Social chit chat and confabulation

Mum was a social person and she was genuinely interested in people and what they had to say.  My friends would say that it was refreshing to meet parents who wanted to know what they were up to, even if they didn’t understand what that was!

This didn’t change with mum’s dementia.  In fact, she became more social and engaging, and she would start a conversation with almost anyone.  She would turn on the social chit chat effortlessly; talking about the weather, what she’d been up to, or what she was going to do, or what her daughters were up to.  These stories were often confabulated, made-up, or facts that had happened many years ago. 

In the early days I used to cringe, try to correct her 'big stories', or apologise on her behalf.  I was embarrassed that my mum would openly tell ‘lies’ to everyone.  Most people who didn’t understand her dementia would believe every word she said.  I clearly remember one of her friends saying to me “I saw your mum in town yesterday and I don’t really think there’s anything wrong with her”.  Mum had managed to ‘pull the wool over her eyes’ very well!  This can be difficult for some families to understand and accept; I always suggest family and friends stay longer than half-an-hour to witness the full extent of a person’s brain changes. 

I learnt to accept mum’s reality, go with her stories, and I would endeavour to indicate to the other person when mum’s stories weren’t true.  This was often done by me gesturing wildly and shaking my head behind mum’s back.  I now wish I had been able to discreetly hand them a card that said “my mum has dementia” as it would have saved a lot of confusion!

In hindsight I now realise that mum’s confabulation, or made-up stories, was her trying to stay relevant, connect with people, and she was following age-old social norms.  How many of us would confess to someone that we don’t remember what we did yesterday, let alone what we are doing tomorrow?  For most of us, social norms will dictate our responses, and people living with dementia are exactly the same.  I remember mum on my wedding day; with utter clarity she understood what the day meant, she knew to thank the celebrant, florist and chef for their amazing jobs, and she accepted congratulations from everyone who spoke to her.  Even in the midst of her moderate dementia, she instinctively knew to follow the social norms of a wedding. 

Research shows that in Alzheimer’s disease the right temporal lobe is preserved longer than the left, and as a result, social cognition and behaviour are relatively retained.   It also plays an important role in understanding non-verbal communication.  This helps to explain why many people living with dementia retain social chit-chat, and seemingly instinctively understand how to react to various social situations.  The right temporal lobe has also been found to be crucial in recognising familiar melodies and rhythm, which explains why mum, even in late-stage dementia, automatically recognised her favourite music and could sing all the words.  And research has found the right temporal lobe to be responsible for swearing and ‘naughty words’.  As a result, a person’s ability to articulate themselves changes and their social filters can disappear.

We tend to focus on what is lost when it comes to dementia, it’s called being human.  Instead, let’s focus on what a person living with dementia retains, accept their confabulation and ‘naughty words’, play their favourite music and be mindful of our non-verbal skills.  By doing so we provide kind and compassionate support and empower them to shine.