• Korsakoff's Syndrome

    (Cerebral Beriberi; Korsakoff's Amnesic Syndrome; Wernicke-Korsakoff Syndrome)

    Definition

    Korsakoff's syndrome is a group of symptoms that affect memory. It is caused by a lack of vitamin B1, also known as thiamine. It mainly affects short-term memory. A related disorder, Wernicke's syndrome, often occurs with Korsakoff's syndrome. Because they often occur together, the range of symptoms caused by the two diseases is often called Wernicke-Korsakoff syndrome.
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    Causes

    Thiamine is necessary for memory and other brain functions. The daily requirement of thiamine is 1-3 milligrams per day. Korsakoff syndrome is found in people with:
    People are at an increased risk of Korsakoff syndrome if they have had:
    • Dialysis
    • Long-term IV nutrition
    • Markedly decreased food intake accompanied by nausea/vomiting due to chemotherapy/cancer
    • Chronic disease, such as AIDS
    In the US, the most common cause of thiamine deficiency is alcoholism . People who drink a lot of alcohol often replace food with alcohol. As a result, they take in fewer vitamins, leading to deficiencies. In addition, alcohol increases the body's need for B vitamins. This interferes with the body's ability to absorb, store, and use nutrients.
    Not all alcoholics get Korsakoff’s syndrome. Some people may be more likely to get it due to genetics. Age also appears to be a risk factor for developing Korsakoff’s syndrome. Alcoholics of more advanced age are more likely to develop the disorder. The direct effects of alcohol on nerves in the brain may also contribute.

    Risk Factors

    Factors that increase your chance of developing Korsakoff's syndrome include:
    • Alcoholism
    • Genetic background
    • Advanced age
    • Persistent vomiting leading to malnutrition
    • Conditions like cancer or procedures like obesity surgery that may lead to poor food intake or absorption of nutrients

    Symptoms

    The main symptoms of the related disorder, Wernicke's syndrome, often occur first. They include:
    The main symptom of Korsakoff's syndrome is severe memory problems. It is most obvious with recent events and new information. Often, people with this condition do not know the date or day. However, long-term memory and overall intelligence are not usually affected. To fill in the gaps in recent memory, patients tend to make up information that fits with the situation. This is called confabulation.
    Unlike people with other memory deficiencies, like Alzheimer's disease , individuals with Korsakoff's syndrome seem unaware of their problem. They also do not typically get worried or concerned when it is pointed out. They tend to develop emotional changes, including little or no response to events around them.

    Diagnosis

    The doctor will ask about your symptoms and medical history. Your mental function will be assessed. Testing your ability to learn new information most likely will show if you have this condition. If you are an alcoholic and/or have Wernicke's syndrome, Korsakoff's syndrome is seriously considered as the cause of your memory problem.

    Treatment

    Treatment involves taking IV thiamine and drinking plenty of fluids right away. Because improvement is slow, you must supplement your diet with oral thiamine for many months, possibly for life. If alcoholism is the cause, you will also need treatment for that condition.

    Prevention

    To reduce your risk of developing Korsakoff's syndrome:
    • Proper diet is key. Foods that are rich in thiamine include lentils, peas, fortified breakfast cereal, pecans, spinach, oranges, milk, and eggs.
    • Do not drink alcohol or only drink in moderation.
    • If you have a drinking problem, talk to your doctor right way about treatment options.

    RESOURCES

    Alcoholics Anonymous http://www.aa.org

    National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov

    CANADIAN RESOURCES

    Alcoholics Anonymous Canada http://www.aacanada.com

    Dietitians of Canada http://www.dietitians.ca

    References

    Gale Encyclopedia of Medicine . Gale Research; 1999.

    Harper C. Thiamine deficiency and associated brain damage is still common throughout the world and prevention is simple and safe. Eur J Neurol. 2006,13:1078-1082.

    Impairments of brain and behavior: the neurological effects of alcohol. Alcohol Health and Research World .1997;1:21.

    Korsakoff syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2012. Accessed February 20, 2013.

    Kuo SH, Debnam JM, Fuller GN, de Groot J. Wernicke's encephalopathy: an underrecognized and reversible cause of confusional state in cancer patients. Oncology . 2009;76(1):10-18.

    Lukas RV, Piantino J, Ksiazek S, et al. MRI changes in a head and neck cancer patient with Wernicke’s Encephalopathy and visual loss. Neuro-Ophthalmology. 2011;35(5-6):272-275.

    The Merck Manual of Diagnosis and Therapy. Simon and Schuster, Inc; 1999.

    Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s encephalopathy and Korsakoff’s psychosis. Alcohol Alcohol . 2006,41:151.

    Yoon CK, Chang MH, Lee DC. Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum. Korean J Ophthalmol . 2005;19(3):239-42.

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