Neuropsychological Rehabilitation

An International Journal

ISSN: 0960-2011 (Print) 1464-0694 (Online) Journal homepage: http://www.tandfonline.com/loi/pnrh20

The confabulation battery: Instructions and

international data from normal participants

Gianfranco Dalla Barba, Barbara Guerin, Marta Brazzarola, Sara Marangoni,

Claudia Barbera & Valentina La Corte

To cite this article: Gianfranco Dalla Barba, Barbara Guerin, Marta Brazzarola, Sara
Marangoni, Claudia Barbera & Valentina La Corte (2018): The confabulation battery: Instructions
and international data from normal participants, Neuropsychological Rehabilitation, DOI:
10.1080/09602011.2018.1436446

To link to this article: https://doi.org/10.1080/09602011.2018.1436446

Published online: 21 Feb 2018.

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NEUROPSYCHOLOGICAL REHABILITATION, 2018
https://doi.org/10.1080/09602011.2018.1436446

The confabulation battery: Instructions and international

data from normal participants
Gianfranco Dalla Barbaa,b,c, Barbara Guerind, Marta Brazzarolae,
Sara Marangonie, Claudia Barberae and Valentina La Corteb,f,g
a
INSERM, Paris, France; bDépartement de Neurologie, Institut de la Mémoire et de la Maladie
d’Alzheimer (IM2A), Hôpital de la Pitié-Salpêtrière, Sorbonne Universités, Université Pierre et Marie
Curie-Paris6, Paris, France; cDipartimento di Scienze della Vita, Università degli Studi di Trieste, Italy;
d
Centre de Recherche de l’Institut du Cerveau et de la Moelle Epinière, Université Pierre et Marie
Curie-Paris6, Inserm U975, Paris, France; eCentro Medico di Foniatria, Padua, Italy; fInstitut of
Psychology, Université Paris Descartes, Paris, France; gCenter of Psychiatry and Neurosciences,
INSERM UMR 894, Memory and Cognition Laboratory, Paris, France

ABSTRACT
Confabulation is an unusual sign in neurological and in neuropsychological
pathologies. In this article we present an objective neuropsychological instrument,
the Confabulation Battery (CB), which allows the quantifying and qualifying of
different types of confabulations. The CB was administered to French and Italian
normal participants. Data from the present study will allow clinicians and
researchers, using the CB, to know how much and in which memory domains their
confabulating patients confabulate compared to normal participants. We present
international data, instructions and guidelines for the CB, a tool used in different
ways worldwide. Not quantifying confabulations, namely not reporting how much
and in which domain patients confabulate, can hardly lead to conclusions on the
neurocognitive bases of this phenomenon. Following the instructions in this article,
versions of the CB can be adapted in different languages and cultures.
Quantification and qualification of confabulation is necessary and demanded in
order to compare sensibly data from different research and clinical groups.

ARTICLE HISTORY Received 3 October 2017; Accepted 30 January 2018

KEYWORDS Confabulation; Memory; Amnesia; Alzheimer’s disease; Confabulation Battery; Memory distortion.

Introduction
The Confabulation Battery (CB) measures confabulations, but should not be considered
and used to assess memory performance. It was designed in 1993 (Dalla Barba, 1993a)
and then expanded in 2009 (Dalla Barba & Decaix, 2009) with the specific aim of quan-
tifying and qualifying confabulations in confabulating patients. Since then several ver-
sions of the CB have circulated and used in different ways worldwide.
Confabulation is an unusual sign in neurological and in neuropsychological pathol-
ogies. The clinical and scientific interest for this phenomenon has a long although

CONTACT Gianfranco Dalla Barba gianfranco.dallabarba@upmc.fr; gdallabarba@me.com Institut de la

Mémoire et de la Maladie d’Alzheimer Hôpital de la Salpêtrière, 47, bd de l’Hôpital, Paris 75013, France
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 G. DALLA BARBA ET AL.

