Korsakoff  Syndrome


Korsakoff  Syndrome is a chronic memory disorder caused by severe vitamin B1 deficiency. Though alcohol abuse is most commonly linked with this disease, AIDS, poor nutrition, chronic infection and certain other conditions too can cause the Korsakoff syndrome to develop.

Vitamin B1 or thiamine helps the brain cells to generate energy from sugar, and if the levels decrease too much, the brain cells cannot produce the necessary energy for proper functioning and Korsakoff syndrome may manifest as a consequence.Korsakoff  Syndrome picture

How and when Korsakoff  Syndrome is Occur?

This syndrome is often, though not always, anteceded by a Wernicke encephalopathy episode which is essentially critical brain reactivity in response to the severe thiamine imbalance. Wernicke encephalopathy is considered a medical emergency causing fatal brain disruption, staggering and stumbling, confusion, abnormal involuntary movements of the eyes, and also lack of coordination.

As the chronic loss of memory during the active period of this syndrome often follows a Wernicke encephalopathy episode, the chronic disease is sometimes called Wernicke-Korsakoff syndrome. Nonetheless, Korsakoff can also occur in persons who have not experienced any Wernicke encephalopathy episode before.

History of  Korsakoff  Syndrome

  • Carl Wernicke first talked of a disease in 1881 that involved paralytic eye, mental confusion, and ataxia and named it as the PHS or polioencephalitis hemorrhagic superiors
  • A Russian psychiatrist known as Sergei Korsakoff spoke of the association between a dysfunctional memory and long-term alcohol abuse in many articles from 1887 to 1891 and termed the disorder as psychosis polyneuritis
  • Murawieff first posited in 1897 that a common etiology could be held responsible for both the syndromes

Korsakoff  Syndrome Causes

Scientists are yet to discover and understand how this disease damages the human brain. The most popular theories that try to explain the underlying cause are illustrated below:

  1. Research has demonstrated the association between severe thiamine deficiency and impairment of storage and retrieval functions of the human memory.
    – The thiamine deficiency leads to an eventual disruption of several neurotransmitters that are responsible for the memory above functions
    – These disruptions lead to widespread, microscopic bleeding as well as scar tissue and also destroy the brain cells
  2. Most Korsakoff syndrome cases stem from alcohol misuse. However, scientists are yet to find out why heavy drinking results in severe vitamin B1 deficiency in some of the alcoholics, while other alcohol abusers may be primarily affected by its effects on the stomach, liver, intestines, heart, or other organs and body systems
  3. Research has found some genetic variations that are likely to increase one’s susceptibility to this disorder, such as:
  • Poor nutrition may also increase the risk
  • Anorexia
  • Fasting
  • Overly stringent dieting
  • Starvation
  • Fast loss surgery
  • Uncontrolled vomiting
  • AIDS
  • Kidney dialysis
  • Chronic infection
  • Metastasis

Korsakoff  Syndrome Symptoms

  • Korsakoff syndrome makes it difficult to grasp new information, and registering events in the short-term as well as long-term memory.
    – Memory issues may very well be strikingly severe, though other social and cognitive faculties are relatively spared. For instance, someone may appear carrying on a consistent conversation, though after a couple of moments that a person is not able to remember that the discussion took place at all or to whom that individual spoke.- Medical science is yet to understand why patients with Korsakof syndrome may confabulate or fabricate things that they are unable to recall. It should never be confused with lying, as such persons may believe the explanations they invented

Korsakoff  Syndrome Diagnosis

Diagnosis is not always uncomplicated. Such patients are often found mentally confused, which can make communication with the specialist difficult. The medical practitioner may rule out the likelihood of a physical ailment if the affected person appears incoherent.

Signs of alcoholism

  • Heart rate
  • Reflexes
  • Eye movements
  • Body temperature
  • Blood pressure
  • LFT or liver function test

Signs of malnutrition

  • Blood tests that look for vitamin B1 (thiamine) deficiency and also measure one’s overall nutritional health
  • Nutritional tests including SAT (serum albumin test) and SVB1 (serum vitamin B1) test
    – SAT measures protein albumin levels, as low levels are likely to indicate potential liver or kidney issues or nutritional deficiencies
    – SVB1 test accesses enzyme activity in the  RBCs (red blood corpuscles) because a low enzyme activity possibly suggests a deficiency of vitamin B1

Other tests

  • ECG or electrocardiogram prior to and post-intake of vitamin B1
  • CT scan to find brain lesions
  • MRI scan to search for change in the brain
  • NPT or neuropsychological test to evaluate the severity of mental deficiencies, if any

Differential Diagnosis

  • TLE or temporal lobe epilepsy
  • CHI or concussive head injury
  • TLI or temporal lobe infarction
  • TGA or transient global amnesia
  • DLB or dementia accompanied by Lewy bodies
  • Alzheimer disease
  • Anoxic encephalopathy
  • HSV or herpes simplex virus
  • TVT or third ventricle tumor

Korsakoff  Syndrome Treatment

  • Orally administering long-term doses of thiamine, and also other supplements of other vitamins as well as magnesium
  • Injecting vitamin B1
  • Eliminating the alcohol dependencies of the patient

(Note: Previously a typical dose of thiamine was hundred milligrams per day via intramuscular, intravenous, or oral administration. However, the US and also the international care protocols are seemingly gearing towards half a gram of thiamine thrice a day for two to three days, and then reassessing the affected individual for further improvement.)

Korsakoff  Syndrome Prevention

One can prevent Korsakoff syndrome by ingesting a balanced diet that is rich in vitamin B-1 (natural sources are mentioned below) and also not consuming alcohol. Food items rich in vitamin B-1 are:

  • Lean pork
  • Peas
  • Rice
  • Whole wheat bread
  • Oranges
  • Spinach
  • Milk

Prognosis

Korsakoff syndrome should always be considered a medical emergency and if left untreated, it results in fatalities up to two in every ten people. Additionally, as many as twenty-five in every hundred individuals belonging to the Korsakoff group require long-term institutionalization.

 

References

Images Copyright: 123RF.com: Roberto Biasini

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