Social Facade and Confabulation

When we are supporting a person living with Dementia, we often identify that they seem to be ‘better’ than they really are. There is a reason for this and, it is called a ‘social façade’.

A social façade is when the person with Dementia talks or behaves as though they do not have Dementia, often this is something that happens with people outside of their immediate family or carer. For example, a visitor to the home may be told by the person with Dementia that they have been out for lunch with a friend. To the visitor, this is plausible and believable. However, the carer knows that this is not what has happened. In situations like this, the person with Dementia is not being deliberately deceptive.

• The person with Dementia will often be able to present really well compared to what their carer says. This is called the ‘social façade’ and it is a self-preservation mechanism. The brain is trying to fill in the gaps where information is missing so, it will often pick the most logical information (which does not always seem the most logical to us). It is not being done consciously.
• Sometimes we think that the person with Dementia is ‘lying’ to us. This is called ‘confabulation’ and is the brain trying to compensate for the gaps in knowledge or understanding. It is not being done on purpose.
• On a good day someone’s memory may seem good (see the bookcase below on how the brain stores memories), we can say the brain picked up all the right books, but on a bad day the books maybe in a muddle or from a different shelf completely.
• Memories can come from different senses for example if you smell fresh baked bread, it may remind you of someone you knew who baked a lot. The smell of fish and chips might remind you of the seaside.
• Hearing music can remind us of a person, place or a different time in our life. This is where, in the bookcase of memories, you have the emotional memory bringing up the factual part of that memory. With someone with dementia that may not always work but, if it brings good emotional memory then that is what is important.

The bookcase shows that books can be picked up and put in the wrong place and when we talk to people the brain will unconsciously pick up a book to fill in the gap. In doing this if they were talking to someone new, the brain can pick up a book and it can come across that they doing very well, however if it is someone very close to the person the brain may not feel the need to pick up a book from the hippocampus to fill in the gap, so then all you have is the amygdala, the emotional memory, and as there is no facts or reason being filling in the gap it can leave the person very anxious and frustrated with raw emotion which can be very overwhelming for them. This can be difficult for the carer to understand. However, it is important to remember that when the person with Dementia appears ‘less able’ with their carer, it may be because they are more comfortable with them, so their brain doesn’t try so hard to fill in the gaps. When the brain is trying to fill in gaps, it is important to remember that this can rarely be sustained for long.

Challenging a person with Dementia who is presenting a social façade or confabulating, is not helpful. It is important that we join people with Dementia in their reality instead of trying to drag them into ours.

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