sparse history. It has been described by Korsakoff (1889) as a pathognomonic sign of the
syndrome that takes his name. Thereafter a number of studies have described confabu-
lations in several pathologies (Baddeley & Wilson, 1986; Kapur & Coughlan, 1980; Lhen-
nitte & Signoret, 1976; Luria, 1976; Stuss, Alexander, Lieberman, & Levine, 1978; Wyke &
Warrington, 1960). Overall there is an almost general agreement that confirmed or sus-
pected damage to the frontal lobe and related structures is frequently associated to
confabulations. However, some studies reported on confabulating patients not
showing frontal, executive impairment (e.g., Dalla Barba, 1993a; Dalla Barba, Boissé, Bar-
tolomeo, & Bachoud-Lévi, 1997; Dalla Barba, Nedjam, & Devouche, 2004).
In his seminal paper Kopelman (1987), following Berlyne (1972) and Bonhoeffer
(1904), distinguished between provoked and spontaneous confabulations and since
the interest for confabulation has progressively increased.
In Kopelman’s view, provoked confabulation, which are plausible memories, may
reflect a normal response to a faulty memory, which reminds Bleuler’s description of
“confabulations of embarrassment” (Verlegenheit Konfabulationen) (Bleuler, 1949),
whereas spontaneous confabulations may reflect “an extremely incoherent and
context-free retrieval of memories and associations” (Kopelman, 1987, p. 1482).
However, the distinction between provoked and spontaneous confabulation may
capture the endpoints of a spectrum in which both types of confabulations are
observed. Patients have been observed in which provoked confabulations were
bizarre and spontaneous confabulations were plausible (Dalla Barba, 1993a,1993b;
Dalla Barba, Boissé, et al., 1997).
In recent years a number of studies has investigated confabulations using different
methods and measures, and providing different neurocognitive interpretations of this
phenomenon (e.g., Bajo, Fleminger, Metcalfe, & Kopelman, 2017; Fotopoulou,
Conway, & Solms, 2007; Gilboa & Moscovitch, 2017; Kopelman, Ng, & Van Den
Brouke, 1997; Schnider & Ptak, 1999; Spitzer, White, Mandy, & Burgess, 2017). Trans-
lations or adaptations of the CB have been used in some of these studies. One of the
aims of this study is to quantify confabulations and to qualify its content with the CB
in normal participants. Data from the present study will allow clinicians and researchers,
using the CB, to know how much, in which memory domains and which type of confa-
bulation their confabulating patients produce compared to normal participants. Not
quantifying and qualifying confabulations, namely not reporting how much, in which
memory domain and which type of confabulations patients produce, can hardly lead
to conclusions on neurocognitive bases of this phenomenon. It is as if conclusions on
the nature of anomia would be drawn comparing patients with one or two anomias
in spontaneous speech with patients with amnestic aphasia. Severe confabulators
may have different cognitive profiles and different brain lesions compared to mild con-
fabulators. Therefore, quantifying and qualifying confabulations may provide useful
information to researchers and objective measures of confabulations to clinicians,
which are particularly useful to clinicians involved in rehabilitation. Indeed a quantitat-
ive and a qualitative assessment of confabulations in different memory domains could
be complementary to the classical assessment of memory, allowing for a full evaluation
of different expressions of memory deficits.
It is patent that the CB measures provoked confabulations, since it is a set of ques-
tions directly addressed to the subject. But, in our experience, we have never observed
patients who confabulate at the CB and who do not confabulate spontaneously. There
are some cases reported in which spontaneous confabulators do not produce provoked
 NEUROPSYCHOLOGICAL REHABILITATION 3

confabulations (Schnider, von Däniken, & Gutbrod, 1996). However, in these cases pro-
voked confabulations are referred to as intrusions in the California Verbal Learning Test
(Delis, Kramer, Kaplan, & Ober, 1987). Intrusions in word list recall are a quite different
phenomenon compared to confabulatory answers to specific questions. It is difficult
to think that a patient who spontaneously confabulates saying that she has to go to
feed her baby (her son is actually over 30; Schnider, von Däniken, & Gutbrod, 1996)
would not confabulate to the specific question “What are you going to do next?”
A number of “home-made” versions of the CB are circulating and used in many
countries. Another aim of this study is to provide administration and scoring instruc-
tions, so that different versions of the CB can be constructed in different languages
and adapted to different cultures.

