Strategic retrieval and the frontal lobes: evidence from confabulation and amnesia.

Confabulation and amnesia are considered disorders of episodic but not of semantic memory. To test the limits of this view, retrieval from episodic and semantic memory was investigated in eight confabulating and nine non-confabulating amnesic subjects, and in 17 matched control subjects, by using a personal and an historical version of the Crovitz [Unconstrained search in long-term memory, Paper presented at the meeting of the Psychonomic Society, St Louis, MO, 1973] cue-word test. In response to cue words such as letter or battle subjects had to describe in detail, respectively, a related event from their personal lives or from history before their birth. We found that a subset of amnesic subjects, those with presumed damage or dysfunction in the region of the ventromedial frontal cortex, would confabulate in response to these cues. Their confabulations involved semantic, historical memories, as much as episodic, personal ones: and that distortions of content were at least as common as those of time. Even when not confabulating, they had much more difficulty than other amnesic subjects in recovering memories related to these cues. In confabulating, as compared to non-confabulating, amnesic subjects, prompting led to an increase in confabulations but also to greater recovery of veridical memories. By comparison, non-confabulating amnesic subjects whose memory loss was as severe as that of the confabulators, had a milder deficit on the personal as well as the historical cue-word test. They benefited from prompting somewhat more than matched control subjects. These results suggest that confabulation is associated with impaired strategic retrieval processes resulting from damage in the region of the ventromedial frontal cortex. These strategic retrieval processes help initiate and guide search in episodic and in semantic memory and they help monitor and organize the output from those systems.