Korsakoff's syndrome: causes, signs and manifestations, diagnosis, how to treat, prognosis

Korsakoff syndrome is a psychopathology that is a type of amnesia and is manifested by loss of short-term memory, retention of long-term memory, disorientation in space and time, and the presence of false memories . The pathology is caused by a lack of thiamine in the body, alcohol abuse, traumatic head injury, and organic brain damage. Severe deficiency of vitamin B1 leads to damage to the hypothalamus and severe amnestic disorders.

The disease was first described by the Russian professor of psychiatry S.S. Korsakov in 1887, which is how it got its name. The scientist determined that the cause of encephalopathy and polyneuritis is chronic alcoholism. Other researchers, several years after Korsakov’s discovery, proved that this disorder develops with various organic lesions of the brain.

Patients with Korsakoff's syndrome do not remember current events and stop thinking and reasoning sensibly. They retain memory of the past, and their orientation in time, space and the surrounding reality is disturbed. Patients tell fictitious life stories that never happened. With this pathology, along with memory impairment, polyneuropathies occur, leading to dulling of all types of sensitivity, the development of paralysis and paresis.

Korsakoff's syndrome is a relatively stable, chronic condition. This is one of the most common diseases that affects older people who abuse strong alcoholic beverages. It is characterized by memory impairment and increasing dementia, lasts up to 15 years and leads to intellectual disability. Impaired memory is not restored, brain activity decreases, and mood changes dramatically.

With severe mechanical damage to the head, Korsakov's syndrome appears and disappears suddenly. A transient form of pathology can also develop with head injury, carbon monoxide poisoning, and postoperative psychosis. The prognosis is considered favorable if the patient has not reached 60 years of age.

Manifestations of Korsakov's syndrome

According to medical reference books and a large psychological encyclopedia, the main symptom of this disease is the inability of a sick person to remember and reproduce new information (fixation amnesia). Everything that happened before the illness was well preserved in memory. A person’s consciousness does not record events that happened with his participation very recently or are happening at the moment. Clinically this manifests itself as follows:

• the patient is poorly oriented in space if he finds himself in a new place. While in a hospital, a person is unable to find the room or bed he needs, but at home such problems do not arise. This is because long-term memory works relatively normally. Moving to a new place or simply rearranging furniture can become severe stress for the patient, which can give impetus to the rapid progression of the disease;
• disorientation in time. If a person has been diagnosed with Korsakoff syndrome , then most likely he will not be able to correctly name today's date, month and year. He simply does not understand where he is and what is happening to him;
• in a conversation, the patient mentions events that have never happened to him (confabulation). The patient's stories can be fantastic; you can hear from him that yesterday he fought with monsters in another universe or sailed in a submarine. Those around him consider this to be fiction or an outright lie, but the patient himself has no idea that he is telling a lie;
• events that have ever taken place in a person’s life are shifted in time space (pseudo-reminiscences). In this way, memory gaps are involuntarily filled. A person’s stories are quite ordinary in nature; he can say that yesterday he went to the theater for a new production or went out of town. But in fact, these events happened much earlier;
• replacing gaps in memory with events from movies or books. The patient has some information, but he does not know when and how he received it. For example, he can pass off a poem he once memorized as his own work. Over time, the sick person perceives other people's thoughts as his own.
• Concentration is difficult, willpower is reduced.

Korsakoff's syndrome is often accompanied by retrograde or anterograde amnesia. The patient's emotional state is unstable. Lethargy, indifference and apathy are replaced by complacency and euphoria.

Amnestic syndrome in alcoholism

The disease is named after the Russian professor of psychiatry S.S. Korsakov, who studied memory disorders in alcoholic polyneuritis. The name of the syndrome comes from the Greek words - the particle of negation "a" and mneme, meaning "memory".

The concept of syndrome means a certain set of clinical signs that characterize a specific disease. Korsakoff's syndrome in alcoholism is a set of symptoms caused by damage to the structures of the limbic system of the brain.

Vitamin B1 deficiency primarily causes changes in the hypothalamus, thalamus, mammillary bodies, leading to severe memory impairment.

Amnestic Korsakoff syndrome is characterized by amnesia:

• retrograde - memories associated with the onset of the disease disappear from memory, but the most distant memories, for example, childhood ones, are preserved;
• fixation – inability to retain current events in memory.

