Korsakoff's syndrome

Korsakov's syndrome, also known in medicine as Korsakov's psychosis, is considered a type of amnestic syndrome. It develops due to a deficiency of vitamin B1. The disease received its name in honor of the Russian psychiatrist S. Korsakov.

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Causes Korsakoff's syndrome

The cause of this syndrome is an insufficient amount of vitamin B1 in the body. It most often manifests itself in people who have been abusing alcoholic beverages for many years. In addition, Korsakov's syndrome can also be detected in patients with hypoxia or severe brain injuries due to poor nutrition. In rare cases, the disease manifests itself after surgery on the temporal part of the head to treat epilepsy.

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Risk factors

The risk of developing this disease increases significantly in the presence of certain risk factors. As a rule, they are all related to eating habits and the state of health:

1. Dialysis.
2. Previous chemotherapy.
3. Old age.
4. Extreme diets.
5. Genetic predisposition.

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Pathogenesis

This syndrome is caused by vitamin B1 deficiency in the human body. This vitamin is a cofactor of some other enzymes, in particular pyruvate dehydrogenase, transketolase, alpha-ketoglutarate dehydrogenase. When the body lacks vitamin B1, this leads to a strong decrease in the utilization of glucose by neurons and damage to the mitochondria.

A decrease in the activity of alpha-ketoglutarate dehydrogenase, as well as a significant energy deficit, leads to the accumulation of glutamate in the human body, and this, in turn, leads to a neurotoxic effect.

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Symptoms Korsakoff's syndrome

There are six symptoms that are the main ones for Korsakoff's syndrome:

1. Amnesia, which is of a fixation nature, that is, a person is unable to remember the events that occurred in the recent past or today. But memories of childhood and youth remain very good. The patient's memory perfectly stores all the events that happened before the onset of the syndrome.
2. Disorientation based on amnesia. It affects space, time, and the skills that a person has acquired throughout his or her life. Such people often cannot live without the care and attention of others.
3. "Invented memories" or confabulation - when gaps appear in memory, the patient tries to fill them with invented events. When memories become unlike reality, we can talk about the development of psychosis.
4. Cryptomnesia is a condition in which events from films or books appear in place of memory gaps, replacing real events.
5. Contemporary events in the patient's memory are replaced by events from his past.
6. The person is unable to carry on a meaningful conversation.

Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome is one of the types of alcoholic psychosis, which can be chronic or manifest as acute alcohol intoxication.

With this syndrome, the patient develops two conditions at once: acute Wernicke's encephalopathy and chronic Korsakov's syndrome. Psychiatrists combine them into one disease, since they are very rarely found separately in alcoholism.

The main symptoms of Wernicke-Korsakoff syndrome are the following three signs:

1. Paralysis of the eye muscles - ophthalmoplegia.
2. A person does not control his movements – ataxia.
3. The patient's consciousness becomes confused.

Often people with Wernicke-Korsakoff syndrome are very inhibited, they cannot make even the simplest conclusions or think logically. They often remember all the details from their past, but at the same time they cannot remember what happened to them a minute ago. If the patient tries to look straight ahead, he begins to feel dizzy and nauseous.

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Complications and consequences

It should be understood that brain damage in some cases is irreversible. Even with timely and correct treatment, patients with Korsakov's syndrome are forever left with fixation memory loss and complications of thinking. About 30-40% of all patients remain disabled.

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Diagnostics Korsakoff's syndrome

To establish a correct diagnosis, it is necessary to conduct diagnostics and differentiation. The basis of diagnostics is the study of the anamnesis (tumors, alcoholism), a thorough study of clinical symptoms.

If the patient has at least one sign indicating a vitamin B1 deficiency, the diagnosis is made without any doubt. For correct diagnosis, a general blood test and liver function tests are used. The doctor also examines the patient, examines his memory (tests are conducted to memorize words, arbitrary and mechanical memorization).

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Tests

The following laboratory tests are carried out:

1. A test to determine the amount of albumin in the blood serum - if its level is too low, this indicates poor nutrition, liver and kidney dysfunction.
2. Analysis to determine the level of vitamin B1 is carried out together with a general blood test.
3. A test for the activity of the enzyme transketolase in red blood cells (erythrocytes). If the activity is reduced, then there is a deficiency of vitamin B1 in the body.

