The Sacramento Assessment of Confabulation (SAC)

Transcription

1 The Sacramento Assessment of Confabulation (SAC) Larry Boles, Ph.D., CCC Emily Smith, MS, CCC California State University Sacramento ASHA 2008, Chicago Good Morning, Chicago! 2 I m m from Sacramento 3 1

2 Is This Confabulation? 4 Is This Confabulation? 5 Defining & Describing Confabulation Definition: the unintentional verbalization incongruous with the present situation (Dalla Barba, 1993) Is associated with frontal lobe damage (Dayus & Van den Broek, 2000) In particular with right-hemisphere frontal lobe damage (Joseph, 1999) 6 2

3 Further Defining & Describing Benson et al. (1995) suggest the orbital and medial frontal cortex as the mechanism for confabulation. Data from numerous studies are consistent with this suggestion (e.g., Papagno & Baddeley, 1997) 7 How have we been measuring confabulation? Measurement 1: My patient confabulates OR Measurement 2: My patient does not confabulate 8 Except Dalla Barba (1993a) measured confabulation quantitatively. Required participants to answer a variety of questions, which required episodic memory, long term memory (including memory for famous people and events). 9 3

4 But Dalla Barba s questions were idiosyncratic to the French e.g., French athletes, politicians, and battles. 10 Development of the Sacramento Assessment of Confabulation (SAC) Modeled after Dalla Barba s questionnaire Research Questions: Can we quantify confabulation beyond does it/doesn t do it? Do normal people score normally and differently than those with TBI? If we can quantify it, what are the consequences for treatment of people with TBI (and possibly others)? If we can quantify it, is there a relationship between confabulation severity and cognitive impairment severity? 11 Issues with the Truth Wait, those weren t lies; they were just innuendo! 12 4

5 From SAC: When did the Vietnam War Start? You got me, Doc I think the US got involved in the 50s or 60s, but that was about the time of the A-bomb Scoring scheme 1 = assumed accurate (with or without elaboration) or plausible or refusal to answer ( I don t know ) 2 = possibly accurate, but includes inaccuracy, exaggeration, or elaboration that obscures the truth 3 = confabulation 14 For Example: When Did The Vietnam War Start? You got me, Doc (1) I think the US got involved in the 50s or 60s, but that was about the time of the A-bomb (2) 1910 (3) 15 5

6 Another Example: What happened December 7, 1941? I don t know (1) Pearl Harbor (1) People were getting ready for Christmas (2) I m gonna say there was a fire. (3) 16 Is This Confabulation? 17 Why the SAC? To establish whether confabulation can be considered on a continuum To determine whether confabulation has potential as a measure in recovery To add precision to our description of confabulation To determine one s willingness to not know 18 6

7 Categories of Questions Personal semantic Orientation (to time and place) General Semantic Memory 19 Personal Semantic Examples Have you ever had a head injury? If so, please tell me about it. 20 Orientation What is the day of the week? What is the date? 21 7

8 General Semantic When did the Vietnam War start? What happened December 7, 1941? What happened September 11, 2001? 22 To whom did we administer this? Normal individuals (n = 90) Mean age 34.6 s.d.; 18.3 Males = 58; Females = 32 Individuals with TBI (n = 31) Mean age 39.9 s.d F =.89 (n.s.) Males = 32; Females = 9 F = 2.06 (n.s.) 23 How did they do? Group Mean SAC Score* SD TBI Dementia Control 10.40*.93 (F = 61.93; df = 2, 143; p =.000) *Control group significantly lower than TBI, Dementia groups 24 8

9 SAC scores by Group 25 Do normal people score normally and differently than those with TBI? Answer: Yes, significantly better, and a mean of 10.4 (10 is a perfect score, and 30 is the worst possible) 26 How did they do by Rancho Level? 27 9

10 Consequences for treatment Reinforcing I don t know or even I don t know, but Rating confidence of assertions/statements 28 Case Study Dr. C, a 63 year-old professor, collapsed in 1998 while giving a lecture. CT scans revealed an aneurysm hemorrhage involving the right frontal lobe and medial portion of the left frontal lobe. Dr. C did not have aphasia, but frequently confabulated, with severe episodic memory deficits. Dr. C s wife participated in therapy. 29 Therapy Questions Therapy Questions We asked Dr. C some questions during every therapy session (19 sessions) Hypothesis: since Dr. C has answered a question (i.e., has "heard himself speak"), he may have more confidence in his correct answers than his incorrect ones. Hypothesis: if a person (his wife) is there to verify the accuracy of his responses, his confidence might be more closely aligned with the truth that is, he might begin to question his confabulations

