A 75-year-old patient has dementia of the Alzheimer's type and confabulates. A nurse should understand that this patient?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Confabulation is the act of filling in memory gaps with fabricated stories or details that the person believes to be true.
This is an unconscious process and is not an attempt to lie or deceive.
It is a characteristic symptom of memory disorders such as Alzheimer's disease and Korsakoff syndrome.
The fabricated memories can be a mix of real past experiences and imagined events, making them feel plausible to the patient.

Option A: This describes impersonation or a delusion of identity, which is different from confabulation. Confabulation is about creating false memories for events, not adopting a new persona.
Option B: This describes the defense mechanism of denial, where a person avoids the reality of their cognitive decline by maintaining a cheerful facade. It is not the same as creating false memories.
Option D: This describes rationalization, a defense mechanism where a person creates logical-sounding excuses to justify their behavior. Confabulation is about memory, not justifying actions.

Clinical Relevance

Nursing practice connection: Use the key finding related to Understanding of confabulation in Alzheimer's disease to guide bedside assessment, documentation, and the next nursing action.
Nurses should not confront or argue with a patient who is confabulating, as this can lead to increased anxiety, agitation, and a breakdown in the therapeutic relationship.
The best approach is therapeutic communication: validate the feeling or theme of the patient's story without reinforcing the false information, and then gently redirect the conversation or activity.
What if the patient's confabulated story places them at risk (e.g., they believe they need to leave the facility to go to a job they no longer have)? The nurse's priority is safety. The nurse should not argue but should use distraction and redirection techniques to guide the patient to a safe activity within the facility, while addressing any underlying emotional needs (e.g., a need to feel useful or busy).

How to Approach the Question

First, identify the key term in the question stem, which is 'confabulates'.
Define this term based on your nursing knowledge of cognitive disorders. Confabulation involves creating stories to fill memory gaps.
Next, evaluate each option to see which one matches this definition.
Option A ('Pretends to be someone else') describes impersonation, not confabulation.
Option B ('Denies confusion by being jovial') describes denial.
Option D ('Rationalizes various behaviors') describes rationalization.

Concept Tested & Keywords

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E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 80-82

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