Korsakoff Syndrome

Korsakoff syndrome is a chronic amnestic state following Wernicke encephalopathy, with severe anterograde and retrograde amnesia.

• Occurs in up to 80% of survivors of untreated Wernicke encephalopathy; alcohol related in most.

• Damage to mamillary bodies, anterior thalamic nuclei and the diencephalic memory circuit.

• Course is usually chronic; partial recovery in 20%.

• Dense anterograde amnesia (inability to form new memories), retrograde amnesia with temporal gradient.

• Confabulation (fabricated memories), lack of insight, apathy.

• Relatively preserved immediate memory, attention, and intelligence.

• Peripheral neuropathy, cerebellar signs may persist.

• Clinical, with history of Wernicke encephalopathy or alcohol misuse.

• Neuropsychological testing: impaired delayed recall, intact digit span.

• MRI: mamillary body atrophy, thalamic and cerebellar vermis atrophy, frontal atrophy.

• Exclude Alzheimer disease, hippocampal amnesia, subdural haematoma, encephalitis, normal pressure hydrocephalus, vitamin B12 deficiency.

• Thiamine and nutritional assessment.

• Thiamine 100 mg orally two to three times daily long term (after IV treatment), plus a multivitamin.

• Abstinence from alcohol (relapse prevention: acamprosate 666 mg three times daily, naltrexone 50 mg daily, psychosocial support).

• Cognitive rehabilitation and structured routines, memory aids, errorless learning.

• Supervised living or residential care for severe cases; capacity assessment and legal safeguards.

• Treat depression, malnutrition and neuropathy.

• No effective drug therapy for the amnesia (cholinesterase inhibitors and memantine have uncertain benefit).