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Summary
A disorder of brain and mental functions, usually related to alcohol abuse, and caused by a deficiency of Vitamin B1/thiamine.
Alternative names
Korsakoff's psychosis. Also often seen in a combined form, as the Wernicke-Korsakoff syndrome.
What is this?
In the Korsakoff syndrome, there are dominant disturbances of recent memory and a tendency to invent recollections to fill the gaps. In Wernicke's syndrome, the marked thiamine deficiency causes nerve damage, both in the central nervous system and in peripheral nerves elsewhere in the body. These can include abnormalities of eye movement and vision, unco-ordinated and unsteady walking, disordered reflexes and loss of muscle bulk. These two conditions occur together so often, Wernicke's usually coming first, that they are often described as the Wernicke-Korsakoff syndrome.
What causes this?
These syndromes are caused by severe thiamine deficiency, usually related to severe alcoholism, both from malnutrition and self-neglect in the alcoholic (alcohol contains so many calories/kilojoules that alcoholics often neglect nutritional foods) , and because alcohol can interfere with the absorption, storage and use of thiamine in the body. There appears to be damage to very specific parts of the brain resulting in the more specific symptoms. These problems may also be seen in relation to severe eating disorders, too, or to a severe vomiting disorder in pregnancy called hyperemesis gravidarum, or in people receiving dialysis.
What are its symptoms?
Typically these include severe disorder of memory, especially in a failure of the formation of new memories, and confabulation, in which the person seeks to cover up memory lapses by inventing plausible 'memories'. In this curious condition, the person may weave complicated and even convincing stories to cover up their loss of memory, both for themselves (they seem to believe the tales) and from others. They seem unaware of the extent of their memory losses, and not worried about it. A doctor who appears to expect to be remembered may be welcomed as an old school friend.
How is it diagnosed?
A careful history and physical examination, as always, may make the diagnosis clear. Blood tests such as a Vitamin B1 level and other chemical tests may help. It needs to be suspected in any alcoholic who shows distinct memory problems.
How is it treated?
Vitamin B1, by mouth or by injection may help improve the general neurological condition, but usually does not improve the memory problems consistently or extensively. Complete abstinence from alcohol is vital.
What is the prognosis?
Without proper treatment, the Wernicke-Korsakoff syndrome is fatal. With treatment the vision and movement problems can be improved usefully, and further worsening of the general disorder stopped. But if the mental symptoms are already severe, they may not improve substantially and long-term in-patient care may be required.
When to call your doctor
When an alcoholic starts to show consistent problems with memory for recent events, starts to invent material to fill in gaps in his recall (we're not talking here about excuses for their drinking binges), or when they start having consistent difficulties in walking steadily or in eye movements.
How can it be prevented ?
Abstinence or only moderate alcohol intake and a good balanced normal diet. And when an alcoholic is admitted to hospital for any reason, giving them thiamine may be a good idea.
