Should confabulation be addressed or ignored?

tiredandlonely

Background: My 58 y.o. alcoholic wife had a psychotic episode in 2016 after quitting drinking. She was hospitalized with a diagnosis of Delirium tremens but I believe she suffered/suffers from Wernicke Korsakoff Syndrome. Over the past seven years she has exhibited symptoms of dementia which I have managed through scheduling and routines. She is withdrawn and mostly anti-social but, in a social situation, appears to be normal to others. Her primary physician has acknowledged the dementia diagnosis but notes no abnormal behavior in her visits.  

Over the years, I have noted what I would describe as minor confabulations (brief comments on things that didn’t occur) but lately she seems to have developed more intricate confabulations. She is generally a happy person and I don’t want to complicate her situation.  

My question is should I challenge or explain her confabulations with her, discuss this with her primary doctor, make an appointment with her neurologist (who only saw her once in 2016) or leave it alone and let her live her life as described.

Thanks in advance for any input or advice!

Dio

So sorry you have to be here, but it's the best place to get firsthand information and experience. IMHO, I'd definitely inform her doctors about her confabulations and seek help from a neurologist. However, there's no use trying to challenge/explain/correct her confabulations with her. It may 1) confuse her more, 2) get into an argument, or 3) her complete rejection of what you have to say...and/or all of the above. If she's generally happy, I'd just let her be.

Ed1937

Here is a video by Teepa Snow. It should be helpful. https://www.youtube.com/watch?v=ISySnaIyzEo&t=26s

PookieBlue

Dear Tired and lonely,

     I’m sorry you are in this situation. If your wife could reason and help herself, the best thing she could do is stop the alcohol. Unfortunately you can’t help someone who won’t help themself. 

     My 78 year old DH also has a history of alcoholism and I’m certain this is the major cause of his dementia as well as the heredity. His 83 year old sister with same history also has dementia. It’s reasonable to believe that years of alcohol abuse will decrease oxygen to the brain and ultimately will burn one’s nines. (Sarcastic reference to Steve Martin movie ‘Man with two Brains’.)

     I tried for years to get him to cut back, but the drinking just increased. I admit that I was his enabler, in that I would procure it for him to prevent him from driving to the store. Since his evening drinking seemed to be his only happiness, it just continued and his cognition as expected just got worse. 

     Although his consumption has decreased the last six weeks, the damage is irreparable. He’s never been a mean drunk, but still, look what it did. Every drink he took broke my heart. Now I am paralyzed in this dementia time space warp continuum.

The only thing I can do is let his adult children be wary of their risk for this.

Last Dance

From: Last Dance, I don't know if you would call it confabulation or not, but before my wife was officially diagnosed with Alzheimer's, there would be times when we'd be with other people and she would tell a story about something that happened to her, but it was really something that happened to me. I never corrected her about it or said anything to her about it. I just felt it was because her childhood was much different than mine. I guess I would just say more peaceful than mine. Whereas mine was full of turmoil, and that continued until I met her. So, she would tell stories about something that really happened to me and not to her I would just pass it off as she just wanted to feel something that I felt. I don’t know  if this makes any sense to you. I think it's just a natural part of the Alzheimer's or dementia process. I would not correct her or say anything to her about it. If she's content let it be, when you really think about it nobody cares about her stories but you.

harshedbuzz

@tiredandlonely

The short answer-- I wouldn't correct or explain around her confabulations whether fueled by an alcohol-related dementia or otherwise.

That said, before my dad was diagnosed with mixed dementia- Alzheimer's and WKS-- I used to bristle at what felt like him rewriting family history. He routinely ascribed his and my sister's worst choices, both addicts and negligent mothers, to me. I obviously knew that I'd never been arrested nor left my children in a bar to go off with some random dude. It was bad enough when he'd do this in front of his friends but when he started spewing this nonsense around my 14-year-old son I snapped. It didn't change anything but get me called a liar. Once dad was diagnosed and we understood why he did this, it was easy enough to explain it to my son and go along with whatever dad was reliving at the time including apologizing if "appropriate". FTR, my son is on spectrum and has the typical sense of justice associated and really struggled with this phase.

