Korsakoff’s Syndrome

What is Korsakoff’s Syndrome?

Korsakoff’s Syndrome is a neurological disorder thought to be primarily attributable to alcohol abuse, which decreases the amount of thiamine or vitamin B1 in a person’s brain. The condition is known by several other names, including alcoholic encephalopathy, alcohol amnestic syndrome, and Korsakoff’s Psychosis, but all of these refer to the same condition which primarily affects middle-aged men between the ages of 45 and 65.

Research shows that continued exposure to alcohol abuse makes a person much more at risk to developing Korsakoff’s Syndrome, although it is also possible to develop it because of an unhealthy diet. Many times, homeless people and alcoholics are the most common victims of Korsakoff’s Syndrome, because alcohol abuse tends to be a hallmark of those two lifestyles.

In total, roughly 2% of the total population of the US is in some way affected by Korsakoff’s Syndrome, and the prevalence of the condition globally is roughly in line with that same figure. It is possible to diagnose Korsakoff’s Syndrome via psychological tests and memory tests, which to be accurate, must be administered after a person has abstained from alcohol for a reasonable period of time.

Korsakoff’s Syndrome Symptoms

The fact that Korsakoff’s Syndrome is caused by a deficiency of thiamine in the brain causes a general cerebral atrophy over a long period of time, and while this condition itself is not externally visible, it causes some classic symptoms which are.

One of these shows up as a lack of coordination, commonly manifested as a difficulty in maintaining balance, even to the point where walking in a straight line becomes problematic. Most other movements of the body are affected as well, including all those more involved activities such as exercise and other physical pursuits. For this reason, victims commonly refrain from such actions, preferring the relative stability of inactivity.

Mental confusion is another characteristic of Korsakoff’s Syndrome, with the victim having difficulty concentrating on anything for more than a brief period. Persistent drowsiness is another hallmark of the condition, especially at those times not normally associated with sleeping. Daytime naps and extended sleeping are common symptoms of someone suffering from the syndrome.

As Korsakoff’s Syndrome obtains a greater hold on a person, it becomes more likely that personality changes are exhibited, and the affected person could become much different than he/she was prior to the onset of the syndrome. People have been known to morph into almost completely different individuals when Korsakoff’s has taken hold of their lives.

Indifference is another general symptom which may be observed, even when a person is presented with fairly sharp stimuli. Actions which might normally trigger a reflex response in others are sometimes completely ignored by Korsakoff’s victims, and lethargy sometimes even appears as something akin to paralysis.

It often becomes very difficult for someone with Korsakoff’s Syndrome to digest new information about any topic, or to store it for later use. Learning skills are also generally disrupted, and it becomes much harder for an afflicted person to observe and retain information about the world surrounding him/her.

One of the most obvious symptoms of Korsakoff’s Syndrome is the difficulty experienced by a victim in trying to remember things. In addition to these obvious memory lapses, people afflicted by Korsakoff’s will sometimes unknowingly try to insert unrelated events and images from their past into memory gaps, thereby distorting their own perception of personal history. This kind of confusion of fact and memory is the reason for the condition sometimes being referred to as Korsakoff’s Psychosis, since it is sometimes manifested as a fairly delusional representation of personal history by the victim.

Causes of Korsakoff’s Syndrome

The immediate cause of Korsakoff’s Syndrome is a pronounced deficiency of vitamin B1 or thiamine. Since the brain and the entire nervous system are enormously impacted by the lack of thiamine, ripple effects are immediately felt in the thalamus and hypothalamus of the brain, and any damage there eventually results in cerebral atrophy.

There are generally two classes of individuals who are most at risk of developing Korsakoff’s Syndrome because of this thiamine deficiency. As mentioned above, alcoholics are prime candidates for developing the syndrome, and the other huge risk pool is those people suffering from chronic malnutrition, since they lack the proper nutrients from a steady food supply. This is very common in third world countries, where proper diet is quite often problematic, and where famines occur with relative regularity.

To a much lesser extent, there are other causes of Korsakoff’s Syndrome, although these tend to be temporary in nature rather than chronic, so that true Korsakoff’s does not really have a prolonged period to set in. One of these lesser causes occurs during severe cases of vomiting in a difficult pregnancy, which can effectively drain the body temporarily of critical vitamin B1 supplies. Another infrequent cause of Korsakoff’s Syndrome occurs in individuals who, for whatever reason, have a fluid-only diet, and do not take in the necessary amounts of thiamine required by the brain for efficient operation.

In any case, all known causes of Korsakoff’s Syndrome are traceable to a severe deficiency of thiamine or vitamin B1, which means that all of them could have been prevented, if there were no such deficiency in a person’s diet.

