Confusion, disorientation, and memory loss are signs of Korsakoff's syndrome, also known as amnesic syndrome. Often, severe alcohol abuse is the trigger. Therapy depends on the cause.
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Korsakoff's syndrome is a complex of symptoms in which there is a pronounced and persistent impairment of the short-term memory. Because the main symptom is memory loss (amnesia), doctors also call it amnesiac psychosyndrome. Other names for Korsakow syndrome are Korsakow disease or Korsakow psychosis.
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What is Korsakoff Syndrome?
In Korsakoff's syndrome, those affected suffer from a loss of memory and disorientation. They typically fill in memory gaps with fantasy stories, so-called confabulations. Amnesia is triggered by the destruction of nerve cells in the brain, which is largely irreversible.
Korsakoff syndrome occurs predominantly in severe alcoholics. Men are affected slightly more often than women. Korsakoff's syndrome occurs most frequently in the age group between 45 and 65 years of age. In most cases, it is due to a lack of vitamin B1 (thiamine), which causes damage to the brain and nervous system. Under certain circumstances, inflammation of the brain or head injuries can also trigger an amnestic disorder.
The symptom complex was described as early as 1887 by the Russian neurologist and psychiatrist Sergei S. Korsakov. He had observed that some of his alcoholic patients suffered from severe memory and orientation disorders and tended to confabulate. Confabulating describes the invention of things, people or events without the conscious intention of deceiving. This means that the patient's memory fills in the gaps without being aware of it, and the patient usually believes what he is saying himself. So what some consider to be typical alcoholic behavior or hallucinations while under the influence of alcohol may already be signs of brain damage.
In Korsakoff's syndrome, nerve cells are irreversibly destroyed. The mamillary bodies, a pair of elevations in the diencephalon that plays an important role in memory formation and learning, and sometimes the thalamus and hypothalamus are typically affected.
Causes of Korsakoff's Syndrome
The cause of Korsakoff's syndrome is usually a persistent deficiency in vitamin B1. Thiamine is a water-soluble vitamin and has an important function in the construction of nerve cells. Since it can only be stored in the body for a few weeks, malnutrition leads to an undersupply relatively quickly.
Alcoholism as a trigger for amnesiac disorder
By far the most common cause of vitamin B1 deficiency is chronic alcohol abuse. Severe alcoholics tend to have a poor and one-sided diet or often "replace" whole meals with alcohol. The result is nutrient deficiencies, primarily in B vitamins and folic acid. About half of all alcoholics develop a vitamin B1 deficiency over time. In addition, pronounced alcohol withdrawal delirium can also cause Korsakov psychosis.
Korsakoff syndrome after Wernicke encephalopathy
In about 80 percent of those affected, memory loss is preceded by Wernicke encephalopathy. It is a brain disease that is also caused by a persistent deficiency in vitamin B1 and causes disorders in the same areas of the brain. Vegetative disorders, eye muscle disorders and, as a result, visual disorders such as double vision, speech disorders, coordination disorders (ataxia), delirium and psychoses occur.
Wernicke encephalopathy is an absolute emergency. If it is not treated in time, it almost always leads to Korsakoff syndrome. Doctors speak of Wernicke-Korsakoff syndrome because of the significant overlap in symptoms.
Other causes of vitamin B1 deficiency
In addition to alcoholism, other diseases and living conditions can also lead to a deficiency in vitamin B1. Possible causes are, for example:
- Malnutrition, for example with long fasts or with anorexia
- one-sided diet, often in older people in need of care
- Metabolic disorders
- chronic gastrointestinal diseases
- Absorption disorders in the gastrointestinal area (absorption disorders)
Brain damage can trigger Korsakoff syndrome
Amnesiac syndrome can also be caused by other damage to the brain, such as:
- Cerebral haemorrhage, stroke, ruptured aneurysm
- Head injury, traumatic brain injury
- Poisoning (intoxication), especially carbon monoxide poisoning
- Lack of oxygen in the brain (hypoxia)
- severe infections such as encephalitis, meningitis, borreliosis
- Brain atrophy in Alzheimer's dementia
In addition, Korsakoff's syndrome can accompany an organically caused psychosis. In this case, it is often reversible.
