Korsakoff Syndrome

Alcohol-related dementia

Korsakoff syndrome is characterised by severe memory loss caused by a lack of thiamine, known as vitamin B1.

This deficiency is most often seen in people with chronic alcoholism, but can also be caused by AIDS, chronic infections, poor nutrition, excessively strict dieting, and a range of other conditions.

The lack of thiamine affects a number of small regions located deep within the brain, and results in the loss of short term memory, while other part of memory remain unaffected, or less affected. This may cause the person to repeat questions constantly, or fail to recognise someone they have met many times since their symptoms began.

Unlike other forms of dementia, Korsakoff syndrome is not always progressive, and symptoms can stabilise and even improve if alcohol is no longer used.

Korsakoff syndrome is considered to be an alcohol-related brain injury, and different to alcohol-related dementia. It is the second stage of Wernicke-Korsakoff syndrome.

Alcohol-related brain injury
Both Korsakoff syndrome and alcohol related dementia are considered alcohol-related brain injuries, and despite the name many health professionals do not consider them dementias, as they are usually treatable and do not always get worse over time, unless drinking continues to occur.

Alcohol-related brain injury can be caused by:

  • Vomiting or poor nutrition, which reduces thiamine levels
  • Direct damage to the brain from falls or getting into fights
  • Alcohol toxins damaging nerve cells, causing chemical changes in the brain, and shrinking brain tissue

Excessive use of alcohol can also affect the brain by:

  • Damaging blood vessels
  • Raising blood pressure
  • Raising cholesterol levels
  • Increasing the risk of heart attack and stroke

Alcohol-related dementia
The second form of alcohol-related brain injury, alcohol-related dementia, has similarities with frontotemporal dementia in that it is characterised by socially inappropriate behaviour. However, as with Korsakoff syndrome, symptoms can be stabilised or reduced by stopping drinking and increasing thiamine levels.

Symptoms include:

  • Social inappropriate behaviour
  • Lack of empathy and sympathy
  • Mood swings
  • Poor planning
  • Problems with decision-making and thinking

These symptoms are caused by the loss of brain tissue due to misuse of alcohol over many years. The symptoms will vary from person to person depending on the areas of the brain that have been affected. Unlike Korsakoff syndrome, not all those with alcohol-related dementia will experience short term memory loss.

Alcohol-related dementia is not considered to be a dementia by some health professionals, as there is a good chance that symptoms can be stabilised or improved by:

  • Detoxing from alcohol
  • Remaining alcohol free
  • Eating a healthy diet
  • Increasing thiamine levels

However, if drinking continues then symptoms will worsen as more regions of the brain are affected. If this occurs, full time care may be required.

Wernicke-Korsakoff syndrome
In some cases, Korsakoff syndrome occurs after a condition known as Wernicke's encephalopathy. When seen together, this condition is known as Wenicke-Korsakoff syndrome.

Wernicke's encephalopathy symptoms often appear suddenly, but may not be obvious, which makes diagnosis difficult.

Symptoms include:

  • Memory loss
  • Disorientation and confusion
  • Weight loss
  • Involuntary, jerky eye movements, or inability to use eye muscles
  • Unsteadiness and poor balance

These symptoms can be treated by injections of thiamine and other B vitamins, however, if left untreated there is a high chance that Korsakoff syndrome will develop, and that permanent brain damage will occur.

Early symptoms

  • Difficulty learning new information
  • No memory of recent events
  • Personality changes
  • Problems with long term memory
  • Confabulation, where the person will make up information or event to fill gaps in their memory. They are most likely not aware they are doing this, or be able to accept that what they remember is not true
  • Difficulty recognising changes in their memory or personality

Causes

Korsakoff syndrome is caused by severely low thiamine levels which result from:

  • Consistent use of alcohol above recommended levels (most common cause), which is 50 units per week for men, and 35 units for women.
  • Poor nutrition
  • Anorexia
  • Excessively strict dieting
  • AIDS
  • Kidney dialysis
  • Chronic infection
  • Chemotherapy

It is often seen in people in their 40s, 50s, although it is seen in people younger or older.

Consuming more than recommended amount of alcohol over a number of years, even by small amounts, can increase your risk for a range of conditions:

It is not currently known why alcohol misuse in some people affects thiamine levels, while in others it affects the liver, stomach, heart, intestines, or other body systems.

Treatment

Unlike other dementias, Korsakoff syndrome is not progressive, meaning that it will not always get worse unless alcohol misuse continues.

Your doctor will discuss treatment options to try and stabilise or improve symptoms, including:

  • Detoxing from alcohol
  • Living alcohol-free
  • Thiamine supplements or injections
  • Other vitamin supplements
  • Nutritional plans

Support Services

A range of Ozcare services are available to you to help with any alcohol-related brain injuries. We offer:

 


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