Treatments for Korsakoff’s Syndrome

Treatments for Korsakoff’s Syndrome will be met with varying degrees of success, depending on how far advanced it is in specific individuals. In cases where the condition has been in place for a long period of time, damage to the brain is often severe enough that it cannot be reversed, and the best that can be hoped for is to avoid further damage.

If diagnosed and treated early enough, it is possible to reverse the damage done by Korsakoff’s Syndrome, so as to allow a victim to recover a more or less normal life. In all cases, when Korsakoff’s Syndrome is diagnosed, treatment should begin immediately, under the close supervision of a family doctor or medical team.

It may also be necessary upon diagnosis to hospitalize the individual in question, either because brain damage has become so severe, or because the severe lack of vitamin B1 has caused other system failures within the body. Treatment will include an immediate infusion of vitamin B1 intravenously, most often via the arm or the hand. In situations where this is undesirable for whatever reason, it can also be orally administered.

In conjunction with this infusion of thiamine, a balanced diet should immediately be instituted for the individual, so that the body becomes used to normal ingestion of needed nutrients again. At times, some patients will exhibit a highly negative reaction to the sudden infusion of thiamine, because they have been so long without it.

This is more common from alcoholic patients rather than malnutrition patients, and the reactions exhibited can include severe sweating, agitation, confusion, insomnia, and even episodes of hallucination. When these negative reactions occur, a much more gradual program of thiamine introduction must be adopted, so as to avoid rejection by the body.

Treatment is extremely critical when Korsakoff’s Syndrome is diagnosed, because without proper treatment, mortality rates are very high among those afflicted. The most common causes of death are infections occurring in the lungs, blood poisoning, and irreversible brain damage. However, if treatment is undertaken in time, victims will notice rapid improvement in any vision problems, muscle coordination, and confusion or disorientation.

Part of the treatment for Korsakoff’s Syndrome involves a complete abstinence from drinking alcohol, and if an afflicted person remains faithful to this commitment, he/she can expect to also recover memory functions, as well as at least some of any lost or inhibited mental function.

Treatment can sometimes be complicated in individuals where Korsakoff’s Syndrome has had a considerable amount of time to cause damage to mental faculties and or physical abilities. For instance, treatment is made considerably more difficult with alcoholics, because they can be expected to go through alcohol withdrawal, and that can be fairly unpleasant for all concerned.

People afflicted by Korsakoff’s can also have great difficulty with personal interaction, and it’s just that kind of personal interaction which is necessary for some aspects of the treatment process.

There can also be permanent loss of cognitive skills and loss of memory in some victims, and that will certainly make recovery more difficult, and less likely to achieve a full state of normalcy.

It’s even possible that people afflicted by Korsakoff’s will have sustained various physical injuries due to their persistent state of confusion, as well as their lack of coordination and ambulatory skills.

Prevention of Korsakoff’s Syndrome

Since there are, generally speaking, two main causes of Korsakoff’s Syndrome, there are also two main routes which prevention can take in order to conquer these causes. In the case of alcoholism, prolonged excessive intake of alcohol must be avoided at all costs. There are, of course, many other problems associated with alcoholism which make it extremely desirable for someone afflicted to discard the habit.

If those other undesirable results aren’t enough to motivate a victim to sober up, the fact that Korsakoff’s can develop into irreversible brain damage and eventually cause death should be a sufficiently motivating factor. This is, in fact, one of the non-negotiable treatment tactics which will be used to help anyone who has been diagnosed with Korsakoff’s Syndrome, since the damage from alcohol has to be stopped before positive results can be seen.

Anyone who begins to develop one or more of the symptoms described earlier in this discussion would be well advised to take it upon themselves to prevent further progress of Korsakoff’s Syndrome by weaning themselves away from alcohol, either gradually or cold turkey.

In the case of people afflicted by Korsakoff’s Syndrome due to malnutrition, the solution is generally not quite so obvious, nor is it easy to put into practice. For the millions of people living in countries where undernourishment is a way of life, options are simply not available for the immediate reversal of malnutrition and the establishment of a healthy diet.

Many world agencies have undertaken trying and providing relief to countries where such conditions prevail, but the number of people involved makes it nearly impossible to reach all of them to improve dietary intake. In addition, many of these people are not easily accessible and live in relatively remote locations, far from good food sources. It is to be hoped that at some point in the future, efforts to improve the diets of undernourished citizens of the globe will become more effective and more widespread, so that this particular cause of Korsakoff’s can be wiped out.

Last Reviewed:
September 18, 2017
Last Updated:
September 18, 2017