Alcohol and Alcoholism Advance Access originally published online on January 16, 2009
Alcohol and Alcoholism 2009 44(2):148-154; doi:10.1093/alcalc/agn118
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The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment
1 King's College London, Institute of Psychiatry, London, UK
2 Molecular Psychiatry Laboratory, Windeyer Institute of Medical Sciences, Research Department of Mental Health Sciences, University College London, London Medical School, 46 Cleveland Street, London W1T 4JF ( United Kingdom)
3 Bexley Substance Misuse Service, South London and Maudsley NHS Trust, London ( United Kingdom)
* Corresponding author: Academic Unit of Neuropsychiatry, Adamson Centre, 3rd Floor, South Wing, St Thomas's Hospital, Westminster Bridge Road, London SE1 7EH, UK. Tel: +44 (0)20 7188 5396; Fax: +44 (0)20 7633 0061; E-mail: michael.kopelman{at}kcl.ac.uk
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Abstract |
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Aims: The Korsakoff syndrome is a preventable memory disorder that usually emerges (although not always) in the aftermath of an episode of Wernicke's encephalopathy. The present paper reviews the clinical and scientific literature on this disorder. Methods: A systematic review of the clinical and scientific literature on Wernicke's encephalopathy and the alcoholic Korsakoff syndrome. Results: The Korsakoff syndrome is most commonly associated with chronic alcohol misuse, and some heavy drinkers may have a genetic predisposition to developing the syndrome. The characteristic neuropathology includes neuronal loss, micro-haemorrhages and gliosis in the paraventricular and peri-aqueductal grey matter. Lesions in the mammillary bodies, the mammillo-thalamic tract and the anterior thalamus may be more important to memory dysfunction than lesions in the medial dorsal nucleus of the thalamus. Episodic memory is severely affected in the Korsakoff syndrome, and the learning of new semantic memories is variably affected. ‘Implicit’ aspects of memory are preserved. These patients are often first encountered in general hospital settings where they can occupy acute medical beds for lengthy periods. Abstinence is the cornerstone of any rehabilitation programme. Korsakoff patients are capable of new learning, particularly if they live in a calm and well-structured environment and if new information is cued. There are few long-term follow-up studies, but these patients are reported to have a normal life expectancy if they remain abstinent from alcohol. Conclusions: Although we now have substantial knowledge about the nature of this disorder, scientific questions (e.g. regarding the underlying genetics) remain. More particularly, there is a dearth of appropriate long-term care facilities for these patients, given that empirical research has shown that good practice has beneficial effects.