Spontaneous confabulation and the adaptation of thought to ongoing reality

Confabulation - the production of fictitious stories - has puzzled clinicians for over a century. Recent studies have singled out spontaneous confabulations as a distinct disorder that is characterized by an inability to adapt thought and behaviour to ongoing reality, so that patients act according to presently inappropriate memories. Lesions that lead people to confabulate always involve anterior limbic structures. Studies on healthy subjects and on patients with lesions of this type indicate that the orbitofrontal cortex, through subcortical connections, suppresses presently irrelevant memories even before their content is consciously recognized. The studies indicate that the monitoring of ongoing reality in thought might be a capacity of the brain's reward system.