Introduction to dementia
Joanne Brooke in Dementia in Prison, 2020
Korsakoff’s syndrome is the most well-known form of ARBD, although is less common than other forms of ARBD such as alcoholic dementia (Ridley et al., 2013). Korsakoff’s syndrome often develops as part of a condition known as Wernicke-Korsakoff syndrome. This consists of two separate but related stages: Wernicke’s encephalopathy followed by Korsakoff’s syndrome and Wernicke-Korsakoff syndrome, which is diagnosed in 1 in 8 people with alcoholism. However, not everyone has a clear case of Wernicke’s encephalopathy before Korsakoff’s syndrome develops (Oudman et al., 2014). Encephalopathy refers to permanent or temporary brain damage, disorder or disease, which affects the brain’s function or structure and may be degenerative. The primary symptom is an altered mental status. Wernicke’s encephalopathy usually develops suddenly, often after abrupt and untreated withdrawal from alcohol. It has a range of different symptoms, but they may not be obvious, and it can be difficult to make a diagnosis (Oudman et al., 2014).
Diagnosis of Dementia
Dawn Brooker, Sue Lillyman, Mary Bruce in Dementia Care, 2023
There are several specific types of ARBD. The two most common types are: alcohol-related ‘dementia’ caused from damage of excessive drinking over a period of time;Wernicke–Korsakoff syndrome (Korsakoff Syndrome) caused specifically by the lack of thiamine normally through drinking over a period of time. Wernicke–Korsakoff syndrome has two stages. Firstly, there will be intense inflammation (swelling) of their brain. known as ‘Wernicke’s encephalopathy’. If not treated as an emergency this can lead to long term brain damage and ‘Korsakoff’s syndrome’ or possibly death.
Nutritional Deficiencies
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
The diagnosis of Wernicke–Korsakoff syndrome is missed in about 25% of cases. Physicians should have a low threshold to suspect this condition, particularly in alcoholics, even in the absence of the complete triad. Supporting data include: RBC transketolase assay. In cases when thiamine deficiency is suspected, the diagnosis can be confirmed by showing a marked reduction in transketolase activity at baseline. The transketolase activity and clinical features may improve quickly, even within hours, after the administration of thiamine. Complete normalization of transketolase activity is usually attained within 24 hours.Low thiamine level.MRI brain.Clinical response to thiamine.
Low rates of thiamine prescribing in adult patients with alcohol-related diagnoses in the emergency department
Published in The American Journal of Drug and Alcohol Abuse, 2021
Nathan M. Peck, Theodore C. Bania, Jason Chu
Alcohol use disorder (AUD) is a pervasive issue in the United States with recent estimates at a 13.9% twelve-month prevalence for the entire population aged 18 or older (1). AUD is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as an alcohol consumption pattern that produces significant impairment or distress and is diagnosed by identifying specific complications of alcohol use or manifestations of alcohol dependence in a given patient (2). Wernicke encephalopathy and Korsakoff’s psychosis are neurologic disorders that most frequently develop in the setting of AUD and are due to thiamine deficiency (3). Given the common etiology of thiamine deficiency for both Wernicke encephalopathy and Korsakoff’s psychosis, and because patients with Wernicke encephalopathy often progress to Korsakoff’s psychosis, these two conditions are often referenced together as Wernicke-Korsakoff Syndrome (WKS). The prevalence of WKS, based on autopsy, is estimated between 0.8% and 2.8% for the entire population and 12.5% among individuals with AUD (4–6).
Preserved intellectual functioning in Korsakoff’s syndrome? Actual and premorbid intelligence in patients with major or mild alcohol-related cognitive disorder
Published in Journal of Substance Use, 2019
Rhody Haalboom, Loes van Aken, Serge J. W. Walvoort, Jos I. M. Egger, Roy P. C. Kessels
Alcoholic Wernicke-Korsakoff syndrome is a chronic psychiatric disorder which is caused by excessive alcohol use in combination with malnutrition, resulting in a deficiency of thiamine (vitamin B1). This deficiency may result in Wernicke’s encephalopathy; an acute physical condition characterized by a clinical triad of confusion, ataxia, and oculomotor abnormalities (Wernicke, 1881). The chronic syndrome of persisting deficits that may occur after Wernicke’s encephalopathy is referred to as Korsakoff’s syndrome (KS), or Alcohol-Induced Major Neurocognitive Disorder, Amnestic/Confabulatory Type, in the nomenclature of DSM-5 (American Psychiatric Association [APA], 2013). Lesions (although not always present or observable using current neuroimaging techniques) have been found in the diencephalon in KS patients, including the mammillary bodies and thalamus, which cause disproportionate anterograde amnesia as well as retrograde amnesia with a temporal gradient (Arts, Walvoort, & Kessels, 2017; Kopelman, 2002). Other characteristics of the syndrome are an almost complete lack of insight, disorientation in time, place and person, achronogenesis (difficulties placing memories in time; Kopelman, 2002), confabulations in the first period after Wernicke encephalopathy (Kessels & Kopelman, 2012), visuoperceptual impairments (Oscar-Berman et al., 2014) and severe executive dysfunction (Maharasingam, Macniven, & Mason, 2013; Moerman-Van den Brink et al., 2019; Van Oort & Kessels, 2009).
Thiamine administration to all patients with alcohol use disorder: why not?
Published in The American Journal of Drug and Alcohol Abuse, 2021
Roberta Agabio, Lorenzo Leggio
In the United States (US), there are almost 5 million alcohol-related visits to Emergency Departments (EDs) per year (1). Many of these visits involve patients with alcohol use disorder (AUD) who have, or are at risk for, thiamine deficiency. These individuals should receive thiamine supplementation (2–4). However, thiamine deficiency is difficult to identify because initial symptoms are often nonspecific, e.g., headaches, fatigue, irritability, and abdominal discomfort (5,6). The lack of thiamine supplementation in patients with thiamine deficiency can contribute to heart failure and sudden death, Wernicke’s encephalopathy, and irreversible brain damage. The latter includes Korsakoff’s psychosis, which is characterized by anterograde amnesia, an inability to remember recent events, and confabulation (5,6). Because Wernicke’s encephalopathy and Korsakoff’s psychosis have a shared etiology and often co-occur, they are often referred to as Wernicke–Korsakoff syndrome (WKS).
Related Knowledge Centers
- Alcohol Abuse
- Alcoholism
- Ataxia
- Eating Disorder
- Korsakoff Syndrome
- Malnutrition
- Ophthalmoparesis
- Thiamine Deficiency
- Wernicke Encephalopathy
- Brain Damage