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With regard to the analysis of confabulations, it would seem that confusion has arisen from mixing up levels of inquiry: phenomenology, neurobiology, disease associations, aetiological speculation and even pragmatics. At a most general level, 'confabulations' should be considered as sharing a conceptual space with delusions, mythomania, 'pseudologia fantastica' and 'pathological lying'. Two phenomena are conventionally included under the name 'confabulation'. The first type concerns 'untrue' utterances of subjects with memory impairment; often provoked or elicited by the interviewer, these confabulations are accompanied by little conviction and are believed by most clinicians to be caused by the (conscious or unconscious) need to 'cover up' for some memory deficit. Researchers wanting to escape the 'intentionality' dilemma have made use of additional factors such as presence of frontal lobe pathology, dysexecutive syndrome, difficulty with the temporal dating of memories leading to an inability temporally to string out memory data, etc.
This chapter concentrates on the issue of insight and memory function. Both awareness of memory dysfunction and awareness of memory function have been studied in relation to focal brain disease and generalized brain disease (dementias). With respect to 'normal' or non-ill subjects, self-reports of memory function have been treated mainly in experimental psychology where, rather than 'insight' or 'awareness', somewhat different frameworks are used. With respect to stage of the dementia, most studies suggest that insight is preserved early in the disease and diminishes with progression of the disease. In line with 'neurological' research, where associations have been described between 'anosognosia' and frontal lobe pathology attempts have been made to examine the role of the frontal lobe in the relationship between loss of insight and dementia. The different conceptualizations of insight influence the way in which the 'clinical' phenomena of insight/awareness and anosognosia are perceived and measured.
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