Korsakoff syndrome

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Korsakov's syndrome (Korsakov's disease) is a brain disease that manifests itself primarily through severe memory impairment. Occurring memory gaps usually fill those affected with invented content (confabulating). The disease mostly occurs in people who have consumed too much alcohol for years. The disorders are usually not completely reversible, even with professional therapy. Read more about the Korsakoff syndrome - symptoms, diagnosis and therapy here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F10

Korsakoff syndrome: description

Korsakov's syndrome is a brain disease that severely reduces memory performance: those affected usually appear confused and disoriented to outsiders and fill any memory gaps that occur with freely invented facts (confabulating).

In the vast majority of cases, Korsakoff's syndrome is the result of longstanding alcohol abuse. In this context, Korsakoff's syndrome is usually preceded by inflammation of the brain (Wernicke encephalopathy), which is also caused by excessive alcohol consumption. Since the symptoms of both diseases are sometimes closely related and Wernicke-Korsakow syndrome often follows Wernicke encephalopathy, doctors summarize both diseases under the term Wernicke-Korsakow syndrome.

However, Korsakoff syndrome can also arise from causes other than alcohol abuse, such as severe head injuries or inflammation of the brain (encephalitis).

Consistent treatment can improve symptoms in some people with Korsakoff's syndrome. However, radical success is only possible with a small proportion of the patients. A very long-standing Korsakoff syndrome with severe deficits is unlikely to be treatable.

Korsakoff syndrome: symptoms

Patients with Korsakoff's syndrome show clear signs of what is known as amnestic syndrome. The term “amnesic syndrome” covers various disorders and changes in the brain that mainly affect memory.

Therefore, people with Korsakoff syndrome often make a very confused and disoriented impression on their fellow human beings. For example, you are not or hardly able to remember new information. What has just been said or discussed with one another may have "disappeared" a moment later. Often people with Korsakoff syndrome also forget things that happened earlier: They may not know where they are (for example in the hospital), what this person in their room (the doctor) wants from them or what their name is - even if they are have been in the hospital for several days / weeks and the doctor treats them several times a day. It may also be the case that you cannot or can hardly remember the time immediately before the onset of Korsakoff's syndrome or admission to the hospital.

In some cases, the so-called old memory is also affected by Korsakov's disease: this is how doctors refer to the memory in which events that occurred further back are stored. In this case, those affected can sometimes no longer remember biographically significant things, for example the death of a loved one or a separation.

Characteristic for people with Korsakoff syndrome is their strong tendency to fill gaps in their memory with freely invented content (confabulating). Patients then respond, for example, to the question of what they did the day before, that they went shopping in town - even if they have been in the hospital continuously for weeks. The doctor suddenly becomes a tax advisor (and the hospital becomes a tax office) because the patient no longer recognizes him as a doctor and fills this gap with other means. The person concerned is not aware of this process and is therefore not done on purpose; so it is not a matter of conscious lying or deceiving.

In addition to these symptoms, Korsakoff syndrome can also affect the personality of those affected. Sick people can appear inappropriately euphoric or distant, but they can also be very depressed and passive.

Korsakoff syndrome: causes and risk factors

Korsakoff syndrome with vitamin B1 deficiency

As a rule, Korsakoff's syndrome is mainly caused by people who have had alcohol problems for a long time. At first, a certain form of encephalitis develops, a so-called Wernicke encephalopathy, which then leads to Korsakoff syndrome. Doctors also speak of a Wernicke-Korsakoff syndrome in this context. The cause of Wernicke encephalopathy is a severe deficiency in vitamin B1 (thiamine), which gradually damages the brain. Doctors assume that those affected subsequently develop Korsakoff syndrome if certain hereditary conditions are met.

A vitamin B1 deficiency occurs in people who are severely alcoholic because, apart from alcoholic beverages, they often do not consume any or almost no food. Thiamine deficiency occurs rather rarely in people who are mildly alcoholic. There are also other diseases that can lead to a vitamin B1 deficiency: These include severe eating disorders, malignant changes in the gastrointestinal tract and diseases of the kidneys. People who are fed by IV fluids in hospital are also at risk of severe vitamin B1 deficiency under certain circumstances. This is particularly the case if the thiamine level has already been severely reduced due to alcohol abuse, eating disorders or other illnesses before the start of the infusion.

Other causes of Korsakoff syndrome

Korsakoff's syndrome (Korsakov's disease) can occur even without a previous vitamin B deficiency. For example, severe head injuries, strokes, malignant changes and / or surgical interventions on the head as well as inflammation of the brain caused by viruses can also lead to Korsakoff syndrome.

Korsakov syndrome: examinations and diagnosis

A conversation with the patient and possibly relatives / carers is often enough for the doctor to suspect Korsakoff syndrome. Particularly in the case of known alcohol dependency and a previous Wernicke encephalopathy, the assumption is that Korsakoff syndrome is present. However, previous head injuries and operations as well as encephalitis from other causes in the medical history can guide the doctor in diagnosing Korsakov's disease.

People who are known to be alcoholic should receive vitamin B1 before the final diagnosis is made in order to treat any (still) existing Wernicke encephalopathy. Since Korsakov's syndrome often results from Wernicke encephalopathy and the two diseases can overlap, the steps to diagnose Wernicke encephalopathy may also be useful. These include a comprehensive blood test, a brain wave measurement (EEG) and an examination of the spinal cord fluid (liquor diagnostics).

In order to rule out other diseases such as malignant growths in the head, strokes, viral infections of the brain and brain damage from other causes, the doctor evaluates images of the skull area (computed tomography, CT and / or magnetic resonance imaging, MRI).

Korsakoff syndrome: treatment

If Korsakoff syndrome was triggered by Wernicke encephalopathy (Wernicke-Korsakoff syndrome), the administration of vitamin B1 can partially help to alleviate the symptoms. Diseases underlying Wernicke-Korsakoff syndrome, such as alcoholism or eating disorders, should also be treated.

Otherwise, further treatment depends on the patient's individual problems. For example, psychotherapeutic or psychiatric treatment can be helpful. The aim here is always to enable the patient to cope with everyday life as well as possible despite illness-related deficits.

Korsakoff Syndrome: Prevention

Korsakoff's syndrome can have many different causes and not all of them can be prevented. However, people with drinking problems or eating disorders can significantly reduce their chances of developing Korsakoff syndrome by seeking medical treatment. In this way, you can significantly reduce the risk of Wernicke encephalopathy, which often occurs as a result of vitamin B1 deficiency in alcoholic and eating disorders. This also prevents Korsakov's syndrome, a common long-term consequence of Wernicke's encephalopathy.

Korsakoff syndrome: disease course and prognosis

Korsakoff's syndrome is a chronic disease that in most cases does not go away completely. After the administration of vitamin B1, the general condition improves significantly in about one in seven patients. It is important for the prognosis whether underlying diseases such as alcohol addiction or eating disorders can be overcome in the long term.

Many people with Korsakoff syndrome are so impaired in their abilities that they can no longer lead an independent life without help.

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