all.

I cannot explain why Dad will only wear that one pair of ripped and torn pair of pants.  Nor why he will only wear a particular pair of shoes.  [I am glad that the assisted living place does laundry twice a day].  Just as soon as his money situation is straightened out, I am going to buy Dad five or six pairs of pants of the exact same make, model, and color of his current favored pair.  Then his favored pair will be-- ahem-- mysteriously shredded beyond repair in the washing machine.  It's called therapeutic lying on the forums.  Much as I despise dishonesty, dementia sometimes insists upon it. 

But I can explain the filling in of failing memory with random untrue snatches of supposes.  Confabulation is what happens when a demented brain is confronted with a blind spot in a narration.  The perceptually impaired brain learns to fill in the missing visual component much like the demented brain manufactures new quasi-memories that never happened.  There is a blankness.  The brain says to itself, "Oh crap.  We can't have that."  And boom.  Bits of visual information rearranges itself.  Or bits of new versions of events emerge.  Dad believes the confabulations.  The essence of confabulation is that it is not conscious lying.  And that is the hell of it all.

No one can argue a demented person out of their confabulations.  It does not work.  It may be almost cruel to try.  Confabulation sucks for the family and friends who remember the demented person before they "got this way."  As badly as all of this has sucked for me, my dad is the one whose functioning continues to spiral downwards until a guaranteed death. 

After the neurology appointment, it was time to leave confabulation and Dad's failing brain alone for a time.  Dad and I went to a small diner.  We sat and ate a leisurely lunch.  Dad enjoyed his chili.  I tasted it.  I said, "This reminds me of the chili we used to get at the ski lodges."  Dad smiled then.  "Yes it does."    

sapphoq on life