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 validate an observation scale for quantifying confabulations, including spontaneous confabulations, in clinical practice. Method: An observation scale consisting of 20 items was developed, the Nijmegen-Venray

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... onfabulation 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 confabulated more (spontaneously and provoked), and more problems in memory and orientation were observed. Correlations with neurological test scores showed that confabulations were associated with memory deficits, but not with intrusions and executive dysfunction on the tests used in this study. 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 an useful addition to existing confabulating measures.