The Confabulation Battery (CB)

Description
The CB is a tool specifically designed for evaluating the quantity and the quality of con-
fabulations in different domains of memory and orientation and the ability to predict
personal and impersonal future. The CB is not a memory test and, accordingly, it
should not be used for the diagnosis of memory disorders, or to evaluate the severity
of these disorders. The CB consists of 165 questions, 15 for each of the following
domains:

1. Personal Semantic Memory (PSM). For example, “Are your parents alive?”
2. Episodic Memory (EM). Episodic autobiographical questions.
3. Orientation in Time and Place (OTP).
4. Linguistic Semantic Memory (LSM). Items 16–30 of the Wechsler Adult Intelligence
Scale vocabulary subtest were selected for a word definition task.
5. Recent General Semantic Memory (RGSM). Knowledge of facts and people, which
have been repeatedly reported in the news during the last 10 years. For
example, “Who is Bin Laden?”
6. Contemporary General Semantic Memory (CGSM). Knowledge of famous facts and
famous people from 1940 to 1990. For example, “What happened in Paris in May
1968?”
7. Historical General Semantic Memory (HGSM). Knowledge of famous facts and
famous people before 1900. For example, “What happened in 1789?”
8. Semantic Plans (SP). Knowledge of issues and events likely to happen in the next 10
years. For example, “Can you tell me what you think will be the most important
medical breakthrough in the next 10 years?”
9. Episodic Plans (EP). For example, “What are you going to do tomorrow?”
10. “I don’t know” Semantic (IDKS). These are questions tapping semantic knowledge
and constructed so as to receive the response “I don’t know” from normal subjects.
For example, “What did Marilyn Monroe father do?”
11. “I don’t know” Episodic (IDKE). These are questions tapping episodic memory and
constructed as to receive the response ‘I don’t know’ by normal subjects. For
example do you remember what you did on March 13, 1985?”
4 G. DALLA BARBA ET AL.

Rationale for the construction of the CB

The rationale that guided the conception of the CB was to devise a research tool, also
usable in clinic for an accurate assessment, to evaluate the quantity, the selectivity and
the quality of confabulations.

. Quantity. In the literature on confabulation, the quantity of confabulations produced

by confabulators is only occasionally specified. Strong conclusions on mechanisms
involved in confabulation are based on the study of patients or groups of patients
considered as “confabulators” whose quantity of confabulations is quite variable.
The result is that a patient producing one confabulation, although repeated, is con-
sidered a confabulator. It is evident that no conclusions on the neurocognitive bases
of confabulations can be drawn if the studied patients are not matched on the basis
of the quantity of confabulations they produce. Moreover, in clinical neuropsycholo-
gical assessment the presence of confabulations is often only evaluated at qualitative
level during the interview. Therefore, it is necessary to devise a tool able to measure
the quantity of confabulations in general and, more specifically, the quantity of con-
fabulations in each memory domain.
. Selectivity. Confabulations are often selective in the sense that they are more fre-
quently observed in episodic memory, orientation in time and place and in personal
future planning (Dalla Barba, 1993a; Dalla Barba, Cappelletti, Signorini, & Denes, 1997;
Dalla Barba, Marangoni, Barbera, & Zannoni, 2017; Dalla Barba, Nedjam, & Dubois,
1999; La Corte, George, Pradat, & Dalla Barba, 2011; La Corte, George, Pradat-Diehl,
& Dalla Barba, 2016). However, confabulations can extend to other memory and cog-
nitive domains (Bajo et al., 2017; Dalla Barba, 1993b; Kopelman et al., 1997). The neu-
rocognitive mechanisms underlying selective and non-selective confabulations may
be different and it is therefore important to evaluate the possible confabulations’
selectivity.

Confabulators, like normal subjects, confabulate only sporadically to “I don’t know”

questions, showing that confabulation is not a tendency by default to answer any
type of question. The reason for including “I don’t know” questions in the CB is to evalu-
ate this possibility and to detect possible cases of confabulatory hypermnesia (Dalla
Barba & Decaix, 2009), i.e., patients who abundantly confabulate to this type of
questions.

. Quality. With the CB confabulations can be classified according to their content.

