(Amnesia in) Korsakoff Syndrome

A summary of causes and physiological processes

As for many different psychopathologies, I was introduced to the Korsakoff Syndrome through Oliver Sacks’ literature. Noticing how many of his former patients were suffering from interesting but nevertheless very tragic symptoms I tried to explore the syndrome in order to understand some of the underlying factors that form the causes and symptomatology of this tragic diagnosis. When looking for a specific explanation of the Korsakoff Syndrome it is noticeable that there are some differences and disagreements throughout the many definitions. Therefore it is preferable to make a general and superficial definition of the Syndrome. The Korsakoff Syndrome can be defined as a neuropsychiatric syndrome as it falls into the category of both neurology and psychiatry. The disease is found in patients that have previously suffered from a Wernicke’s encephalophaty which is characterized by symptoms like amnesia, cognitive and behavioral dysfunctions, the Wernicke’s encephalophaty and the Korsakoff syndrome are often screened together as they only differ in details.  

The main cause of the syndrome seems to be a thiamine deficiency which in general leads to tiredness, memory problems, decreased physical and mental performance. Thiamine is also known as vitamin B1, this vitamin is essential in the production of triphosphate (ATP) a molecule that is important and necessary to transport energy within cells.

In the specific case of the Korsakoff Syndrome the main symptoms are  different forms of amnesia which show themselves in different forms of memory loss or altering. This leads to a severe inability to learn or form new memories, confabulation (the person makes up stories), loss of memory and hallucinations (the person sees or hear things that are not actually there). The confusion and loss of mental activity can ultimately progress to coma or death. Physically speaking there can also be a loss of coordination in the muscle movement that is called ataxia and often becomes visible by severe leg tremor. Abnormal eye movement can be another symptom, the patient might have a strange back and forth movement in the eye that is called nystagmus, drooping eyelids and having a double vision also count as symptoms of the syndrome.

As said before, the main reason for a Wernicke’s encephalophaty (which if untreated leads to the Korsakoff syndrome) is a thiamine deficiency which can be caused by chronic alcohol abuse. The Korsakoff syndrome is almost always associated with alcohol abuse but we have to clarify that every process or happening that leads to a thiamine deficiency can be a trigger for a Wernicke’s encephalophaty and ultimately for the Korsakoff syndrome. Other known causes for the syndrome are eating disorders like for example bulimia, chronic vomiting (through different causes), psychiatric disorders, cancer and chemotherapy which is often used to treat cancer patients. Common findings in cases of Korsakoff syndrome have been damage in the periaqueductal (gray matter located around the cerebral aqueduct) and paraventricular (nucleus in the hypothalamus) grey matter, atrophy in the mammillary bodies and thalamus, volume deficits in the hippocampus, cerebellar hemispheres, pons, and anterior superior vermis.

References

Covell, T., & Siddiqui, W. (2021). Korsakoff Syndrome. PubMed. https://pubmed.ncbi.nlm.nih.gov/30969676/

Vasan, S., & Kuma, A. (2021, August 11). Wernicke Encephalopathy. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK470344/