Korsakoff syndrome, also called Wernicke-Korsakoff syndrome, is a neurological disorder caused by a severe lack of thiamine, or vitamin B1. Thiamine is essential for helping the body turn food into energy.
This condition develops in two phases, starting with Wernicke encephalopathy, which can cause confusion, tremors, and muscle weakness. If this first phase is not treated, it can progress to Korsakoff syndrome, which mainly affects long-term memory.
Treatment for Korsakoff syndrome involves replacing vitamin B1 and managing complications. It works best when started early, as problems with memory and learning are often permanent.
Main symptoms
The main symptoms of Korsakoff syndrome are:
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Difficulty remembering the past and forming new memories
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Making up stories to fill gaps in memory
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Difficulty planning, organizing, and making decisions
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Repeating actions or speech
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Lack of motivation and apathy
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Sudden mood changes
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Hallucinations
These symptoms appear when the previous phase, known as Wernicke encephalopathy, is not treated properly.
In this early phase, the person may already have confusion, difficulty communicating, poor coordination, tremors, and muscle weakness.
According to the National Institute on Alcohol Abuse and Alcoholism, Wernicke’s disease can also cause low blood pressure and vision problems, such as abnormal eye movements or double vision.
Confirming a diagnosis
Korsakoff syndrome is usually diagnosed by a neurologist based on the person’s symptoms, health history, and physical exam.
The doctor may order blood tests to check thiamine levels, transketolase activity, serum albumin levels, and a complete blood count (CBC). These tests can help identify nutritional deficiencies and related complications.
In people with a history of alcohol use, liver function tests (LFTs), blood alcohol testing, and drug screening may also be done.
Imaging tests, such as an MRI or CT scan, may also be used to confirm the diagnosis or rule out other neurological causes.
Main causes
The main cause of Korsakoff syndrome is vitamin B1 deficiency, which can occur due to:
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Chronic alcohol use, which affects the absorption, storage, and use of thiamine
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Gastrointestinal diseases, such as inflammation in the intestines or stomach
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Surgical procedures, including bariatric surgery
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Some medical treatments, such as chemotherapy or long-term use of diuretics
Some health conditions can also lead to thiamine deficiency, such as advanced cancer, HIV infection, kidney failure requiring dialysis, and rare genetic changes.
Treatment options
The acute phase, known as Wernicke encephalopathy, is considered a medical emergency and treatment should be started right away. Care may involve an emergency medicine doctor, neurologist, or primary care doctor, and may also include a specialist in alcohol use disorder when alcohol use is involved.
In the acute phase, vitamin B1 is given directly into a vein or muscle, along with hydration, nutritional support, and, in some cases, care for alcohol use disorder.
In the chronic phase, which is Korsakoff syndrome, vitamin B1 replacement and oral supplements are still recommended, but they usually have little effect on severe memory problems.
At this stage, treatment is based on the person’s symptoms and may include cognitive rehabilitation therapy, physical therapy, occupational therapy, and psychological or psychiatric follow-up to help manage changes in behavior and mood.
Starting treatment quickly is essential to relieve symptoms, reduce complications, and prevent permanent damage, which may include irreversible brain injury.
Can Korsakoff syndrome be cured?
Korsakoff syndrome has no cure. Treatment may lead to some improvement, especially when started early, but damage to memory and learning ability is usually permanent.
In the initial phase, called Wernicke encephalopathy, treatment can reverse many symptoms, such as confusion, vision changes, and problems with motor coordination.