Dalla Barba and co-workers analysed the content of 424 confabulations produced
by confabulating amnesiacs and by patients with Alzheimer’s disease (La Corte,
Serra, Boissé, & Dalla Barba, 2010). According to the quality of their content, confabu-
lations have been classified as follows:
○ Habits Confabulations (H, more than 50% of the confabulations produced by the
participants). H confabulations consist of habits considered by the patient as per-
sonal specific episodes. An example of H confabulation is a hospitalised patient,
who, to the question “What did you do yesterday?” answers “I went at work.” In
this case a habit, a routine, a repeated episode is considered as a specific
episode, what the patient has done the previous day.
 NEUROPSYCHOLOGICAL REHABILITATION 5

○ Misplacements (Mis, about 20% of confabulations produced in the study). These

are confabulations consisting of true episodes and facts misplaced in time and
place. For example, “What happened in Nurenberg?” “A trial against the Nazi
four years ago.”
○ Memory Fabrications (MF, about 20% of confabulations produced in the study).
These are plausible memories, semantic or episodic, without any recognisable
link with personal or public events. For example, “What does Chernobyl remind
you?” “A bomb explosion, a massacre.”
○ Memory Confusions (MC, about 15% of confabulations produced in the study).
These are confusions with other personal or public events related to the target
memory or confusion between family members. For example, “Who is Margaret
Thatcher?” I know, she is an actress.”
○ Autoreferential Contaminations (AC, about 10% of confabulations produced in the
study) occur when patients questioned about public or historical events, refer to
the event in a personal context. For example, “Who is Obama?” “He is the President
of the US, he is a good friend, we had dinner together last week.”
○ Semantically Anomalous Confabulations (SA, less than 10% of confabulations pro-
duced in the study) are those confabulations with an extremely bizarre and
semantically anomalous content. For example, “My cousin does osteopathy in
butterflies”.

Classification confabulators/non-confabulators
Based on previous single and group studies on confabulators from Dalla Barba’s group,
patients are considered (Serra et al., 2014):

. Severe confabulators if they produce 40% or more confabulation to EM questions.

. Moderate confabulators if they produce between 30% and 40% of confabulations to
the same questions.
. Mild confabulators if they produce between 15% and 30% of confabulations to the
same questions.
. Non-confabulators if they produce fewer than 15% of confabulations to these
questions.

Administration’s instructions (in inverted commas what is said to the subject).

. General instructions

The administration of the CB starts with the 15 questions concerning OTP followed by
the questions of PSM. The rest of the questions are presented in a randomised order.
Instructions given orally to the participants are in inverted commas.
“With this questionnaire we aim at better understanding different aspects of
memory. That’s why there are different questions concerning different subjects.”
It is important to emphasise that it is not a memory test or a test of general culture or
politics.
6 G. DALLA BARBA ET AL.

“It is normal and expected that you can’t answer some questions, so do not hesitate to answer ‘I
don’t know’ if you do not have a response.”

. Instructions given to the participant before administering the OTP and PSM
questions.
“I’m going to ask you some questions about your present situation and about the place where you
are. Try to respond as precisely and simply as you can.”

One minute is allowed for each response. Record or transcribe the participant’s
responses.

. Instructions given to the participant before question 31.

“The following questions do not have a logical link between them, so you do not have to find a
logic between these questions. Very simply, try to respond in the most detailed and precise way.”

One minute is allowed for each response. The CB requires approximately 120 minutes to
complete. Record or transcribe the participant’s responses. If questions refer to EM,
assure that he/she is referring to a concrete episode and encourage (actions, people,
time of the day, emotions or thoughts associated to this, possibly, specific episode.)

