Wernicke-Korsakoff syndrome: Symptoms, causes, and treatment

Wernicke-Korsakoff syndrome is a neurodegenerative disorder. It is the result of a deficiency of vitamin B-1, also known as thiamine.

A common cause of Wernicke-Korsakoff syndrome (WKS) is the heavy, regular consumption of alcohol over an extended period, but stomach surgery, severe intestinal problems, cancer, and malnutrition can also lead to its development.

Researchers disagree on whether WKS consists of two separate but related disorders, or if its symptoms are the spectrum of a single disorder.

Some believe Wernicke’s to be the initial, onset phase and Korsakoff syndrome to be the chronic, long-term state. Wernicke’s encephalopathy often leads to Korsakoff syndrome even after treatment.

Various difficulties in thought processing and changes in the nervous system characterize WKS. Without early treatment, it can lead to permanent brain damage and death.

In this article, we look at the symptoms, causes, and treatment of WKS.

Symptoms

Most people with WKS first develop Wernicke’s encephalopathy first, and later develop Korsakoff syndrome. Below we outline the symptoms of each condition:

Wernicke’s encephalopathy

confused person
WKS can lead to confusion and memory loss.

Wernicke’s encephalopathy (WE) is a type of brain injury that classically causes three main problems:

vision problems

confusion

difficulty walking

A deficiency of thiamine causes WE. Every cell in the body requires thiamine, and humans cannot produce it, so all sources of the vitamin must be dietary. The heart, brain, kidney, and liver require especially high levels of thiamine.

When thiamine is not available in high enough amounts, the body cannot perform basic and necessary cell functions. This leads to the health problems that constitute WE.

Brain cells are particularly sensitive to low levels of thiamine, which is why many of the symptoms of WE present as neurological.

An individual with WE may experience:

confusion

altered mental status

jerky or involuntary eye movements

droopy upper eyelids

double vision

poor balance and difficulty walking

Often, individuals with WE may appear malnourished and underweight. They may also experience low blood pressure, heart problems, and low body temperature.

The symptoms of WE vary between people, which makes it difficult to diagnose. The coordination issues and physical effects of WE can also resemble those of alcohol intoxication, so heavy drinking may mask WE.

Without treatment, WE might progress to coma, and it can be fatal in some people.

Korsakoff syndrome

Memory loss and problems managing day-to-day tasks are key features of Korsakoff syndrome (KS).

People with KS often experience difficulties in learning new information. The person may also unintentionally make up information that bridges the gaps in their memory. Doctors refer to this as confabulation.

Some people have described confabulation as forming false memories, but these do not form part of a deliberate deception on the part of the person with KS. The brain unconsciously attempts to fill gaps in memory.

Problems with short-term memory can lead problems with making new memories and recalling recent events. An individual with KS may undergo personality changes, showing apathy and a lack of concern or displaying talkative and repetitive behavior.

The symptoms of KS may gradually improve over time, but an estimated 25 percent of people with KS experience a permanent form of the condition.

WE and KS relate to each other in the following ways:

WE often occurs before KS develops.

As KS symptoms increase, WE symptoms tend to decrease.

If a person successfully receives treatment for WE, KS may not develop.

alcohol leads to WKS
Regular, heavy alcohol intake can lead to WKS.

WKS is most common among people with alcohol use disorder. Thiamine deficiency is a common effect of heavy, regular alcohol consumption.

Individuals whose bodies do not absorb nutrients efficiently, who are malnourished, or who fast for a long time may experience thiamine deficiency as well.

Heavy drinking is often accompanied by poor diet, but alcohol also interferes with the proper absorption of nutrients from the digestive system. Thiamine is needed by the body to convert food into energy. It is stored in small quantities in the liver, but only for up to 18 days.

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