Generality
Korsakoff syndrome is a reversible neurological disorder that occurs due to a severe vitamin B1 deficiency.
Symptoms of Korsakoff syndrome consist of severe memory disorders (such as anterograde amnesia and retrograde amnesia), changes in personality, confabulation, apathy, etc. Furthermore, some people suffering from Korsakoff syndrome also suffer from a form of encephalopathy, called Wernicke's encephalopathy.
The therapy involves the administration of thiamine, first parenterally and then orally. The treatment can last a long time and complete recovery can take place even years later.
What is Korsakoff syndrome?
Korsakoff's syndrome - also called Korsakov 's syndrome or Korsakoff's psychosis or amnesic-confabulatory syndrome - is a neurological disease that usually arises in chronic alcoholics and, sometimes, in long-term malnourished people.
Being characterized by memory disorders, doctors consider it a form of dementia (hence, the fourth name of dementia of Korsakoff ), although it is of a temporary nature.
Epidemiology
According to various statistical surveys, concerning several countries of the world, Korsakoff syndrome would be present in 0.8-3% of the general population.
The most affected are men aged between 45 and 65, with a history of chronic alcoholism. However, individuals of all ages can get sick, therefore men younger than 45 and older than 65 years.
In women, Korsakoff syndrome is a more rare phenomenon and it affects mostly young adults. Furthermore, it should be remembered that the female sex is more vulnerable to the disease, as a woman's body is more sensitive to the effects of alcohol.
Finally, in the next chapters, we will see how Korsakoff syndrome is often associated with a particular form of encephalopathy, called Wernicke's encephalopathy. The simultaneous presence of these two morbid conditions is called Wernicke-Korsakoff syndrome.
ORIGIN OF THE NAME
Korsakoff's syndrome is named in honor of Sergei Korsakoff, the Russian neuropsychiatrist who first, in the late 19th century, described its general characteristics.
Causes
A cause of Korsakoff syndrome is a severe deficiency of vitamin B1, or thiamine .
This vitamin - which is found above all in meat, cereals, eggs and dried legumes - plays a fundamental role in energy metabolic processes, in particular those concerning carbohydrates.
TIAMINA DEFICIENCY: WHAT IS IT FOR?
Other situations that can cause a vitamin B1 deficiency are:
- Wrong diet
- Recurrent vomiting
- Food disorders
- Side effects of chemotherapy
- Pregnancy hyperemesis
- Mercury poisoning
HOW THE ALCOL INDICATES THE LACK OF TIAMINA
Alcohol abuse acts on the absorption of thiamine and causes a deficiency in at least three ways:
- Many people suffering from alcoholism do not eat according to the nutritional needs of their organism, therefore essential elements such as vitamins etc. are missing.
- Alcohol interferes with the thiamine conversion process in its active form. The vitamin B1 that is taken with food must undergo a certain process to take action: this process, in those who abuse alcohol, is reduced.
- Alcohol inflames the inner wall of the stomach, causing recurrent vomiting. This reduces the absorption of ingested nutrients, including thiamine.
Risk factors FOR Korsakoff's syndrome
- Alcohol abuse
- Chemotherapy treatment (chemotherapy)
- Renal dialysis
- Wrong diets, as a result of which certain foods are not taken
- Old age
- Genetic factors
- Suffering from Wernicke's encephalopathy
Symptoms and Complications
To learn more: Symptoms Korsakoff syndrome
Korsakoff syndrome typically causes severe memory disorders . These consist of amnesia - that is memory loss - that can be of anterograde and / or retrograde type.
Anterograde amnesias are neurological deficits that make it difficult to store new information, while retrograde amnesias are neurological deficits that cause the loss of memories prior to the onset of the disease.
OTHER IMPORTANT SYMPTOMS
Doctors and neurological disease experts believe that, in addition to memory disorders, Korsakoff syndrome is at the origin of other equally important symptoms and signs, such as:
- Confabulation . It is a psychiatric disorder for which sufferers build false memories, referring to situations or events that never really happened.
It usually arises during the early stages of the disease and, according to experts, it would be a way to fill memory gaps.
- Mental confusion .
- Sudden personality changes .
- Apathy, or reduction of behaviors aimed at a purpose, due to an absence of motivation.
- Little participation during conversations.
WHAT MAKES MEMORY LOSSES?
From the autopsies performed on Korsakoff syndrome patients, the presence of brain lesions and signs of atrophy at the level of the dorsal nuclei of the thalamus, of the mammillary bodies of the diencephalon and of the hypothalamus emerged.
All these anatomical regions of the central nervous system are involved in one way or another in the memory process and this explains why a patient with Korsakoff's syndrome manifests various types of amnesia.
DOES THE INTELLECTIVE QUOTE SUBJECT ALTERATIONS?
According to some studies, the intellectual system of people with Korsakoff syndrome would be unaffected, although there is damage to the brain structure.
