Unraveling Apathy in Korsakoff Syndrome Patients Receiving Long‐Term Care With and Without Cerebrovascular Comorbidity

Abstract

Background Korsakoff syndrome (KS) is a severe neuropsychiatric disorder caused by acute deficiency of vitamin B1 and concomitant alcoholism. Patients with KS are particularly vulnerable for cerebrovascular comorbidity. KS is characterized by cognitive and neuropsychiatric symptoms, one of which is apathy. Apathy is a pathological lack of goal‐directed behaviors, goal‐directed cognitions, and goal‐directed emotions. Cerebrovascular accidents are known to carry a risk for developing apathy. Apathy has a dramatic effect on the autonomy and daily lives of patients suffering from this condition. Methods We assessed general apathy and related subconstructs in fifteen patients with KS, fifteen patients with KS and cerebrovascular comorbidity who reside in a 24‐hour care facility, and fifteen healthy controls. Results Compared with healthy controls, both KS patient groups showed higher levels of apathy as rated by a close informant. We found no difference between both KS patient groups and the healthy control group on the self‐report section of the Pleasant Activities List, suggesting that motivation is still intact in KS patients. It is important to note a discrepancy was found between self‐reporting and proxy reporting on this list. KS patients with cerebrovascular comorbidity showed more severe emotional blunting compared to both KS patients without cerebrovascular comorbidity and healthy controls. The competency to consent was lower in patients compared with healthy controls, but no difference was found between KS patients with cerebrovascular comorbidity and those without. Conclusions Our results suggest that KS patients show increased levels of general apathy compared with healthy controls. Patients show a diminished competency to consent and increased emotional blunting, while motivation is not compromised. Cerebrovascular comorbidity in KS forms a high risk for emotional blunting. The results of this study suggest that apathy is a severe problem in KS. More attention in both the literature and clinical practice would benefit this complex patient population.

Behavioral, Emotional and Social Apathy in Alcohol-Related Cognitive Disorders

“…In addition, we aim to relate the three dimensions of apathy to everyday functioning and overall cognitive performance. Based on previous results [ 8 , 9 , 13 , 16 , 17 ], we hypothesize that all three dimensions of apathy will be present in patients with AUD, ARCI and KS. We expect behavioral apathy to be the most frequently reported dimension of apathy in all three groups and hypothesize that especially behavioral apathy is negatively related to everyday functioning and cognitive performance.…”

“…Furthermore, AES-I scores were found to correlate with overall cognitive dysfunction as measured with the Montreal cognitive assessment (MoCA) and everyday executive dysfunction [16]. In another recent study [17], higher rating of general apathy (assessed using the AES-I total score) were found in patients with KS with and without cerebrovascular comorbidity, as compared to healthy controls, but no significant correlation with executive functioning was found, possibly because of the small sample size. More importantly, the AES-I does not fully cover the most current definition of apathy.…”

Virtual Reality in Korsakoff’s Syndrome

“…Both the implementation and clinical indiciation for virtual reality techniques were straightforward, leading to a rapid increase in observed quality of life of the patients. The request for action resulted in multiple moods and actions despite the severity of apathy following Korsakoff's syndrome (Oey et al, 2021). Results were therefore remarkable and highlight the positive effects of the use of virtual reality technology in clinical long-term care practice for Korsakoff's syndrome patients.…”

Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff’s Syndrome: A Network Analysis

“…Dorst and colleagues investigated the multidimensional nature of apathy in KS and concluded that social functioning is impaired, and that social apathy is most severe in KS (as compared to behavioral and emotional apathy) [66]. In line with this, KS patients have been described as 'flat and emotionally detached' [1] and Oey and colleagues describe that 'emotional blunting' (described as patients still experiencing emotions but being unable to display them) occurs in KS [67]. The negative association between apathy and social participation that we found might be explained by this.…”