Wernicke-Korsakoff Syndrome: a treatable memory disorder
9 November 2020
We most often associate the symptoms of dementia with high-profile conditions such as Alzheimer’s disease or Parkinson’s. But dementia comes in many forms, and has many causes.
Wernicke-Korsakoff Syndrome (WKS) is a fascinating type of dementia, as it is one of the few types that is actually preventable and treatable.
WKS is most often associated with alcoholism and, as a condition, falls victim to the stigma alcoholics often experience. But alcohol is just part of the story of this syndrome.
WKS is the combination of two diseases occurring simultaneously: Wernicke’s disease and Korsakoff syndrome. People develop Wernicke’s disease due to poor diet, which can then progress into Korsakoff syndrome.
You may be familiar with Wernicke’s disease by its other name, Wernicke encephalopathy. A deficiency in vitamin B1 (thiamine) can cause areas of damage to the brain known as lesions. This is because thiamine is important for generating energy in the brain for brain cells to function. When brain cells don’t get enough energy to work, they can die, resulting in lesions. These brain lesions are what cause the symptoms of Wernicke’s disease: for example, visual problems like double vision, drooping eyelids and erratic horizontal and vertical eye movements. Wernicke’s disease is also characterised by difficulties in muscle coordination and confusion, which can make people defensive or aggressive.
Roughly 80% of patients with Wernicke’s disease will develop Korsakoff syndrome. Symptoms of Korsakoff syndrome are similar to other types of dementia. They include memory loss as well as an inability to form new memories, resulting in retrograde amnesia – that is, forgetting things that happen after the disease has developed. Other symptoms include hallucinations, exaggerated storytelling, and difficulties understanding language and communicating.
Links to other conditions
Alcoholism is the leading cause of WKS because alcoholics often have a poor diet and alcohol impedes the absorption and storage of vitamin B1. However, because thiamine deficiency underpins WKS rather than the alcohol directly, other conditions can also cause WKS, albeit less commonly. Eating disorders such as anorexia are associated with WKS because patients don’t consume enough nutrients, specifically vitamin B1. People who have had gastric bypass surgery to restrict how much they can eat are at risk for a similar reason. Gastric cancer can also cause WKS because, even though the person may be eating enough nutrients, the cancer prevents them from being completely absorbed.
Treatment and prevention
WKS should be treated immediately after diagnosis to give the best chance of effectively alleviating symptoms and preventing disease progression. The key is for the intervention to occur before permanent damage has been done to the brain. Once a patient has Korsakoff syndrome, most of the time irreversible damage has already occurred.
The initial treatment is to give the patient a vitamin B1 injection, as this is the fastest method of administration. After that, vitamin B1 can be prescribed as a tablet alongside nutritional support to maintain a diet rich in vitamin B1. Foods containing high levels of vitamin B1 include peas, rice, milk, nuts, seeds, oranges and spinach.
Ultimately, the most effective long-term treatment is to address the underlying cause of the vitamin deficiency: so, treating the alcoholism or eating disorder with support and rehabilitation, or enhancing the cancer treatment. Charities such as Alcohol Change UK and We Are With You can help people with alcohol dependency to reduce their drinking, while Beat Eating Disorders and Anorexia & Bulimia Care support people with eating disorders.