Korsakoff Syndrome: inventing memories to compensate forgetfulness

 

Korsakoff syndrome is a memory problem that is usually due to alcohol abuse or overly restrictive diets that lead to vitamin deficiency. Find out here what it consists of, what are its main symptoms, causes, treatment and how we prevent it.

Korsakoff Syndrome

Korsakoff Syndrome

What is the Korsakoff Syndrome?

Korsakoff syndrome is a chronic memory disorder due to severe deficiency of thiamine, or vitamin B1.

Thiamin helps the brain produce energy from sugar. When levels fall drastically brain cells can’t generate enough energy to function properly and as a result, Korsakoff syndrome can develop.

It is believed that this deficiency causes damage to the thalamus and mammillary bodies of the hypothalamus. Mammillary bodies are brain parts or small structures with many connections to the hippocampus (an area closely related to memory). There is also general brain atrophy, loss, and neuronal damage.

Research has shown that this deficiency alters the substances responsible for transmitting signals between brain cells and storing memories. These alterations can destroy neurons and cause bleeding and microscopic scars throughout the brain tissue.

This syndrome is often, but not always, preceded by an episode of Wernicke’s encephalopathy. This consists of an acute reaction of the brain due to a severe lack of thiamine. Wernicke’s encephalopathy is a medical emergency that causes severe life-threatening brain disturbance, mental confusion, uncoordinated movement and abnormal and involuntary eye movements. Because Korsakoff syndrome is commonly preceded by an episode of Wernicke’s encephalopathy, the chronic disorder is sometimes called Wernicke-Korsakoff syndrome. However, Korsakoff can develop without a previous episode of this encephalopathy.

Korsakoff Syndrome Symptoms

Korsakoff is characterized by memory problems but retaining consciousness. This may give the impression during conversations that he is in full possession of his faculties.

However, he has severe alterations in recent memory. The person will ask the same questions over and over again, read the same page for hours, and is not able to recognize the people they have seen several times in the course of his illness.

Memory problems can be very severe, both short-term memory and long-term memory with many memory gaps or memory loss, while other skills such as social or thoughts may be relatively intact.

The main symptoms are:

  • Anterograde amnesia: inability to form new memories or learn new information.
  • Retrograde amnesia: severe loss of existing memories, prior to the beginning of the disease.
  • Confabulations: invented memories that are believed by the individual himself as real because of memory gaps.
  • Conversation with low content.
  • Lack of introspection.
  • Apathy.

Individuals with Korsakoff syndrome may show different symptoms. In some cases, a patient may continue to “live in the past”, convinced that his life and the world remain unchanged since the beginning of the disorder.

Others may display a wide variety of confabulations. Retrograde amnesia does not happen to all memories alike but affects more in recent events. The older the memories, the more they remain intact. This may be because recent memories are not fully consolidated in our brains, therefore, being more vulnerable to their loss.

Confabulations in Korsakoff Syndrome

One of the most characteristic symptoms of people with Korsakoff syndrome is the confabulations. They often “collude” or invent information they can’t remember. It is not that they are “lying”, but actually believe their invented explanations. There is still no agreed scientific explanation as to why this happens.

Korsakoff Syndrome-

Korsakoff Syndrome-Confabulations

Some people may show constant, even frenetic, conspiracies. They continually invent new identities, with detailed and convincing stories that support them, to replace the reality they have forgotten.

Causes of Korsakoff Syndrome

We know that excessive intake of alcohol can harm our nervous system. In fact, in most cases, Korsakoff’s syndrome is due to alcohol abuse and its consequences on our brain.

Research has identified some genetic variations that may increase the risk of this disorder. In addition, poor nutrition can also be an important factor.

Korsakoff syndrome can also be caused by eating disorders, such as anorexia, overly restrictive diets, starvation, or sudden weight loss after surgery. Also by uncontrolled vomiting, HIV virus, chronic infection or cancer that has spread throughout the body.

Treatment of Korsakoff Syndrome

Intervention for Korsakoff syndrome should be approached from a multidisciplinary point of view, in which doctors, psychologists, and neuropsychologists will work to achieve the best results.

Some experts recommend that people who consume large amounts of alcohol or have other risks of thiamine deficiency, take oral supplements, always under the supervision of a doctor.

It is also recommended that anyone who has had a history of alcohol abuse or symptoms associated with Wernicke’s encephalopathy be injected with thiamine. For people who develop Korsakoff Syndrome, treatment with oral thiamine, other vitamins and magnesium may increase the chances of symptoms improving.

 Korsakoff Syndrome

Medical Treatment of Korsakoff Syndrome

A psychological intervention will revolve around maintaining alcohol abstinence. From the neuropsychological point of view, it will help to compensate for their deficits, so that the patient can integrate socially and lead a life as normal as possible. CogniFit is a tool that trains different cognitive skills affected by Korsakoff Syndrome. 

Prognosis of Korsakoff syndrome

Some data suggest that about 25 percent of people with Korsakoff syndrome recover, half improve but don’t fully recover, and another 25 percent remain the same.

According to these researchers, the mortality rate is high, between 10 and 20%. This is mainly due to lung infection, septicemia, liver decompensation disorder and an irreversible thiamine deficiency state.

Early attention and treatment for Korsakoff symptoms is very important. Early treatment of Wernicke’s encephalopathies may improve prognosis and prevent Korsakoff’s syndrome. For example, eye problems begin to improve in hours or days, motor problems, in days or weeks. Although some 60% of patients may have some residual symptoms.

According to these authors, once the Korsakoff syndrome has been established, the prognosis is quite pessimistic. Approximately 80% of patients are left with a chronic memory disorder. These can get to learn simple and repetitive tasks that involve procedural memory (motor memory).

Cognitive recovery is slow and incomplete and reaches its highest level of recovery after one year of treatment. Although recovery may occur, it depends on factors such as age or alcohol withdrawal.

Tips for Preventing Korsakoff Syndrome

Korsakoff Syndrome

Tips for Preventing Korsakoff Syndrome

The primary advice is to reduce your alcohol intake to a minimum. The less alcohol, the better. Although we think that drink very little, the fact is that even in small amounts, we are already damaging our body.

  • A healthy and non-restrictive diet will ensure the synthesis of the vitamins needed to function properly and in particular thiamine or B1.
  • Go to the doctor whenever we detect memory problems. He will establish if it is a problem associated with normal aging or some kind of dementia.
  • Maintain a good support system, since loved ones will be of help in case any disturbing symptoms appear.
  • If you think you drink more than you do and don’t know how to quit, go to a professional who will help you reduce your alcohol intake.

Feel free to leave a comment below.

This article is originally in Spanish written by Andrea García Cerdán.

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.