Table 1: Items of the Checklist for Cognitive Blackouts (CCB).
|Within the last six months how often did it happen to you that ...|
|(1)||... you wanted to get something from another room and when you
got there you had forgotten what it was that you went there for?
|(2)||... you forgot to keep a date or an appointment or would have
forgotten them without being reminded about it beforehand
(e.g. by a calendar or by others)?
|(3)||... you took a break from reading a book or a text and when
you returned to it you had serious difficulties in recalling
what you had read or picking up where you had left off?
|(4)||... you had to think about what month it is?|
|(5)||... you had significant difficulties finding your way at a place
that was new to you (e.g. in a hotel or locating your car in a
big shopping center's parking lot)?