Korsakoff Syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Thiamine helps brain cells produce energy from sugar. When levels fall too low, brain cells cannot generate enough energy to function properly.
Korsakoff syndrome is most commonly caused by alcohol misuse, but can also be associated with AIDS, cancers that have spread throughout the body, chronic infections, poor nutrition and certain other conditions.
Korsakoff syndrome is often — but not always — preceded by an episode of Wernicke encephalopathy, which is an acute brain reaction to severe lack of thiamine. Wernicke encephalopathy is a medical emergency that causes life-threatening brain disruption, profound confusion, staggering and stumbling, lack of coordination, and abnormal involuntary eye movements.
Because the chronic memory loss of Korsakoff syndrome often follows an episode of Wernicke encephalopathy, the chronic disorder is sometimes know as Wernicke-Korsakoff syndrome. But Korsakoff syndrome can also develop in individuals who have not had a clear-cut prior episode of Wernicke encephalopathy.
Korsakoff syndrome and its associated thiamine deficiency is not the only mechanism through which heavy drinking may contribute to chronic thinking changes and cognitive decline. Alcohol misuse may also lead to brain damage through the direct toxic effects of alcohol on brain cells; the biological stress of repeated intoxication and withdrawal; alcohol-related cerebrovascular disease; and head injuries from falls sustained when inebriated.
Causes and Risk Factors
Scientists don’t yet know exactly how Korsakoff syndrome damages the brain. Research has shown that severe thiamine deficiency disrupts several biochemicals that play key roles in carrying signals among brain cells and in storing and retrieving memories. These disruptions destroy brain cells and cause widespread microscopic bleeding and scar tissue.
Most cases of Korsakoff syndrome result from alcohol misuse. Scientists don’t yet know why heavy drinking causes severe thiamine deficiency in some alcoholics, while other may be affected primarily by alcohol’s effects on the liver, stomach, heart, intestines, or other body systems.
Treatment
Some experts recommend that heavy drinkers and others at risk of thiamine deficiency take oral supplements of thiamine and other vitamins under their doctor’s supervision.
Many experts also recommend that anyone with a history of heavy alcohol use who experience symptoms associated with Wernicke encephalopathy, including acute confusion, prolonged nausea and vomiting, unusual fatigue or weakness, or low body temperature or blood pressure, be given injectable thiamine until the clinical picture grows clearer.
Once acute symptoms improve, individuals should be carefully evaluated to determine if their medical history, alcohol use and pattern of memory problems may be consistent with Korsakoff syndrome. For those who develop Korsakoff syndrome, extended treatment with oral thiamine, other vitamins and magnesium may increase chances of symptom improvement.
Abstaining from alcohol is a cornerstone of effective long-term treatment. Those with Korsakoff syndrome have a reduce tolerance for alcohol and may be at high risk for further alcohol-related health problems.
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