KORSAKOFF SYNDROME
Description
● Definition:
A severe thiamine (vitamin B1) deficiency is the cause of Korsakoff Syndrome, a chronic neuropsychiatric condition that is most frequently linked to long-term alcohol abuse but can also be brought on by chronic sickness, continuous vomiting, starvation, or eating disorders.
Known as Wernicke–Korsakoff syndrome (WKS), it often develops as Wernicke's encephalopathy progresses.
● Case presentation:
➣Patient: a guy 65-year-old
➣Previous history: Roux-en-Y hepaticojejunostomy followed by radiation for cholangiocellular carcinoma (Klatskin tumour)
➣Issues:
developed blockage of the gastric outlet
After being diagnosed with peritoneal carcinomatosis, a palliative gastrojejunostomy was performed.
➣Nutrition: Total parenteral nutrition (TPN) was given since the patient was unable to accept oral food.
Day 10 of the hospital course:
Reduced reactivity to spoken cues
Horizontal nystagmus on both sides
Fatigue and confusion
Confabulation
➣Diagnosis: imaging plus clinical Treatment of Wernicke's encephalopathy: Intravenous thiamine replenishment began
➣Result: By Day 2, the encephalopathy had regressed (orientation regained).
Within a month, imaging anomalies were almost completely gone.
Pathophysiology:
In areas of the brain important for memory and learning, thiamine deficiency damages neurones and affects glucose metabolism.
➣ Affected regions include the thalamus (mediodorsal nucleus), the mammillary bodies (atrophy is common), the hippocampal connections, and the cerebellum (affected coordination).
Amnestic syndrome with executive impairment and confabulation is the outcome.
● Causes and Aetiology:
➣ Chronic alcohol abuse (the most prevalent cause) – disrupts the absorption, storage, and utilisation of thiamine;
➣ Malnutrition – anorexia nervosa, starvation, and prolonged fasting;
➣ Chronic illness – AIDS, cancer, dialysis, and hyperemesis gravidarum;
➣ Absorption is impaired by post-bariatric surgery or gastrointestinal disorders.
● Clinical Features:
➣ Amnestic Syndrome Core Symptoms
➣ The incapacity to create new memories is known as anterograde amnesia.
➣ The loss of prior memories (patchy) is known as retrograde amnesia.
➣ Confabulation is the unintentional creation of tales to fill in memory voids.
➣ Disorientation, particularly in the short term.
➣ Apathy is characterised by a lack of initiative and emotional apathy.
● Related Cognitive Impairments
Reduced focus and attention; learning challenges; and impaired executive function (planning, problem-solving).
➣ Neurological Signs (usually from Wernicke's encephalopathy before)
• Ataxia (disorder of gait and balance).
• Nystagmus or ophthalmoplegia.
• peripheral nerve damage.
●Course:
• Wernicke's encephalopathy (confusion, ataxia, abnormalities of the eyes) in the acute phase.
• Korsakoff syndrome (memory problem, confabulation) is a chronic phase.
• Korsakoff syndrome can become irreversible if left untreated.
●The diagnosis:
➣ Clinical diagnosis—no single test—based on malnutrition or alcohol abuse history.
➣ Cognitive testing: significant memory loss accompanied with retained intellect Mammillary body atrophy, thalamus, cerebellum, and ventricular enlargement on MRI/CT Neuropsychological tests: language and attention are mostly unaffected, but memory is compromised.
● Differential diagnosis: dementias, including Alzheimer's disease.
• Brain damage from trauma.
Delirium.
• Mental health conditions.
●Therapy:
➣ Instant thiamine replacement:
• Intravenous thiamine (before to glucose administration, to prevent Wernicke's disease).
• Oral thiamine maintenance.
➣ Avoiding alcohol is essential for stabilisation and potential recovery.
➣ Nutritional assistance
• Vitamin and mineral-balanced diet.
➣ Support and Rehabilitation
• Rehabilitation of cognition.
Occupational therapy, long-term care, and psychosocial assistance.
Protocol
● Issues That Nurses Face
➣ Memory and Cognitive Problems:
• Severe anterograde and retrograde amnesia: Patients lose track of safety warnings, prescriptions, or instructions.
• Confabulation: False narratives render historical accounts untrustworthy.
• Learning new routines may be challenging and needs frequent reinforcement.
➣ Emotional and behavioural difficulties:
• Apathy → loss of drive, cessation of therapy.
• Aggression or irritability → frustration brought on by memory loss or disorientation.
• Impulsivity and poor judgement increase the risk of self-harm, wandering, or dangerous behaviour.
• Physical and neurological issues include ataxia and neuropathy, which raise the risk of accidents and falls.
• Dehydration and malnutrition can cause people to overlook basic self-care.
➣Problems with compliance include:
• Inadequate adherence to diet, therapy, and alcohol abstinence.
• Memory loss and social neglect that makes follow-up difficult to attend.
➣ Ethical and Social Issues:
• Stigma.
•Caregivers' stress and family strain.
• Ethical quandaries that arise when people decline treatment yet are incapable of doing so.
● Nursing Management in Korsakoff Syndrome:
➣ Immediate/Medical Care
•Administer thiamine (as prescribed, usually IV before glucose).
•Monitor for signs of Wernicke’s encephalopathy (confusion, ataxia, eye signs).
•Manage comorbidities: liver disease, malnutrition, electrolyte imbalance.
➣ Cognitive & Behavioral Support
•Use simple, clear instructions, repeated often.
•Provide orientation cues: clocks, calendars, signboards, photos.
•Establish structured daily routines to reduce confusion.
•Encourage participation in memory aids (notebooks, alarms).
•Address confabulation calmly without confrontation.
➣ Safety Measures
•Prevent falls: safe environment, assistive devices, supervision if needed.
•Monitor nutrition and hydration status closely.
•Observe for risky behaviors (wandering, impulsivity).
➣ Psychosocial Support
•Encourage alcohol abstinence → involve support groups (AA, counseling).
•Provide emotional support to reduce apathy and depression.
•Educate family/caregivers about memory deficits, expected prognosis, and coping strategies.
➣ Long-Term Care & Rehabilitation
•Nutritional counseling and balanced diet.
•Occupational therapy for daily living activities.
•Cognitive rehabilitation programs (relearning skills, memory training).
•Referral to community services and long-term care facilities if needed.
Notes
https://doi.org/10.1097/MD.0000000000031904