The motivation for actions and the ability to purposefully act in a patient with alcoholism are preserved, but he can, turning away from the interlocutor, forget about the topic of the conversation, and about the interlocutor himself, too.

In Korsakov's syndrome caused by alcoholism, the damage to the limbic system is always bilateral, in which memory impairment is not restored.

Reasons for formation

The development of Korsakoff's syndrome is caused by a lack of thiamine (vitamin B1) in the body. This microelement is involved in the mechanism of formation of nerve impulses and their transmission between individual nerve cells. Disturbances in these metabolic processes lead to the deep structures of the brain suffering.

Such vitamin deficiency, as mentioned above, most often develops as a result of prolonged alcohol consumption, since the body’s absorption of this vital microelement is disrupted. First, the alcoholic develops acute encephalopathy, which, if left untreated, in most cases leads to the development of Korsakoff's syndrome.

Other causes of Korsakoff amnestic syndrome are:

1. Severe head injuries affecting different parts of the brain.
2. Age-related degenerative processes such as Alzheimer's type dementia and Pick's disease.
3. Diseases of the nervous system caused by various infections.
4. Encephalitis of various types.
5. Intoxication of the body, including heavy metals.
6. Diseases of the digestive tract and vomiting that continues for a long time.
7. Constant malnutrition due to alcoholism, the fight against excess weight with the help of debilitating diets or fasting.
8. As a side effect of chemotherapy.
9. The consequence of surgical operations on the temporal lobes, they are performed to treat epilepsy.

All of these neurological diseases affect limbic structures, organic damage to which can cause serious malfunction of the brain.

A case of the development of amnestic syndrome after a patient was bitten by a centipede, which is found in Japan, was also described. Insect venom penetrates various parts of the brain and blocks the processes responsible for the normal functioning of memory.

Korsakoff's amnestic syndrome may not progress for many years, and with timely and competent treatment, regression of the main symptoms is observed.
However, if the disease is ignored, Korsakov's psychosis develops. The patient in this state is completely unable to navigate in time and space, and no longer recognizes the people around him. He has delusional thoughts and ideas, which are immediately erased from memory, and isolated hallucinations may also occur.

Symptoms

The main symptoms of Korsakoff's syndrome:

• fixation amnesia;
• disorientation in time and space;
• false memories.

Fixation amnesia manifests itself as the inability to remember current events. Patients forget who they saw a few minutes ago, what they said, read or heard. They can say hello to the same people several times, repeat questions over and over again, or read one page from a book for several days.

Verbal memory deteriorates the most, figurative memory deteriorates less, and emotional memory suffers virtually no damage. For example, when finding yourself in a situation in which an unpleasant incident occurred, a person becomes angry, but cannot explain what this is connected with. Along with fixation amnesia, memory for events that happened in the past is preserved.

Korsakoff's syndrome is characterized by a pronounced loss of orientation in time: patients cannot name today's date, and in some cases they do not identify the time of year. In addition, many patients are disoriented in their surroundings: they do not remember the location of the rooms in their apartment.

Another component of Korsakoff's syndrome is false memories (paramnesia). They can manifest themselves in such forms as:

• pseudo-reminiscences – replacement of present events with past ones;
• confabulation - adding fictitious elements to real memories;
• cryptomnesia (rarely observed) - the perception of information read, heard or seen as experienced.

Other signs of Korsakoff's syndrome:

• intellectual impairments, which are expressed in stereotyping and monotony of actions, as well as the inability to adequately evaluate one’s judgments;
• decrease in the level of volitional activity.

The symptoms of the disease have some features depending on the age of the patient:

• Children rarely have attacks of paramnesia;
• middle-aged people often arrive in a state of euphoria;
• elderly patients become apathetic and lose track of time.

Diagnostic methods

A diagnosis such as Korsakoff syndrome can be made after detecting signs of vitamin B1 deficiency. A blood test and testing of basic liver functions can indicate a thiamine deficiency. In addition, a general examination of the patient is carried out. However, to make a clinical diagnosis, it is necessary to have a stable symptom - impaired memory function due to prolonged use of alcoholic beverages. Psychological tests for memorizing phrases or individual words help identify memory problems.

For treatment to be successful, it is important at the diagnostic stage to differentiate Korsakov's syndrome from other pathological processes in the nervous system, which can also be caused by alcoholism. It is also important to rule out other disorders that may cause memory problems that are not related to alcohol use. These include: dementia, organic brain damage, depressive disorders, etc.

