<p>A patient with Korsakoff syndrome of psychiatric and alcoholic etiology presenting as DSM-5 mild neurocognitive disorder</p>

Abstract

Background: Wernicke’s encephalopathy (WE) and Korsakoff syndrome (KS) are underdiagnosed. The DSM-5 has raised the diagnostic threshold by including KS in the major neurocognitive disorders, which requires that the patient needs help in everyday activities. Methods: We report clinical, neuropsychological, and radiological findings from a patient who developed Wernicke-Korsakoff syndrome as a result of alcohol use and weight loss due to major depression. We assess the diagnosis in the context of the scientific literature on KS and according to the DSM-IV and the DSM-5. Results: The patient developed ataxia during a period of weight loss, thus fulfilling current diagnostic criteria of WE. WE was not diagnosed, but the patient partially improved after parenteral thiamine treatment. However, memory problems became evident, and KS was considered. In neuropsychological examination, the Logical Memory test and the Word List test were abnormal, but the Verbal Pair Associates test was normal (Wechsler Memory Scale-III). There were intrusions in the memory testing. The Wisconsin Card Sorting Test was broadly impaired, but the other test of executive functions (difference between Trail Making B and Trail Making A tests) was normal. There was atrophy of the mammillary bodies, the thalamus, the cerebellum, and in the basal ganglia but not in the frontal lobes. Diffusion tensor imaging showed damage in several tracts, including the uncinate fasciculi, the cinguli, the fornix, and the corona radiata. The patient remained independent in everyday activities. The patient can be diagnosed with KS according to the DSM-IV. According to the DSM-5, the patient has major neurocognitive disorders. Conclusions: Extensive memory testing is essential in the assessment of KS. Patients with a history of WE and typical clinical, neuropsychological, and radiological KS findings may be independent in everyday activities. Strict use of the DSM-5 may worsen the problem of Wernicke-Korsakoff syndrome underdiagnosis by excluding clear KS cases that do not have very severe functional impairment.

Corpus Callosum Atrophy in Alcohol-Dependent Men with Memory Disorders and Visual Attention Difficulties

“…Studies on patients suffering from the Korsakoff syndrome have reported that a reduction in mammillary bodies, thalamus, hypothalamus, basal ganglia, cerebellar vermis and damaged white-matter tracts (partially in genu of the corpus callosum) was responsible for a set of higher-order cognitive dysfunctions, including verbal working memory, immediate and delayed verbal recall, verbal and visual recognition, executive functions, but in attention processes the difficulties was not observed [68]. However, in spite of unclear regional brain dysfunction, verbal memory disorder was seen especially in patients with Korsakoff's syndrome, but not in the non-demented alcoholic patients [69].…”

Alcohol‐related brain damage: A mixed‐method evaluation of an online awareness‐raising programme for frontline care and support practitioners

“…ARBD is a substantial public health concern, and yet research suggests that there is currently a lack of knowledge and understanding of ARBD amongst both the general public and, perhaps more importantly, health‐care professionals [ 9 , 10 ]. This is reported to have resulted in individuals going undiagnosed and, in some cases, misdiagnosed [ 11 , 12 , 13 ] and therefore untreated [ 14 , 15 ]. There is evidence that ARBD is not a degenerative condition and research also suggests that not only can it be prevented with adequate support, but also that those with the condition have the potential to improve and even reverse their symptoms if recognised early in the disease trajectory and managed promptly [ 16 ].…”