Scoring instructions
Responses are scored as “correct”, “wrong”, “I don’t know”, and “confabulation”. For EM,
responses are scored “correct” when they match information obtained by a relative or
an accompanying person. Correct responses are self-evident for semantic memory
questions. For “I don’t know” questions, both semantic and episodic, an “I don’t
know” response is scored as correct. Since there is no sufficiently acceptable external
criterion capable of defining confabulation, for its detection an arbitrary decision
necessarily is made. In order to distinguish between a wrong response and a confabula-
tion a clear-cut decision is adopted only for answers to questions probing orientation in
time. In this case the most strict criterion was chosen: answers to questions regarding
the current year, season, month, day of the month, day of the week and hour of the
day are judged to be confabulations only if erring for more than five years, one
season, two months, ten days, three days or four hours, respectively. Answers to
other questions of the CB are independently rated as “correct”, “wrong”, and “confabu-
lation” by three different raters. In the following results, interrater reliability was 100%.
This suggests that one rater may be sufficient in clinical practice. It must be emphasised
that the decision as to whether an answer is wrong or confabulatory is never puzzling,
although it is made on an arbitrary or subjective basis. As far as questions concerning
personal and semantic plans are concerned it might be argued that any possible
answer is a confabulation, since, by definition, the future is only “probable” and there
are in principle no “correct” answers to questions about the future. Yet, answers con-
cerning the future can be definitely confabulatory when they show a marked discre-
pancy, or a real contradiction with what a predicted future event might be, in view of
the present situation. For example, although he was hospitalised and despite the fact
that there was not a television in the ward, to the question “What are you going to
do tonight?” a patient answered “I’ll have dinner with my wife and then watch the
news at the television.”
 NEUROPSYCHOLOGICAL REHABILITATION 7

Methods
The CB was administered to 97 French participants [59 female, mean age: 60.1 (stan-
dard deviation, SD = 16.8), range: 26–93, years of education: 14.4 (SD = 3.7), range: 9–
20, all right-handed] and 97 Italian participants [43 female, mean age: 46.7 (SD = 14.1),
range: 25–80, years of education: 13 (SD = 3.9), range: 5–17, all right-handed]. The
French sample included 15 individuals aged between 25 and 40 years (mean =
33.5; SD = 3.9), 16 between 41 and 50 years (mean = 44.8; SD = 2.8), nine between
51 and 60 years (mean = 49.9; SD = 7.3), 28 between 61 and 70 (mean = 67.3; SD =
1.6), 18 between 71 and 80 years (mean = 75.7; SD = 1.6), and 11 between 81 and
93 years (mean = 84.7; SD = 10.4). Thirty-three participants had less than 12 years
of education, 64 had 12 or more years of education. The Italian sample included 47
individuals aged between 25 and 40 years (mean = 32.21; SD = 3.91), six between
41 and 50 years (mean = 44.66; SD = 2.50), 21 between 51 and 60 years (mean =
55.47; SD = 2.79), 14 between 61 and 70 (mean = 65.42; SD = 3.13), nine between
71 and 80 years (mean = 74.88; SD = 3.62). Thirty-eight participants had less than
12 years of education, 59 had 12 or more years of education. As a group, the
French participants were significantly older and more educated than the Italian par-
ticipants. Participants had no history or current evidence of any medical, neurological,
or psychiatric disease. They were also screened for any prior history of serious head
injury, prolonged loss of consciousness, or active use of medications that could
affect cognition or of recreational drugs. The study was conducted in accordance
with the ethical standards laid down in the Declaration of Helsinki (2000) and was
approved by the Ethical Committee Ile de France VI by and the Centro Medico di
Foniatria Review Board.

Statistical analyses
In the statistical analyses the α value was set at 0.05 and the familywise error rate was
controlled with the Bonferroni correction where appropriate.

Results
Participants’ performance in the CB is reported in Figure 1. The French participants pro-
duced significantly more correct responses than the Italian participants (t test) in ques-
tions of EM [F(1,192) = 14.3, p < 0.001], OTP [F(1,192) = 33.6, p < 0.001], CGSM [F(1,192) =
13.4, p < 0.001] and HGSM [F(1,192) = 5.7, p < 0.05]. No significant difference between
the two groups emerged for the number of confabulations produced in each domain
of the CB.
Overall participants produced 645 confabulations (315 and 330 the French and the
Italian sample, respectively). None of the participants produced more than one confa-
bulation in EM questions, therefore, according to our criteria, none of them was even
a mild confabulator. Out of the 165 questions of the CB, none of the participants pro-
duced more than 12 confabulations.
Habit Confabulations were the more frequently observed type of confabulations
(50%), confirming the results of previous studies (Dalla Barba & Boissé, 2010; La Corte
et al., 2010). Memory Confusions, Memory Fabrications and Misplacements accounted
for 26%, 13% and 6%, respectively, of the total number of confabulations.
8 G. DALLA BARBA ET AL.