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Instrumental diagnostics

In some cases, specialists use instrumental methods to diagnose Korsakov's syndrome:

1. ECG (electrocardiography) – with its help you can see how much the patient’s condition has changed after taking vitamin B1.
2. CT (computed tomography) – it is used to detect disturbances in the cerebral cortex, which are often found in Wernicke-Korsakoff syndrome.
3. MRI (magnetic resonance imaging) – shows ischemic and hemorrhagic damage that is atypical for Korsakoff syndrome.

Differential diagnosis

It is worth understanding that this syndrome can arise not only against the background of alcohol dependence. Therefore, it is very important to differentiate it from similar syndromes: delirium, dementia and amnestic syndromes that are not associated with the use of alcoholic beverages.

Treatment Korsakoff's syndrome

The treatment is carried out in a hospital, since during the therapy it is necessary not only to use medications, but also to have the help of a psychologist. If the treatment is effective, the first positive results can be seen no earlier than two years after the start of therapy. The patient's recovery is always a very long process.

In some cases, patients are also offered complex subject training during treatment. This is a rehabilitation method and is called "disappearing cue". The use of memory medications is ineffective. Alcohol is absolutely prohibited during and after therapy.

Medicines

Parenteral administration of glucose. Glucose solution is a detoxifying and rehydrating agent based on dextrose monohydrate.

Glucose takes part in metabolic processes in the human body, helps to enhance recovery and oxidation processes, improve liver and heart function. The solution is injected into a vein at a rate of no more than 7.5 ml per minute. The standard dose for adult patients is up to 3000 ml per day.

For patients with decreased glucose tolerance, decompensated diabetes mellitus, hyperglycemia, hyperlactacidemia and in hyperosmolar coma, the drug is prohibited to be administered. In some cases, negative consequences may develop: thrombophlebitis, hypervolemia, hyperglycemia, bruising, fever, infections, polyuria, allergy.

Vitamins

Treatment of Korsakoff syndrome requires intravenous vitamin B1 (thiamine) therapy. To obtain a positive effect from such therapy, it must be carried out for 3-12 months (depending on the severity). However, only in 20% of cases are memory loss and dysfunction in the brain reversible.

As a rule, combined administration of IM and IV injections with vitamin B1 is used 3 times a day for 2-3 days. If the patient responds adequately to the therapy, the injections are continued. To achieve a clinically significant effect, treatment with 1 gram of thiamine is sometimes used.

For long-term maintenance therapy, oral administration of B vitamins, in particular B1, is used. All these measures must be combined with proper nutrition.

Thiamine. Available in the form of injection solution and capsules. The daily required dose of vitamin B: for adult men - up to 2.1 mg, for the elderly - up to 1.4 mg, for adult women - up to 1.5 mg, for children - up to 1.5 mg.

Parenteral administration of thiamine usually begins with a small dose. If the patient has demonstrated good tolerance to the drug, the dose is gradually increased. The dosage is prescribed by the attending physician, but is usually as follows: for injections up to 50 mg every day once every 24 hours. For tablets: up to 10 mg from one to five times per 24 hours. Duration of administration is up to forty days.

Patients with thiamine intolerance are prohibited from taking the drug. Sometimes the following symptoms may appear: urticaria, rash, itching, allergy, tachycardia, anaphylactic shock.

Prevention

The best method of preventing this syndrome is constant monitoring of the content of vitamin B1 and thiamine in the blood serum. It is also important not to abuse alcoholic beverages, lead a healthy lifestyle, and eat right.

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Forecast

The prognosis of this disease depends very much on the degree of its progression. The earlier you start treatment, the more favorable the prognosis will be. Korsakov's syndrome without proper therapy often ends in death. As a rule, death occurs due to infectious lung diseases, septicemia, irreversible organic damage to the brain.

If the patient begins timely treatment, improvements occur in the following areas:

1. Vision is restored within a couple of hours or several days.
2. Coordination of movements improves after a few weeks
3. Consciousness returns to the patient within a few weeks.

To restore mental functions and memory, the patient must completely give up drinking alcohol. It is very important to eat a balanced diet, which will help control the level of normal thiamine indicators in the future. It is very important to include in your daily diet such products as: peas, rice, lean pork, whole grain bread, milk, oranges.

If treatment is started too late, the prognosis is unfavorable. In 25-40% of cases, patients with Korsakov's syndrome become disabled with behavioral problems and mental retardation. The disease is more severe if it is accompanied by other concomitant diseases of the brain.

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