Occasionally, he'd get stuck in a storyline about having committed what would be considered criminal behavior. During those times, we'd limit his interaction with other people aside from critical medical appointments because it was simpler than trying to convince people it was the dementia talking.

Most of dad's confabulations were pretty benign. One example would be the day I took him to sell his car; he thought I was going to steal it (because a horribly dented Taurus is very desirable) and agreed to sell it to prevent that. A win for me. He told the gentleman doing the paperwork about driving his favorite car along the ocean only it was all confused. The night he seemed to be describing was him driving his TR3 in Cape Ann around 1960 according to mom who was there. But the details made no sense-- he said the car was his 1999 Miata (not his, it's mom's; a car which "lived in FL exclusively until I moved them north and had it shipped here) and that he was in Cape May (my parents used to spend summers there in the 1970s at which time my mom owned an MGB). The story and they feelings that came with it were absolutely real to him-- just as suffering through his sister's and mine's transgressions were-- the details just weren't factual.

Like @Last Dance 's dear wife, dad often subsumed the experiences of others. In his mind, he was the protagonist of all stories as his dementia progressed. This had a different feel than his conflated memories. I can recall trying to get him off the couch to move around a bit, as per his PT. He explained that he couldn't because he'd just had his knee replaced (pointing to his elbow). My mom had had her knees both replaced and he was annoyed that she was gone for a few days each time and then didn't wait on him as was usually the case. Later, he even started to confuse what he'd seen on television as having happened to him. Mom liked to watch crime dramas in the evening. The next day dad, who couldn't recall what he'd had for lunch, would repeat the plot of the prior evening's show with him as the victim telling me that "the bad guys came and kidnapped and murdered me last night". I had to put parental controls on the big TV to avoid him getting upset-- even TWC was a problem as he believed all weather was just outside his door.

Confabulation is seen in other kinds of dementia, but it seems to be a bigger thing with those who have WKS. For dad it seemed like he often had the gist of an event, especially the emotional content, but backfilled the details with something more immediate. Other WKS symptoms dad had were some eye issues, terrible spatial reasoning, inability to regulate his temperature (always cold- thermostat set for 85F in July) and a rolling gait even when sober.

HB

Denise1847

When we go to a new place like a restaurant, my DH will always tell me that we were there before and sat in the same place. Before I knew better, I would try to correct him, but I finally wised up and say "hmm, I don't remember that."

ButterflyWings

HB - you have been an inspiration to me for many years. The patience, caring, and insight that you display to not only your dear mom but your dad who sounds like such a handful, is remarkable and inspiring. Your clarity and humor just make my day. Even when we are looking at (and living) the tragedy of dementia as clear-eyed as possible, finding the wry ironies and some humor, if possible, is sometimes the only thing keeping total despondency at bay for me.

Just had to say I appreciate you and thank you for your example of how not only to be a highly effective family caregiver with some measure of independence, but also a supportive forum mate here in this priceless circle. As this forum with its suggestions, cautions, ideas, and encouragement from you and others literally has been the lifeline and light that guides me then and now. I am laughing at your Taurus comment right now. (You know you secretly wanted his prize car, now lol). If people could only see the invisible thought bubble with the running reflections in most of our heads while pretending to go along with our PWD LOs most outrageous moments... well at least they might understand my periodic eye-rolling and mumbling under my breath.

Dear Tired and Lonely, I agree your LOs confabulations are some of the many convos where you should say something agreeable and noncommittal, and just let it roll off your back. But yes, this seems to signal progression, so I'd definitely raise it with the neuropsych in case any of his thoughts start to bother him and require med management. With DH's alternate reality, I have long relied on the repertoire of least resistance like "Oh? Wow, really? huh! you know I'm not sure but can find out, maybe, I think so, umm hmm, etc.". Those worked when DH was having hallucinations and delusions back in mid-stages, and they still work now that he's a man of many fewer words with short convos that leave me clueless as to what he's trying to say. So, I act as if it all makes sense, as I've been doing for years now, through one phase or another of this Alz journey.

tiredandlonely

Thank you to all who have responded. I am grateful to have a supportive and understanding group such as this. As I continue to research and learn, all you have said will be considered in this journey.