Figure 1. Performane of French and Italian sample in the Confabulation Battery (CB). Abbreviations : corr =
correct; conf = confabulations; PSM = Personal Semantic Memory; EM = Episodic Memory; OTP = Orientation in
Time and Place; LSM = Linguistic Semantic Memory; RGSM = Recent General Semantic Memory; CGSM = Contem-
porary General Semantic Memory; HGSM = Historical General Semantic Memory; SP = Semantic Plans; EP = Episo-
dic Plans; IDKS = I don’t know Semantic; IDKE = I don’t know Episodic.

Confabulations in different age categories are reported in Table 1. Overall the mean
amount of confabulation is very low (mean range 0–2.6/15). Participants tend to confa-
bulate slightly, but significantly more in “I don’t know” (IDK) questions than in other
domains of the CB (t test; all p < 0.05.)
Table 2 reports confabulations according to different educational categories. Here
also the amount of confabulation is very low (mean range 0–3.1/15), and individuals
tend to confabulate slightly, but significantly more in IDK questions than in other
domains of the CB (t test; all p < 0.05.).

Discussion
Although quantifying confabulations is necessary in order to compare patients or group
of patients matched for the amount of confabulations produced and to draw

Table 1. Mean number of confabulations [and standard deviation (SD)] in different age categories.
Age years (mean; SD)
25–40 41–50 51–60 61–70 71–80 81–93 (87.8;
Domains of the CB (33.5; 3.9) (44.8; 2.8) (51.0; 7.3) (67.3; 1.6) (75.7; 1.6) 10.4)
PSM 0 0 0 0 0 0
EM 1 (0) 0 1 (0) 0 1 (0) 0.5 (0.5)
OTP 0 0 0 1 (0) 0 0
LSM 0 0 0 0 0 0
RGSM 1 (0) 1 (0) 0.8 (0.4) 0 1 (0) 0.8 (0.32)
CGSM 1 (0) 1 (0) 0.8 (0.4) 1 (0) 2 (0) 1 (1)
HGSM 1 (0) 1.2 (0.4) 0.9 (0.2) 1 (0) 2 (1) 1.2 (0.4)
SP 0 0 0 0 1 (0) 0.5 (0.5)
EP 0 0 0 0 1 (0) 0.5 (0.5)
IDKS 1.4 (0.6) 2 (1) 2.3 (1.1) 2.4 (1.3) 2.1 (0.3) 2.0 (0.8)
IDKE 1.6 (0.7) 2.2 (1.9) 3.5 (3.2) 2.3 (1.8) 2.6 (1.6) 1.8 (0.9)
Total mean number of 0.6 (0.6) 0.8 (0.7) 0.8 (1.0) 0.8 (0.8) 1.1 (0.9) 0.7 (0.7)
confabulations
 NEUROPSYCHOLOGICAL REHABILITATION 9

Table 2. Mean number of confabulations [and standard deviation (SD)] in different educational categories.
Years of education
Mean (SD)
Domains of the CB 12.8 (4.1) 13.7 (3.0) 14.8 (1.3) 16.6 (1.9)
PSM 0 0 0 0
EM 1 (0.5) 0 1 (0) 1 (0)
OTP 0 1 (0) 0 1 (0)
LSM 0 1 (0) 0 0
RGSM 1 (0.5) 0.7 (0.3) 1 (0) 1 (0)
CGSM 2.0 (1) 1 (0) 1 (0) 1 (0)
HGSM 1.5 (1) 1 (0) 1.2 (0.3) 1 (0)
SP 0.8 (0.5) 0 0 0
EP 1.7 (0.6) 0 0 0
IDKS 2.1 (0.8) 2.4 (1.2) 2.1 (1.1) 1.7 (0.8)
IDKE 2.2 (1) 3.1 (3.2) 2.2 (1.9) 1.6 (0.7)

