The name “Wernicke Korsakoff syndrome” can be described as collection of symptoms produced due to the effects of long-term alcohol consumption. It can also be described as spectrum of disease caused due to thiamine deficiency. The symptoms of this disorder resemble ataxia and amnesia. People with WK syndrome will forget the events that happened recently having short term memory loss.
Since the syndrome was initially described by Karl Wernicke, a German neurologist in 1881, this disorder was named after him. It was first named as Wernicke encephalopathy. This disorder is included in the category of amnestic disorders, caused by substance or alcohol abuse.
Symptoms :
People with WK syndrome can remember about the past events since the memories are stored in deep regions of the brain. But the problem is they forget the events and things that happened recently (within minutes). The brain would not be able to store memories of new information.
The symptoms of people with WK syndrome differ depending on the intensity of brain damage. Those with alcohol abuse can have confusion, weakness, changes in vision and loss of muscle coordination. It can cause double vision, blurred vision or drooping of eyelids for some people. They tend to forget any new information shared with them. However they are fully alert mentally and can talk fluently and perform social habits without any problem.
Characteristic Features of WK Syndrome :
Initial stage of WK encephalopathy patients would show confusion of thoughts and disturbed eye movement with ataxia which can occur due to severe alcohol consumption also. But if the intoxication effects remain even after hours it can be due to WK syndrome.
In the final stage of WK syndrome patients would show anterograde amnesia with severe memory loss. Reterograde amnesia is described as memory loss of past events and anterograde amnesia is loss of memory of recent events. Another interesting symptom of WK syndrome is confabulation. It is also called falsification of memory wherein the person would build up stories for his memory loss.
How far it is prevalent?
- WK syndrome has been increasing significantly in recent times due to increased chronic alcohol consumption.
- Almost 10-20% of the cases with dementia happen to occur due to alcohol related issue.
- Aged people, who are drinking for long term, are susceptible to this disorder.
Causes :
- WK syndrome can occur due to alcohol abuse which can lead to thiamine deficiency.
- The rate of thiamine deficiency may vary in individuals.
- If thiamine is not absorbed in your blood properly it can cause thiamine deficiency. If thiamine is not utilized properly in the cells it can cause this problem.
- One cannot predict which region of the brain gets affected due to thiamine deficiency.
- Certain medical conditions like thyrotoxicosis, intense spread of cancerous cells in the body and repeated dialysis can cause thiamine deficiency.
- AIDS and hyperemesis gravidarum can also cause this problem.
- People who have undergone bariatric surgery (weight loss surgery) should monitor their thiamine levels for several months since it can reduce thiamine to large extent.
Diagnosis :
It is difficult to detect WK syndrome since the symptoms resemble many other psychiatric disorders. The doctor will have to collect complete history of the patient, his/her drinking habit and health related issues. He would complete physical exam, paying close attention to eyes, reflex reaction and muscle atrophy. He would test his mental ability to recollect simple information or ask to perform a new task that requires memory.
Based on observation, he may order for blood test, to check cholesterol level, glucose level and serum thiamine level. Urine test is to be done to check alcohol level in urine. Lumbar puncture is done to detect any CNS infection. Further testing is to be done to detect encephalopathy.
Treatment :
It is challenging to treat patients with WK syndrome. A team of experts are to be involved for treatment, since experts from various disciplines like psychiatry, neurology, dietician and therapist for stopping alcohol would be involved. Depending on the health condition of the patient, he/she would be hospitalized or accommodated in specialized home to provide flexible service.
For patients with severe thiamine deficiency supplementary thiamine is to be given intravenously or orally. Prompt medical care can save the patient from going into amnesia. In many cases thiamine supplement has shown improved performance of memory testing. For improving memory, doctors may prescribe donepezil or rivastigmine which can block the breakdown of acetylcholine thus retaining the memory. Some doctors use classical conditioning method for these patients for remembering things.
Outlook :
Recovery (in full) is not possible with WK syndrome patients, especially those who are with anterograde amnesia. Most of the patients will lose the ability to remember any new information and cannot even perform daily tasks on their own. They are to be treated in some kind of home and involved in performing easy tasks that they can remember before the onset of illness.
Prevention :
Since chronic usage of alcohol is the main cause of WK syndrome, it can be prevented with guidance and medications. Long term alcohol users should be advised about taking supplementary thiamine to prevent this disorder.