11 Treatment Paradigm Ask question (to Dr. C) that could be verified by Ms. C After he gave his answer, asked him how confident (1-10) he was that it was correct Ms. C verified accuracy We discussed it and the option of I don t know or I m not sure Next question 31 Example Larry: Tell me the name of one person you spoke to yesterday other than Ms. C. Dr. C: I spoke with Bill Clinton. Larry: Okay, how confident are you that you spoke with Bill Clinton? Dr. C: Well, he was pretty elusive, so hmm. I guess I d say about a 5. [conferred in session with Ms. C, who verified that he had not spoken with Bill Clinton] Larry: Dr. C, if I ask you who you ve spoken to, it s okay to take your time, or that you can t remember. In fact, do you remember someone you spoke to yesterday? Dr. C: No, not really. Larry: Yeah, that s more like it. Okay let s move on Correct Answer Responses across 19 Sessions How Confident Are You That Your Answer is Correct? (Data for Correct Answers Only) Confidence Linear (Confidence)

12 10 Incorrect Answer Responses Across 19 Sessions How Confident Are You That Your Answer is Correct? (Data for Incorrect Answers Only) 9 8 Confidence Linear (Confidence) Remaining Questions Does confabulation decrease on the SAC longitudinally/with progress in memory? Does confabulation decrease on the SAC longitudinally/with progress in cognitive status? What if we gave the SAC to Dr. C pre- and post-treatment? 35 Remaining Questions Remaining Questions What does this mean about our tentative operational definition about confabulation? the unintentional verbalization incongruous with the present situation (Dalla Barba, 1993) If it s entirely unintentional, how do we explain that Dr. C had less confidence in his incorrect answers? 36 12

13 Out On a Limb, But Could confabulation, as used here, be used to more precisely measure severity of cognitive-communicative impairment? We ll see what happens longitudinally We need more data comparing SAC scores with other relevant measures (e.g., Rancho, WMS, etc.) References Ackil, J. & Zaragoza, M. (1998). Memorial consequences of forced confabulation: Age differences in susceptibility to false memories. Developmental Psychology, 34, Benson, D., Djenderedjian, A., Miller, B., Pachana, N., Chang, L., Itti, L., Eng, G., & Mena, I. (1995). Neural basis of confabulation. Neurology, 46, Clare, I. & Gudjonsson G. (1993). Interrogative suggestibility, confabulation, and acquiescence in people with mild learning disabilities (mental handicap): Implications for reliability during police interrogations. British Journal of Clinical Psychology, 32, Dalla Barba, G. (1993a). Confabulation: Knowledge and recollective experience. Cognitive Neuropsychology, 10, Dalla Barba, G. (1993b). Different patterns of confabulation. Cortex, 29,

14 References Dalla Barba, G. (1999). Confabulation and temporality. In L.-G. Nilson. & H. J. Markowitsch (Eds.), Cognitive neuroscience of memory (pp ). Seattle, WA: Hogrefe & Humber. Dalla Barba, G., Cipolotti, L. et al. (1990). Autobiographical memory loss and confabulation in Korsakoff's syndrome: A case report. Cortex, 26. Dalla Barba, G., Mantovan, M., Cappelletti, J.Y., & Denes, G. (1998). Temporal gradient in confabulation. Cortex, 34, ). Dayus, B., & van den Broek, M. (2000). Treatment of stable delusional confabulations using self-monitoring training. Neuropsychological Rehabilitation, 10, DeLuca, J. & Cicerone, K.. (1991). Confabulation following aneurysm of the anterior communicating artery. Cortex, 27, DeLuca, J. (1992). Cognitive dysfunction after aneurysm of the anterior communicating artery. Journal of Clinical and Experimental Neuropsychology, 14, References DeLuca, J. (1993). Predicting neurobehavioral patterns following anterior communicating artery aneurysm. Cortex, 29, DeLuca, J. & Diamond, B. (1995). Aneurysm of the anterior communicating artery: A review of neuroanatomical and neuropsychological sequelae. Journal of Clinical and Experimental Neuropsychology, 17, DeLuca, J. & Locker, R. (1996). Cognitive rehabilitation following anterior communicating artery aneurysm bleeding: A Case report. Disability and Rehabilitation, 18, Fischer, R., Alexander, M., D Esposito, M., & Otto, R. (1995). Neuropsychological and neuroanatomical correlates of confabulation. Journal of Clinical and Experimental Neuropsychology, 17, Gudjonsson, G. (1984). A new scale of interrogative suggestibility. Personality and Individual Differences, 5, Gudjonsson, G. (1987). A parallel form of the Gudjonsson Suggestibility Scale. British. Journal of Clinical Psychology, 26, References Gudjonsson, G. & Clare, I. (1995). The relationship between confabulation and intellectual ability, memory, interrogative suggestibility and acquiescence. 19, Personality and Individual Differences, 19, Gudjonsson, G. & Sigurdsson, J. (1996). The relationship of confabulation to the memory, intelligence, suggestibilty and personality of prison inmates. Applied Cognitive Psychology, 10, Johnson, M., Hashtroudi, S. & Lindsay, D.S. (1993). Source monitoring. Psychological Bulletin, 114, Johnson, M., O'Connor, M. & Cantor, J. (1997). Confabulation, memory deficits, and frontal dysfunction. Brain and Cognition, 34,