hypotheses on this phenomenon, this is only seldom done. The aim of this study was to
provide international data and to describe administration and scoring instructions for
the CB. The CB has been extensively used by our group, showing that it is a good
tool, not only to quantifying, but also to classify different types of confabulations. Differ-
ent versions of the CB are used by different research and clinical groups internationally.
Here a more exhaustive description of the CB than was reported in previous papers is
stated. Following the instructions described in this article, the CB can be constructed
in different languages and adapted to different cultures without losing the power of
the original version of the CB.
We administered a French and an Italian version of the CB to French and Italian par-
ticipants. The French participants were significantly older and more educated than the
Italian participants and committed more correct responses than the Italian participants
in questions of EM, OTP, CGSM and HGSM. While the difference concerning semantic
memory questions may be explained by the difference in age and education, this is
not the case for EM questions and orientation in time and place, which are not affected
by these variables. In spite of these differences, the results show that different versions
of the CB can be constructed safely in different languages and for different cultures.
According to the criteria proposed elsewhere (Serra et al., 2014), none of the individ-
uals participating in this study was an even mild confabulator, since none of them pro-
duced more than two confabulations (15%) to EM questions of the CB. This indicated
that, according to the criteria proposed (Serra et al., 2014), the CB discriminates well con-
fabulators from non-confabulators. In fact, according to these criteria, participants pro-
ducing 15% or fewer confabulations to EM questions are classified as non-confabulators.
Participants in this study produced only a few confabulations. Nevertheless, confabu-
lations they produced were mainly Habits Confabulations. The few confabulations in
this study are driven by routines and habits; participants consider habits, repeated
events and routines as specific and unique episodes of their life. The present results,
together with previous results from our group (Dalla Barba & Boissé, 2010; La Corte
et al., 2010), show that strongly represented information may interfere in episodic
recall when the target EM is, for whatever reason, lacking or inaccessible.
Both the French and the Italian participants produced more confabulations to IDK
questions than to other types of questions. They produced only few confabulations
to these questions, but still more than in other domains. This is possibly due to
10 G. DALLA BARBA ET AL.

individuals’ tendency to find an answer, although the answer is, by definition, unavail-
able. However, this tendency is also observed in confabulating patients, who produce
some confabulations, of the Habits type, like normal subjects, without reaching “confa-
bulatory hypermnesia”, in which confabulations to IDK questions are around 80% (Dalla
Barba & Decaix, 2009). Overall, these observations show that normal participants, like
brain damaged participants, tend to “create” memories when the memories at issue
are unavailable. This is consistent with Kopelman’s definition of provoked confabula-
tions observed in amnesic patients and in normal subjects (Kopelman, 1987). The CB
measures this type together with other types of confabulations, including incoherent
and context free confabulations, e.g., Autoreferential Contaminations and Semantically
Anomalous Confabulations.
The CB not only provides a detailed assessment of confabulation for research pur-
poses. It can be used in treatment and rehabilitation, as our group currently does. Con-
fabulators are very often unaware of their confabulations. Patients’ confabulatory
responses to questions of the CB can be used in rehabilitation by explaining to the
patient and to the caregiver what a confabulation is and which type of confabulation
the patient is producing. One patient, recovering from confabulation, said to one of
the authors of the present article (MB) “I still produce some Misplacement Confabula-
tions”. Recognising confabulatory errors is important in rehabilitation to regain aware-
ness and the CB can be used for this aim.
The CB does not correlate significantly with other psychometric measures, e.g.,
frontal/executive functions (Dalla Barba, 1993a, 1993b; Dalla Barba & La Corte, 2013,
2015; Dalla Barba et al., 1999). Further research is needed to see whether subtypes of
confabulation identified by the CB correlate with other measures of confabulation
and cognitive functions.
In conclusion, here we present data and guidelines for the CB, a tool widely used in
different ways worldwide. Following the instructions in this article, versions of the CB
can be adapted in different languages and cultures. Quantification and qualification
of confabulation is necessary and demanded in order to compare sensibly data from
different research and clinical groups1.

Note
1. The French and Italian versions of the CB are available on request from the first author:
gianfranco.dallabarba@upmc.fr

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This study was partially supported by the “Agence Nationale de la Recherche” [grant number ANR-09-
EMER-006]

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