Assessment of confabulation in patients with alcohol-related cognitive disorders: The Nijmegen-Venray Confabulation List (NVCL-20)

OBJECTIVE: Even though the first awareness of confabulations is often based on observations, only questionnaires and structured interviews quantifying provoked confabulations are available. So far, no tools have been developed to measure spontaneous confabulation. This study describes and validates an observation scale for quantifying confabulation behavior, including spontaneous confabulations, in clinical practice. METHOD: An observation scale consisting of 20 items was developed, the Nijmegen-Venray Confabulation List-20 (NVCL-20). This scale covers spontaneous confabulation, provoked confabulation, and memory and orientation. Professional caregivers completed the NVCL-20 for 28 Korsakoff (KS) patients and 24 cognitively impaired chronic alcoholics (ALC). Their ratings were related to the Dalla Barba Confabulation Battery (DBCB), Provoked Confabulation Test (PCT), and standard neuropsychological tests. RESULTS: The categories of the NVCL-20 have "good" to "excellent" internal consistency and inter-rater agreement. The KS patients confabulated more (both spontaneously and provoked), and more memory and orientation problems were observed. Correlations with neuropsychological test scores showed that confabulations were associated with memory deficits, but not with intrusions or tests of executive dysfunction. CONCLUSIONS: The NVCL-20 is the first instrument that includes items addressing spontaneous confabulation. Administration is reliable, valid and feasible in clinical practice, making it a useful addition to existing confabulating measures

Association of pneumothorax and hypotension with intraventricular haemorrhage.

To test the hypothesis that acute hypotension resulting from pneumothorax would be associated with severe brain injury (grade 3 or 4 intraventricular haemorrhage), 67 very low birthweight (VLBW) infants of 32 weeks' gestation or less with respiratory distress syndrome and pneumothorax were studied. Thirty six had pneumothorax associated with systemic hypotension and 31 had pneumothorax with normal blood pressure. The groups were similar in gestational age and severity of their respiratory distress syndrome. Thirty two of 36 of infants with pneumothorax associated with hypotension (89%) had grade 3 or 4 intraventricular haemorrhage. This percentage was significantly greater than the percentage for infants with pneumothorax and normal blood pressure (three of 31, 10%). The risk ratio for grade 3 or 4 intraventricular haemorrhage for infants with pneumothorax associated with hypotension was 9.8 compared with neonates with pneumothorax and normal blood pressure. These observations are consistent with the hypothesis that systemic hypotension and cerebral hypoperfusion are important factors leading to intraventricular haemorrhage in VLBW infants