15 References Jorn, M. & Rybarczyk, B. (1995). Interpreting the confabulations of geriatric medical inpatients: Two case studies. Clinical Gerontologist, 16, Joseph, R. (1999). Frontal lobe psychopathology: Mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia. Psychiatry: Interpersonal and Biological Processes, 62, Kapur, N. & Coughlan, A. (1980). Confabulation and frontal lobe dysfunction. Journal of Neurology, Neurosurgery and Psychiatry, 43, References Kassin, S. & Kiechel, K. (1996). The social psychology of false confessions: Compliance, internalization, and confabulation. Psychological Science, 7, Kopelman, M. (1987). Two types of confabulation. Journal of Neurology, Neurosurgery, and Psychiatry, 50, Kopelman, M., Ng, N., & Van den Brouke, O. (1997). Confabulation extending across episodic, personal, and general semantic memory. Cognitive Neuropsychology, 14, Kramer, S., Bryan, K. & Frith, C. (1998). 'Confabulation' in narrative discourse by schizophrenic patients. International Journal of Language & Communication Disorders, 33, References Lu, L., Barrett, A., Schwartz, R., Cibula, J., Gilmore, R., Uthman, B., & Heilman, K. (1997). Anosognosia and confabulation during the Wada test. Neurology, 49, Moscovitch, M. & Melo, B. (1997). Strategic retrieval and the frontal lobes: Evidence from confabulation and amnesia. Neuropsychologia, 35, Myers, P.S. (1999). Right hemisphere damage: Disorders of communication and cognition. San Diego, CA: Singular, p Papagno, C. & Baddelley, A. (1997). Confabulation in a dysexecutive patient: Implication for models of retrieval. Cortex, 33,

16 References Parkin, A.J. (1987). Memory & amnesia: An introduction. New York: Basil Blackwell. p Ptak, R., Birtoli, B., Imboden, H., Hauser, C., Weis, J. & Schnider, A. (2001). Hypothalamic amnesia with spontaneous confabulations: A clinicipathologic study. Neurology, 56, Schnider, A. (2000). Spontaneous confabulations, disorientation, and the processing of 'now'. Neuropsychologia, 38, Schnider, A., Ptak, R., von Kaniken, C., & Remonda, L. (2000). Recovery from spontaneous confabulations parallels recovery of temporal confusion in memory. Neurology, 55, Schnider, A., von Daniken, C. & Gutbrod, K. (1996). The mechanisms of spontaneous and provoked confabulations. Brain, 119, Smith, P. & Gudjonsson, G. (1995). Confabulation among forensic inpatients and its relationship with memory, suggestibility, compliance, anxiety, and self-esteem. Personality and Individual Differences, 19, References Stuss, D., Alexander, M., Liberman,A., & Levine, H. (1978). An extraordinary form of confabulation. Neurology, 28, Weinstein, E. (1996). Symbolic aspects of confabulation following brain injury: Influence of premorbid personality. Bulletin of the Menninger Clinic, 60, Wells, G. & Bradfield, A. (1998). "Good, you identified the suspect": Feedback to eyewitnesses distorts their reports of the witnessing experience. Journal of Applied Psychology, 83, Wertz, R.T. (1984). Language disorders in adults: State of the clinical art. In A.L. Holland (Ed.). Language disorders in adults: Recent advances. San Diego, CA: College-Hill Press, Pp Zaragoza, M., Payment, K., Ackil, J., Drivdahl, S. & Beck, M. (2001). Interviewing witnesses: Forced confabulation and confirmatory feedback increase false memories. Psychological Science, 12,