Korsakoff's syndrome

Disease/Disorder

Anatomy or system affected: Brain

Definition: Korsakoff's syndrome is a neurological condition involving disturbances in the ability to form short-term memories, often resulting in confabulation and psychosis, and is attributable to deficiencies in thiamine often associated with chronic alcohol use.

Key terms:

alcohol dependence: a substance use disorder where alcohol consumption leads to a sustained pattern of significant problems involving alcohol tolerance and/or withdrawal and which may impair health, relationships, or other functioning

alcohol-related dementia: a chronic condition of overall deterioration in all mental functions, such as memory, concentration, judgment, and which may involve personality change and mood problems, that is attributable to alcohol-related behavior

confabulation: verbal behavior reflecting that a person is making up a story to replace facts or information they do not recall or otherwise remember

intoxication: the condition of having consumed a drug and being under its influence to the point of experiencing a range of reactions from excitement to stupefaction

long-term memory: information stored in the mind and that refers to knowledge, experiences, thoughts, and perceptions over lengthier periods of time

psychosis: a mental state, that may be brief or lengthy, where a person has a loss of contact with reality, sees or hears or otherwise experiences things that are not truly present, and suffers from impaired social, emotional, and/or mental functioning

short-term memory: information stored in the mind that refers to knowledge, experiences, thoughts, and perceptions that may have just occurred recently

thiamine: a nutritional substance known as vitamin B1 derived from food sources like meats, yeasts, and the bran of grain, that is necessary for normal neurological activity and carbohydrate metabolism

Wernicke's encephalopathy: a condition associated with Korsakoff's syndrome characterized by confusion, problems of muscle coordination, and visual problems

Causes and Symptoms

Individuals are recognized as having Korsakoff's syndrome when they appear to be confused and have memory loss as well as short-term memory problems, such as difficulty forming new memories. They may think it is the wrong year, for example, ten years earlier than the present day. They may not understand why someone they know suddenly looks so old, because in their mind it is ten years ago and the person should still look as they did then. Individuals with Korsakoff's syndrome may have memory loss. Individuals with this syndrome also often tell stories that sound perfectly rational to them and uninformed observers, but are complete fabrications. Confabulation is the term used to describe the process of telling such stories. In the absence of being able to recall the actual detail of certain memories, the individual will make up stories or segments of stories to fill in the blanks. This is not necessarily willful lying to cover up a failure to remember something. Instead, the person often fails to recognize that they have made up a story. This can in turn lead to more confusion and, as the condition worsens, to psychosis. Individuals with Korsakoff's syndrome may also have hallucinations and perceive objects and people who are not really there.

The cause of this syndrome is attributable to thiamine deficiency. Often this can happen with unusual eating habits, problems with the body absorbing thiamine (as can occur after certain illnesses or surgeries to the gastrointestinal system), or a diet deficient in thiamine. Individuals with alcohol dependence sometimes will fail to eat properly and consequently suffer nutritionally. Lack of thiamine in the diet can result in Korsakoff's syndrome. Thiamine deficiency can also occur as a result of AIDS, cancer, hyperemesis gravidarum, long-term IV therapy, long-term dialysis, and thyrotoxicosis.

Korsakoff's syndrome often occurs in conjunction with another disorder called Wernicke's encephalopathy. It is a separate condition, but the two occur so frequently together that they are known as Wernicke-Korsakoff syndrome. This combination of problems is associated with severe and chronic alcohol dependence. The typical presentation is that the symptoms of Wernicke's encephalopathy will present first and then disappear before they are followed by Korsakoff's syndrome, which is chronic.

Treatment and Therapy

The treatment for Korsakoff's syndrome generally begins with a thorough assessment of the symptoms presenting. There are many conditions that involve memory problems. Additionally, there are other health and mental health issues that can complicate the interpretation of memory issues. Thorough evaluation is the first step in any good treatment regimen. An examination of the nervous system and muscular system may reveal abnormal eye movement, abnormal or decreased reflexes, rapid heart rate, low blood pressure and body temperature, muscle weakness and atrophy, and problems with coordination and gait. Individuals suspected of having Korsakoff's syndrome can have lab tests to check their general nutrition and serum thiamine levels, as well as their liver enzyme levels.

Once the condition is identified, treatment relies on the replenishment of thiamine to the body. It is also necessary to keep the affected individual out of harm until they are stabilized and confusion and psychosis are minimized. Treatment efforts also will focus on decreasing any behaviors or conditions that may predispose an individual to be unable to consume or properly metabolize thiamine.

Shots of B1 vitamins are common and may reverse some of the symptoms, such as problems with coordination or vision. Memory may also improve if the condition has not yet become chronic. When chronic alcohol problems are present, however, often by the time the syndrome is discovered, memory problems can be permanent. As such, early attention to keeping a well-balanced diet is critical in individuals identified as being at risk for chronic alcohol problems to avoid Korsakoff's syndrome.

Perspective and Prospects

Historically discussed as Wernicke-Korsakoff syndrome, these conditions that often occur together in individuals with alcohol-related problems are now more appropriately discussed separately as Korsakoff's syndrome and Wernicke's encephalopathy. This is partly because additional associations have been drawn between each of these disorders and other conditions and causes. Korsakoff's syndrome also is associated with other problems resulting from thiamine deficiencies. One example in this regard is surgeries that remove sections of the gastrointestinal tract. Such surgeries may diminish the ability of the body to absorb varied vitamins, including thiamine, and result in Korsakoff's syndrome. Additionally, treatment professionals understand that high levels of glucose can trigger Wernicke's encephalopathy in individuals at risk. As such, a common practice now is to first administer thiamine to avoid triggering these additional symptoms. Future work on these problems is likely to focus on increasing methods of identifying individuals at risk for these problems, improving prevention efforts to stave off the problems, and improving therapies related to mitigating long-term memory loss.

Bibliography

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Campellone, Joseph V. "Wernicke-Korsakoff Syndrome." MedlinePlus. US Natl. Lib. of Medicine, Natl. Inst. of Health, 14 Feb. 2014. Web. 18 Mar. 2015.

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Schildkrout, Barbara. Masquerading Symptoms: Uncovering Physical Illnesses that Present as Psychological Symptoms. Hoboken, NJ: Wiley, 2013.

"Thiamine (Vitamin B1)." MedlinePlus. US Natl. Lib. of Medicine, Natl. Inst. of Health, 23 Oct. 2014. Web. 18 Mar. 2015.