Non-alcoholic Korsakoff psychosis

Amnestic syndrome can be caused not only by alcohol intake. However, today many consider strong drinks to be the culprits in the development of the disease. Skull injuries and other diseases can also lead to the development of Korsakoff syndrome, but this happens extremely rarely. Treatment of non-alcoholic type syndrome is carried out according to a completely different scheme, so before prescribing complex therapy, it is important for the doctor to make the correct diagnosis, based on the cause of the disease.

Treatment and prevention

Treating Korsakoff syndrome is quite difficult. The success of therapy will depend on many factors, including:

• degree of social adaptation of the patient;
• his age;
• health status;
• duration of alcohol consumption;
• degree of brain damage.

The main problem is that a person who begins to develop Korsakoff's syndrome does not realize it. Memory lapses can also remain invisible to others, since the patient masks them with long statements and florid thoughts. Even after diagnosis, patients often refuse treatment, considering themselves completely healthy people.

Treatment carried out after diagnosis is aimed at eliminating the cause that caused it. If memory defects are the result of alcoholism, then the basis of therapy is drugs containing thiamine and other trace elements that can minimize brain damage.

Nootropic drugs can significantly improve memory, increase the patient’s attentiveness and learning ability. If anxiety and increased excitability are present, the patient may be prescribed antipsychotic drugs in small doses.

Forecast

The prognosis of Korsakoff syndrome is considered favorable and quickly curable if the disease began to develop as a result of trauma to the brain, skull, or subarachnoid hemorrhage. The worst thing for the patient is if the disease begins its active development after a heart attack or during a lack of thiamine in the body. In this case, the victims require hospital treatment.

Attention! Even with proper adherence to the treatment regimen, only 20% of patients are completely cured of Korsakoff syndrome. The treatment will have a positive effect on the health of patients after 12-24 months, during which the treatment should proceed in full. First, the therapy will take place in a hospital, after which the person will need to take medications at home, as well as visit sanatoriums every six months.

Risks and forecasts

It is almost impossible to completely get rid of a disease such as Korsakoff syndrome, since brain damage is often irreversible. But with timely treatment, it is possible to stop the development of the disease, as well as significantly improve the patient’s condition.

Recently, the number of patients with Korsakoff's syndrome has decreased markedly, since thiamine is used in the treatment of alcoholism at all its stages. As a result, it is possible to prevent the development of vitamin B1 deficiency, which is the main cause of amnestic syndrome.

In addition to people leading an antisocial lifestyle and abusing alcohol, people who may be exposed to the following factors are also at risk:

• treatment of cancer using chemotherapy;
• dialysis;
• radical dietary restrictions caused by the desire to lose weight or religious beliefs;
• advanced age;
• genetic predisposition.

Since the disease is based on a certain pattern of behavior, for example, alcoholism or poor nutrition, Korsakoff's syndrome is highly preventable. First of all, it is necessary to limit the consumption of alcoholic beverages, as well as introduce foods containing B vitamins into the diet. The latter is important for all people, since thiamine is necessary for vital processes, but it is not synthesized in the body.

Etiology of the pathological condition

Korsakov's syndrome refers to disorders in the field of psychiatry. The main reason for the development of the anomaly is a deficiency of vitamin B1 (thiamine), which is responsible for the full functioning of the limbic system (pictured), whose responsibilities include:

• coordination of the work of internal organs;
• sense of smell;
• behavioral instincts;
• memory;
• emotionality;
• dream;
• degree of perception;
• attention;
• assimilation and reproduction of new information.

Lack of the vitamin, Beriberi disease, leads to cell death, bleeding from brain vessels (microhemorrhage), and destruction of the myelin sheath of nervous tissue. These negative processes cause a deterioration in intellectual level and memory - so-called mnestic disorders. Korsakoff's disease can be caused by:

1. Wernicke's encephalopathy.
2. Age-related changes (senile, old age).
3. Traumatic brain injuries of varying severity.
4. Impaired blood supply due to prolonged hypoxia (suffocation).
5. Tumors.
6. Complications of infectious diseases.
7. Alcohol poisoning.
8. Long-term toxicosis during pregnancy.
9. Encephalitis of herpetic nature.

Doctor Wernicke, who continued the study of chronic Korsakoff psychosis, expanded the boundaries of etiology, including among the triggers of the disease an acute neurological disorder with a variety of manifestations.