The Columbia University Scale for Psychopathology in Alzheimer's disease (CUSPAD) was developed as a short, semistructured instrument that can be administered by a clinician or trained lay interviewer to the relatives or caregivers of patients with probable Alzheimer's disease (AD). The components of the scale focus on symptoms of psychosis, behavioral disturbance, and depression. A simple decision-tree approach is used to identify the presence of specific psychotic features and makes it possible for the instrument to be used by trained lay interviewers. Interrater reliability has been established. Use of this scale in a multicenter longitudinal study of patients with mild to moderate AD revealed that agitation was the most common and persistent symptom, depressed mood with vegetative signs was the least common and least persistent, and paranoid delusions and hallucinations showed moderate persistence over time. Besides its established psychometric properties, the strengths of the CUSPAD include its brevity, clarity in assessing psychotic symptoms, and ease of administration. These features make it useful for cross-sectional and longitudinal evaluation of the symptoms of psychopathology in AD. The main disadvantage is the lack of quantitative ratings of severity for many of the components, making it unsuitable for use in psychopharmacologic trials.