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)? |