Alcohol Affected Dementia/Wernicke-Korsakoff Syndrome

Wernicke's encephalopathy (WE) is an acute neurological illness caused by severe deficiency of the vitamin thiamine (vitamin B1). It can occur suddenly and is characterized by problems with the eyes, problems with gait and balance, and an overall perplexed state. Alcoholism is usually the cause of thiamine deficiency but case of WE can also be attributed to anorexia nervosa and disorders associated with high levels of vomiting. Because the chronic memory loss of Korsakoff syndrome often follows an episode of Wernicke encephalopathy, the chronic disorder is sometimes known as Wernicke-Korsakoff syndrome. But Korsakoff syndrome can also develop in individuals who have not had a prior episode of Wernicke encephalopathy. Korsakoff syndrome also can be caused by anorexia, overly-stringent dieting, fasting, starvation or weight-loss surgery; uncontrolled vomiting; AIDS; kidney dialysis; chronic infection; or cancer that has spread throughout the body. In those who develop Korsakoff syndrome, with or without a preceding episode of Wernicke encephalopathy, there are few studies on long-term outcomes. Available data suggest that about 25 percent of those who develop Korsakoff syndrome eventually recover, about half improve but don't recover completely, and about 25 percent remain unchanged. Some research suggests that those who recover from an episode may have a normal life expectancy if they abstain from alcohol.

Signs & Symptoms:

  • Problems with the eyes include disorders of their control of direction, coordination and movement
  • Problems with gait and a loss of balance or equilibrium called ataxia
  • A global confused state where the person is apathetic, has little awareness of their immediate situation
  • Difficulties with space, attention and concentration
  • Inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thining and social skills are relatively unaffected. For example, individuals may seem able to carry on a coherent conversation, but moments later be unable to recall that the converation took place or to whom they spoke
  • May "confabulate," or make up, information they can't remember. They are not "lying" but may actually believe their invented explanations. Scientists don't yet understand why Korsakoff syndrome may cause confabulation

Total population figures for the prevalence have proved very difficult to estimate (Blansjaar et al, 1992). In the Hague, the Netherlands gave a prevalence figure of 48 per 100,000 total population. Australia estimated there are 6.5 per 100,000 new cases each year.

Tips for First Responders:

  • You may find you may have made a traffic stop where the driver has (Wernicke) Korsakoff syndrome. If the driver seems to have difficulty understanding you, or if their explanation of why they were in violation of the law seems extremely odd, consider an evaluation for this medical condition.
  • If you have apprehended someone whose behavior seems to fulfill the symptoms of this syndrome, consider requesting hospitalization
  • Turn off lights and sirens as soon as possible
  • Speak slowly and clearly
  • Use "adult" words, but ask questions one at a time, rather than asking multiple part questions
  • Ask the individual if s/he wears a medic alert device (this may tell you where they live)
  • Maintain a calm manner; this may help the individual to relax if s/he is anxious

Sources: Moriyama, Y., Mimura, M., Kato, M., & Kashima, H., "Primary alcohol dementia and alcohol-related dementia," 2006; Isenberg-Grzeda, E., Kutner, H. E., & Nicolson, S. E., "Wernicke-Korsakoff Syndrome: Under-Recognized and Under-Treated," 2012.