Korsakoff syndrome: An overlook (Review)

Abstract

This review aimed to analyze the latest neurobiological findings regarding Korsakoff syndrome, since alcoholism is the most prevalent addiction worldwide. In addition, we analyzed the optimal treatment that can be administered in order to minimize the symptoms and improve the outcome of these patients. The disruption of memory circuits within the brain of alcoholic patients results in the amnestic syndrome known as Korsakoff syndrome. It is generally characterized by a chronic neuropsychiatric syndrome caused by vitamin B1 (thiamine) deficiency. Other categories of patients can develop Korsakoff syndrome without consuming alcohol such as AIDS patients, terminally ill cancer patients, or patients with chronic infections and malnutrition. Vitamin B1 is required in the Krebs cycle for production of adenosine triphosphate (ATP). It is also a cofactor in the production of acetylcholine and certain neurotransmitters. Alcohol consumption can decrease the intake, gastrointestinal absorption and cellular utilization of vitamin B1. Treatment of alcohol withdrawal along with high doses of vitamin B1 can improve the general outcome of patients. A small percentage of patients can recover from Wernicke's encephalopathy with no permanent brain damage. The onset of Korsakoff syndrome darkens the prognosis. Alcohol abstinence is an absolute recommendation and prevents the extension of neural damage. Contents 1. Research methods 2. Introduction 3. Clinical features 4. Neurobiology 5. Treatment strategies 6. Conclusions Research methodsThe review started from an extensive search of Korsakoff syndrome for the last 10 years over the database PubMed ® /MEDLINE (http://www.ncbi.nlm.nih.gov/pubmed). Even if the trigger for this disease can be found in more than 2,700 scientific articles and 9 clinical trials, the Korsakoff keyword returned only 160 published scientific papers, 91 in the last 5 years and only one clinical trial. As research keywords we used 'Korsakoff' OR 'Korsakoff syndrome' OR 'Wernicke' AND 'Wernicke encephalopathy' AND 'alcohol' AND 'Thiamine' AND 'brain structures' AND 'treatment'. In the same time 'Korsakoff' search over Web of Knowledge returned 342 scientific articles but only one published in Romania. We constructed an Excel table highlighting these findings, we eliminated the duplicates, we kept the review articles because some of them bring upfront old results or ideas that are still valid and useful.

Clinical evaluation and management of a 45-year-old man with confusion, psychosis, agitation, stereotyped behavior, and impaired speech

“…(3) Mr. A's body mass index was 19.5 which was within normal range, but he was dependent on “junk food” for years due to his difficulty ambulating and poor self-care. Malnutrition was reasonably suspected in Mr. A's case and can be an exacerbating factor for Wernicke-Korsakoff syndrome, as malnutrition alone can cause Wernicke-Korsakoff syndrome [ 5 , 7 , 11 ]. (4) Mr. A had not received any IV thiamine or high dose PO thiamine prior to his admission to UMMC.…”

Problemas ligados ao álcool em centros de emergência (PLACE)—People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention

“…AWS symptoms include autonomic hyperactivity, nausea, vomiting, headache, tremors, anxiety, psychomotor agitation, and, in more severe cases, hallucinations, occupational delirium, delirium tremens, seizures, and death. It can cause irreversible neurological comorbidities, such as Wernicke-Korsakoff syndrome, which includes acute onset of Wernicke's encephalopathy (confusion, oculomotor disturbances, and ataxia), which, if untreated, can progress to or coexist with Korsakoff syndrome characterized by anterograde and retrograde memory deficits, limited learning ability, and impaired executive function (Popa et al, 2021). Additionally, Marchiafava-Bignami syndrome, a highly rare but rather severe condition characterized by demyelination and necrosis of the corpus callosum causing dementia, altered mental status, spasticity, dysarthria, ataxia, gait abnormalities, and seizures can also occur in malnourished chronic alcohol users, presumably due to combination of alcohol-induced neurotoxicity (with an uncertain nature) and deficiency of the B-complex vitamins (Singh and Wagh, 2022).…”

Self-Reported Pain and Pain Observations in People with Korsakoff’s Syndrome: A Pilot Study

“…Korsakoff's syndrome (KS) is a neuropsychiatric disorder caused by a thiamine deficiency [1]. KS is often associated with chronic abuse of alcohol [2]. The prevalence rates of KS are between 1 and 2% in the general population and 12 and 14% in the alcohol misusing population [1].…”