Signs of Wernicke-Korsakoff Syndrome or Alcohol Dementia

Wernicke-Korsakoff syndrome (also called alcohol dementia) is a set of neurological conditions that result from a thiamine (vitamin B1) deficiency. It's often caused by alcohol abuse but may be caused by other chronic conditions as well.

When someone is deficient in thiamine, the brain is less able to process sugar into energy that it can use to function. This, in turn, may lead to the development of symptoms of dementia, including confusion and memory loss. Wernicke-Korsakoff syndrome can significantly affect life expectancy and needs immediate treatment.

Wernicke-Korsakoff syndrome consists of two separate conditions: Wernicke encephalopathy, which develops first, and then Korsakoff syndrome, which often presents as the symptoms of Wernicke encephalopathy are subsiding.

This article discusses the signs of Wernicke-Korsakoff syndrome, its prevalence, and risk factors. It also covers what diagnostic tests are used, how it's managed, and what the life expectancy is.

Signs of Wernicke Encephalopathy

Symptoms of Wernicke encephalopathy include:

• Confusion
• Leg tremors
• Staggering
• Decreased muscle coordination
• Vision and eye changes (including eyelid drooping, double vision, and abnormal back and forth eye movements)

Wernicke encephalopathy symptoms are often categorized as a triad of ocular (eye), cerebellar (balance and body control), and confusion symptoms.

Wernicke encephalopathy is a condition that requires immediate medical attention and with appropriate treatment, can be reversible.

Signs of Korsakoff Syndrome

Symptoms of Korsakoff syndrome consist of:

• Memory loss (including the ability to retrieve old memories and the ability to form new ones),
• Hallucinations
• Confabulation (making up stories)

Korsakoff syndrome is usually a chronic condition that typically, but not always, follows an episode of Wernicke encephalopathy.

How Common Is Wernicke-Korsakoff Syndrome?

It's difficult to know how common Wernicke-Korsakoff syndrome is, as research indicates that it is significantly under-diagnosed. One study published in 2009 references the rate as about 1%–2% of the general population and 12%–14% in those who abuse alcohol. However, its diagnosis is frequently missed as evidenced by a higher identification of the disorder in brain autopsies than during life.

Risks for Wernicke-Korsakoff Syndrome

The most common risk for Wernicke-Korsakoff syndrome is alcohol abuse, but it can also be triggered by AIDS, cancer, chronic infections, kidney dialysis, anorexia, and the inability of the body to absorb nutrients from food. Interestingly, the risk is also increased after bariatric surgery for obesity.

Some cases of Wernicke encephalopathy may also be brought on by extreme dieting which prevents the body from receiving the nutrients it needs to maintain healthy functioning.

Diagnostic Tests for Wernicke-Korsakoff Syndrome

In order to diagnose Wernicke encephalopathy, thiamine levels in the person's blood should be tested. Thiamine is also known as vitamin B1. 

There is no single test for Wernicke-Korsakoff syndrome. Instead, it is diagnosed by ruling out other conditions. The evaluation may include cognitive assessments, blood tests, and neurological screenings to evaluate eye movement, muscle strength, and coordination. MRIs may also be used to identify the lesions in the brain that may develop as a result of the disease.

Some cases of non-alcoholic Wernicke encephalopathy have been missed because other medical conditions are present, such as severe bipolar disorder or schizophrenia that caused eating disorders. Testing for thiamine disorders when acute confusion and disorientation is present is critical to identification and appropriate treatment.

Treatment and Management of Wernicke-Korsakoff Syndrome

Wernicke encephalopathy requires immediate treatment which usually consists of high doses of thiamine given intravenously. Some research indicates that when Wernicke encephalopathy is due to alcohol misuse, the person may require a higher dosage of thiamine than when it develops from other causes.

Ongoing treatment for Wernicke-Korsakoff syndrome includes abstinence from alcohol, adequate nutrition, and vitamin supplementation.

Life Expectancy of Wernicke-Korsakoff Syndrome

The prognosis for Wernicke-Korsakoff syndrome is varied. With appropriate treatment, the Alzheimer's Association estimates that approximately 25% of people will recover completely, about half will improve but not regain full functioning, and about 25% will remain about the same.

Any improvement in functioning usually occurs within the first two years after the symptoms began. Life expectancy may remain normal if the person does not drink alcohol.

According to the Merck Manuals, about 10%–20% of people with untreated Wernicke encephalopathy will not survive. However, with treatment, the prognosis of Wernicke-Korsakoff syndrome is far superior when compared to that of Alzheimer's disease and other types of dementia whose declines are chronic and progressive, despite attempts of treatment.

Summary

Wernicke-Korsakoff syndrome, also called alcohol dementia, is a set of conditions that can cause symptoms of confusion, memory loss, and disorientation, as well as physical signs such as muscle weakness and eye movement problems. It's caused by a deficiency in thiamine, which can lead to symptoms of dementia.

The most common risk factor for Wernicke-Korsakoff Syndrome is alcohol abuse, but it can also be triggered by AIDS, cancer, chronic infections, kidney dialysis, and anorexia. Diagnostic tests include cognitive assessments, blood tests, and neurological screenings.

Wernicke-Korsakoff syndrome requires immediate treatment with high doses of thiamine. With treatment, about 25% of people recover completely. Without treatment, about 10-20% of patients won't survive.