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Symptoms of Korsakoff Syndrome
A Korsakoff syndrome usually manifests itself with a typical triad of symptoms. Almost all those affected show:
- Memory problems
Retrograde and anterograde amnesia
The memory disorders mainly affect memory and short-term memory, less often long-term memory. Both retrograde and anterograde amnesia occur in different degrees. Affected people have difficulty remembering what they have just experienced (anterograde amnesia). They also sometimes forget events that occurred before the onset of the disease (retrograde amnesia). Sometimes there is a disruption of the sense of time. Other cognitive functions are usually not affected.
In addition, other symptoms of varying degrees can occur, such as:
Many patients show signs of a personality change. Drive disorders associated with a loss of spontaneity and dullness are typical.
Diagnosis in Korsakov: This is how we found the amnesiac syndrome
The diagnosis of Korsakov's syndrome is made using neurological examinations. First, the doctor asks the patient to check the functioning of his short-term memory. Discussions with relatives may also be used.
A CT (computed tomography) usually shows a regression (atrophy) of the brain in the forehead area. The atrophy of the mammary bodies can be seen on MRI (magnetic resonance imaging).
Therapy with Korsakow: alcohol abstinence and vitamin B1 substitution
The first measure to be taken in the case of Korsakoff's syndrome caused by a vitamin B1 deficiency is to give high doses of vitamin B1 infusions over several days. At the same time, many of those affected are given saline infusions, as dehydration is common, especially among alcoholics. In the case of malnutrition, a general vitamin and nutrient deficiency is compensated for.
Subsequently, vitamin B1 should be substituted for as long as necessary. In the case of reliable patients who are willing to cooperate, this can be done later via tablets, otherwise intravenous administration is preferable. The consistent administration of thiamine leads to a slight improvement in the symptoms of many sufferers or at least prevents them from getting worse.
The most important therapeutic measure for an alcohol-related Korsakoff syndrome is the consistent and sustained abstinence from alcohol.
Course and life expectancy in Korsakoff syndrome
While Wernicke encephalopathy is usually quite treatable with timely treatment, the overall prognosis for Korsakoff syndrome is poor. With consistent abstinence from alcohol and therapy with vitamin B1, the progression of the symptoms can usually be stopped, but a cure is not possible in the end stage.
Many patients can no longer manage their everyday life on their own and become nursing care. In the case of non-cooperating, mentally severely impaired patients, compulsory admission to an appropriate care facility may be necessary. Good care in a specialized nursing home can partially prevent the disease from progressing.
Life expectancy in Korsakoff's syndrome depends very much on the extent of the brain damage and on maintaining alcohol abstinence. Basically, the life expectancy of alcoholics is about 15 percent below the average life expectancy.
Prevention: prevent Korsakoff syndrome
The most important aspect of prevention is to refrain from excessive alcohol consumption. People with alcohol problems should seek appropriate addiction treatment as early as possible. The family doctor can be the first point of contact here.
If you have a known alcoholism, you should strictly abstain from alcohol for life.
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Addiction prevention measures
The line between regular alcohol consumption and alcoholism is often blurred. All measures to prevent alcohol dependence can be seen as important preventive measures for alcohol-related diseases. This includes, above all, educating young people about the possible risks of alcohol.
Avoid vitamin B1 deficiency
Basically, everyone should pay attention to a varied, vitamin-rich diet. B vitamins are mainly found in legumes, whole grain products, meat and fish.
Good vitamin B1 suppliers are:
Risk groups such as alcoholics or malnourished elderly patients should ideally receive regular thiamine as a dietary supplement.
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