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Wernicke-Korsakoff Syndrome

The Centers for Disease Control and Prevention (CDC) reports that about 88,000 people die every year from complications involving alcohol abuse. These complications range from acute problems like alcohol poisoning or serious accidents to chronic health damage like heart disease or liver cancer. Among the potential long-term complications associated with abusing alcohol is wet brain or alcohol-related dementia, common terms for Wernicke-Korsakoff syndrome (WKS). About 1-2 percent of the US population develops WKS, with men between 30 and 70 years old being slightly more affected than women in the same age group.

What Is Wernicke-Korsakoff Syndrome?

Wernicke-Korsakoff syndrome is a combination of two conditions in the brain caused by thiamine, or vitamin B1, deficiency: Wernicke’s encephalopathy and Korsakoff syndrome or Korsakoff’s psychosis. While they are separate conditions with different symptoms, they often co-occur, especially in people who have struggled with long-term alcohol dependence and abuse. However, Wernicke-Korsakoff syndrome can occur because of any underlying cause leading to thiamine deficiency, including bariatric surgery, colon or gastric cancer, or problems with the stomach and intestines, leading to malabsorption of nutrients.

Wernicke’s Encephalopathy

Typically, Wernicke’s encephalopathy develops first, causing damage to the thalamus and hypothalamus. If or when those parts of the brain have been permanently damaged, Korsakoff’s psychosis will begin.

Symptoms associated with Wernicke’s encephalopathy include:

  • Loss of muscle coordination, starting with a leg tremor and leading to progressive ataxia
  • Vision changes, including double vision, eyelid drooping, and abnormal eye motions called nystagmus
  • Alcohol withdrawal symptoms while also appearing drunk
  • Extreme confusion
  • Loss of mental activity, possibly progressing to coma or death

Wernicke’s encephalopathy is the primary condition out of the two in WKS. Although there are instances in which Korsakoff’s psychosis develops first, the brain damage caused by untreated Wernicke’s encephalopathy is more likely to trigger Korsakoff’s psychosis than vice versa. About 80-90 percent of people who develop Wernicke’s encephalopathy develop Korsakoff’s psychosis.

Korsakoff’s Psychosis

Symptoms of Korsakoff’s psychosis include:

  • Inability to remember events or create new memories
  • Loss of previous memories
  • Confabulation, or making up stories to replace lost memories
  • Seeing or hearing things that are not there or experiencing other hallucinations

Once a person develops both these conditions, they are at risk of falling after passing out (syncope), suffering heart problems stemming from rapid heart rate (tachycardia), and low blood pressure when standing (postural hypotension).

Wet Brain, Alcohol-Related Dementia, and Professional Help

The two biggest risk factors for developing Wernicke-Korsakoff syndrome are malnutrition and alcohol abuse, with alcohol use disorder (AUD) being the leading cause of this condition in the developed world. Although the condition sometimes spontaneously clears up on its own, there is a risk that damage can become permanent or lead to death. Harm caused by untreated WKS includes:

Those presenting with any signs of Wernicke’s encephalopathy, Korsakoff’s psychosis, or both should be tested for AUD. Diagnosis of Wernicke-Korsakoff syndrome will include:

  • Serum albumin test that measures a protein in the blood that can indicate problems with kidney or liver problems or malnutrition, which leads to low levels of albumin
  • Serum vitamin B-1 test as low levels of this vitamin will indicate that thiamine deficiency is causing brain damage
  • Brain scans, including a CT scan or MRI, to examine brain regions
  • An electrocardiogram (ECG or EKG) before and after taking thiamine supplements

Treating Wernicke-Korsakoff Syndrome and Underlying Addiction

Drinking too much is usually credited as a direct cause of Wernicke-Korsakoff syndrome. Excessive alcohol intake interferes with how thiamine is absorbed by the gastrointestinal tract and reduces the ability of the liver to store the vitamin. With less B12 available in the body, many organ systems will begin to struggle, especially the brain. About 25 percent of people who develop WKS require long-term treatment in an institutional setting like a hospital; recovery from the condition can take years and requires abstinence from alcohol.

Typically, people who develop WKS and get appropriate medical treatment will receive intravenous thiamine and/or magnesium, and there should be noticeable improvement in mental and physical functioning within two or three weeks. If Wernicke’s encephalopathy is treated before Korsakoff’s psychosis develops, it is impossible to avoid complete Wernicke-Korsakoff syndrome. Although there are few other medical treatments for WKS – perhaps physical and occupational therapy – the most important concurrent medical treatment should be ending physical dependence on alcohol, so the person can remain sober while recovering from the disorder.

Avoiding alcohol is the only way to prevent the development of Wernicke-Korsakoff syndrome associated with abusing this substance. There may be later, unpredictable circumstances leading to the development of WKS, but if you stop drinking, you can prevent Wernicke-Korsakoff syndrome from this cause.

If you worry about your alcohol consumption habits, speak with an addiction specialist, physician, or therapist. Medical professionals can diagnose whether you struggle with AUD or problem drinking based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They can then guide you through how to abstain from alcohol.

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