WERNICKE-KORSAKOFF SYNDROME
As anticipated, Korsakoff syndrome is associated with discrete frequency with a particular neurological pathology, called Wernicke's encephalopathy .
Typically characterized by ophthalmoplegia, ataxia and mental confusion, Wernicke's encephalopathy has at least a couple of aspects in common with Korsakoff's syndrome. In fact, in a similar way to the latter:
- It arises due to insufficient intake of vitamin B1 through the diet.
- It is particularly common among alcoholics and malnourished people.
According to some statistical surveys, the simultaneous presence of Wernicke's encephalopathy and Korsakoff's syndrome - a condition previously defined as Wernicke-Korsakoff syndrome - would result in about 80% of high-level alcoholics .
Other studies report lower frequencies, such as one case per 8 people suffering from alcoholism.
Other symptoms of Wernicke's encephalopathy:
- Amblyopia, pupil abnormalities, retinal hemorrhage, papilledema and vision loss
- Hearing loss
- Apathy, irritability, drowsiness, tiredness and slowing of movements
- Depression, psychosis
- Lactic acidosis
- Hypothermia, hyperhidrosis and polyneuropathies
- Dysphagia, sleep apnea, epilepsy and stupor
- Cardiovascular disorders
- (Final stage of the disease) Spastic paralysis, choreic dyskinesia and coma
Diagnosis
At the moment, there is no laboratory or brain test to verify if a person suffers from Korsakoff syndrome or another form of dementia.
This explains why doctors, dealing with a suspected case of Korsakoff syndrome, base their research first on a thorough physical examination (does the patient feed properly?) And on a questionnaire to assess the disorders of the memory and any dependence on alcohol.
IF THE PATIENT IS AN ALCOHOLIST
If the patient is an alcoholic, a valid diagnostic tool to detect Korsakoff syndrome is to observe the results of alcohol detoxification .
In fact, if the patient were to show improvements from the neurological point of view, it would mean that he suffers from temporary dementia, different for example from Alzheimer's disease.
Treatment
The therapy for those suffering from Korsakoff syndrome mainly involves the administration of high doses of thiamine (even more than 100 mg) and the adoption of a healthy and complete diet from the nutritional point of view.
For alcoholics, failure to adopt such a countermeasure (even in the presence of appropriate thiamine administration) makes it impossible to achieve any form of healing.
MODE? OF ADMINISTRATION OF THE THIAMIN
At least in the first phase of treatment, vitamin B1 must be administered, intravenously or intramuscularly (parenteral routes), from 2 to 3 times a day. Generally, injection doses should not exceed 100 mg.
If higher amounts are required, additional administrations (another 50 mg) must be taken by mouth, as high doses of thiamine parenterally can trigger serious anaphylactic reactions.
Once the initial phase of therapy has been passed, doctors gradually reduce the dose of thiamine and use only oral administrations.
Vitamin B1 injections could also last for 12 months .
High doses of thiamine should be accompanied with glucose injections
If given in high quantities, thiamine could damage the body's cells. To avoid this, vitamin B1 injections are often accompanied by glucose injections.
NUTRITIONAL SUPPLEMENTS
If the patient is severely malnourished, he may need external supplements to:
- Magnesium
- Cobalamin (vitamin B12)
- Ascorbic acid
- Folic acid
- Nicotinamide (vitamin B3)
- Zinc
- Phosphorus
- Taurine
RECOVER THE MEMORY
For retrograde amnesia and in general all memory disorders, there is a particular form of rehabilitation aimed at recovering past memories.
Several patients who use them get good results.
TREATMENT IN CASE OF WERNICKE-KORSAKOFF SYNDROME
The treatment envisaged for patients with Wernicke-Korsakoff syndrome is almost entirely similar to that just described for the Korsakoff syndrome alone.
The only difference is an addition to vitamin B1-based therapy, consisting in the administration of anti - inflammatories for the treatment of edema in various parts of the body (papilledema in particular).
Prognosis
Unlike many other forms of dementia (vascular dementia, Alzheimer's disease, etc.), Korsakoff's syndrome is potentially reversible .
Indeed, the analysis of a large number of cases showed that:
- 25% of patients recovered completely, showing a complete recovery of neurological abilities.
- 50% of the patients recovered partially, still reporting some cognitive deficits.
- 25% of the patients showed no signs of recovery.
According to some studies, the ability to recover depends on the timeliness of the diagnosis - later the disease is diagnosed, the more difficult it is to completely recover the neurological faculties - and from the putting into practice of appropriate treatments (for example, the lack of detoxification from alcohol can affect decisively on the poor outcome of the therapy).
RECOVERY TIMES
Recovery times are generally very long.In fact, even those who respond very positively to therapy do not recover before two years have passed since the beginning of treatment.
Indeed, patients were observed for whom it was necessary to wait 10 years.
Prevention
Especially in countries of the so-called Western world, where alcoholism is the main cause, Korsakoff's syndrome can be largely prevented by following a healthy lifestyle.
