Session Host Name: Jon Evans Host's Role: Introduction
Confabulation and Reality Filtering
Summary Abstract:
Confabulation has been described as “the emergence of memories of events and experiences which never took place” (Wernicke 1900). Most confabulations are verbal statements reflecting a confusion of memories, but with no impact on behavior. This is different for behaviorally spontaneous confabulation (BSpC), a rare form in which patients –at least intermittently– act according to their false ideas. BSpC may emanate from a Wernicke-Korsakoff syndrome or focal damage to the orbitofrontal cortex or its connections due to aneurysm rupture, traumatic brain injury, tumor resection or other causes. In most cases, patients enact premorbid habits, such as, going to work. Testing of orientation shows that they fail to correctly perceive true ongoing reality and their current role and tasks. Thus, BSpC constitutes a natural model for how the brain filters out ongoing reality in thinking to distinguish it from fantasies and daydreams. This talk reviews 30 years of research exploring the mechanisms underlying this capacity, which we now call “Orbitofrontal Reality Filtering, ORFi”. Evidence from cognitive experimentation, imaging, and electrophysiology with brain-lesioned and healthy subjects will be presented that indicates that ORFi is a pre-conscious process, which depends on an extinction signal from the posterior medial orbitofrontal cortex (area 13), produced when a thought finds no correlate in the present reality.
Number of Credit Hours: 1.0
Level of Instruction: Advanced
Learning Objectives:
1. Recognize behaviorally spontaneous confabulation among diverse forms of confabulation
2. Describe the role of the orbitofrontal cortex for confabulation and the sense of true present reality
3. Formulate future research questions on confabulation
Presenter(s):
Armin Schnider, MD
University Hospitals of Geneva
Armin Schnider studied medicine at the University of Basel/Switzerland. He then specialized in neurology in Bern, Zürich, and Los Angeles. Since 1998, he is the chairman of the Division of neurorehabilitation at the University Hospitals of Geneva and full professor of neurorehabilitation at the University of Geneva. His research has mainly concerned the field of behavioral neurology, with an emphasis on memory disorders. For almost 30 years, he has studied the clinical phenomena of confabulation and disorientation, leading to the discovery of a mechanism necessary to synchronize behavior with ongoing reality: orbitofrontal reality filtering (ORFi). He is the author of numerous scientific articles on this topic and of a monograph reviewing the history and current concepts of confabulation and false memory: “The Confabulating Mind. How the Brain Creates Reality” (2nd edition, Oxford University Press 2017).
