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. It is also common in people whose bodies do not absorb food properly (malabsorption). This can sometimes occur with a chronic illness or after weight-loss (bariatric) surgery.
Korsakoff syndrome causes problems learning new information, inability to remember recent events and long-term memory gaps. Memory difficulties may be strikingly severe while other thinking and social skills are relatively unaffected. For example, individuals may seem able to carry on a coherent conversation but moments later are unable to recall that the conversation took place or with whom they spoke.
Those with Korsakoff syndrome may “confabulate,” or make up, information they can’t remember. They are not “lying” but may actually believe their invented explanations. Scientists don’t yet understand the mechanism by which Korsakoff syndrome may cause confabulation. The person may also see or hear things that are not there (hallucinations).
Korsakoff syndrome is a clinical diagnosis representing a physician’s best judgment about the cause of a person’s symptoms. There are no specific laboratory tests or neuroimaging procedures to confirm that a person has this disorder. The syndrome may sometimes be hard to identify because it may be masked by symptoms of other conditions common among those who misuse alcohol, including intoxication or withdrawal, infection, or head injury.
Experts recommend that a medical workup for memory loss or other cognitive changes always include questions about an individual’s alcohol use. Anyone admitted to the hospital for an alcohol-related condition should be professionally screened for memory loss and cognitive change. The screening should include supplementary questions to assess recent memory. If screening suggests impairment, the person should receive a more detailed cognitive workup.
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 experiences 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. If there is no improvement, consideration should be given to treatment of comorbid deficiencies and medical conditions, and the need for long-term residential care or supportive accommodation.
Abstaining from alcohol and maintaining a healthy diet is a cornerstone of effective long-term treatment. Those with Korsakoff syndrome have a reduced tolerance for alcohol and may be at high risk for further alcohol-related health problems.