Korsakoff syndrome

Classification according to ICD-10
F10.6	Mental and behavioral disorders caused by alcohol Amnestic syndrome - Korsakoff psychosis caused by alcohol or other psychotropic substances - Unspecified Korsakoff syndrome
F11.6 - F19.6	Korsakoff syndrome caused by other psychotropic substances
F04	Organic amnesia syndrome, not caused by alcohol or other psychotropic substances
ICD-10 online (WHO version 2019)

The Korsakow syndrome (also Korsakoff syndrome ; synonym: Korsakow symptom circle , Korsakow symptom complex or Korsakow disease ) is a form of amnesia (memory disturbance). A first detailed description was published in 1887 by the Russian psychiatrist and neurologist Sergei Korsakow (1854-1900) on the basis of an examination of 18 alcoholics as a polyneuritic amnesic syndrome .

The alcoholic Korsakoff's syndrome ( ICD  F10.6) is often referred to as variant of the clinical picture in the literature beriberi specified (ICD E51.1), commonly vitamin B ₁ includes -Mangelerkrankungen (ICD E51). According to the ICD , Korsakoff 's syndrome can be caused by other psychotropic substances (ICD F11.6, F12.6,…, F19.6) or in other ways than psychotropic substances (ICD F04: “organic amnesic syndrome ").

Symptoms

Amnesia is at the forefront of the syndrome named after Korsakov . Both the forgetting of old memory contents ( retrograde amnesia ) and the inability to remember new experiences ( anterograde amnesia ) occur. Most of the time, however, it is marked anterograde amnesia and old memories are relatively unaffected. The memory impairment can be so pronounced that it is not possible for the patient to memorize facts for a few seconds. In addition, patients often unconsciously link their gaps in their memory of current events with old memories. Confabulation is less common, i.e. gaps in memory are filled with pure fantasy content . In sum, the impairment of memory often means that patients can no longer find their way around their local and temporal surroundings. In addition to the impaired memory, a number of other psychiatric symptoms can occur. This describes a lack of drive , increased tiredness and extreme fatigue, euphoria and strong emotional fluctuations.

In addition to these symptoms, which are caused by damage to the central nervous system , the peripheral nerves are also affected. A polyneuropathy that typically affects the legs develops . This causes disorders of motor skills and sensitivity . In addition, it also damages the autonomic nervous system. Symptoms such as paleness of the skin or increased cold sensations appear.

Occurrence and causes

Korsakoff's syndrome was first described in chronic alcoholics, but was later also observed in many other brain damage: traumatic brain injury , certain cerebral haemorrhages ( aneurysm of the anterior communicating artery) and other damage to the anterior limbic system , particularly the posterior orbitofrontal cortex . A tumor can also be responsible for this. It can also be used in many toxicoses such as B. carbon monoxide intoxication , encephalitis or infections such as typhus or typhoid .

However, even today, Korsakoff's syndrome is still mainly associated with alcoholism.

Cause thiamine deficiency

Korsakoff syndrome can occur alone or - and this is the typical case - in the course of or in connection with Wernicke encephalopathy (ICD E51.2; Wernicke- Korsakoff syndrome ). Their cause (and even one of their diagnostic criteria - ICD E51) is a thiamine deficiency (vitamin B ₁ deficiency) due to malnutrition (such as starvation in anorexia nervosa ), malnutrition or absorption disorders . The spread of the thiamine deficiency disease beriberi - ICD E51.1 - in East Asia was due to the spread of husked rice as a staple food. If the Wernicke encephalopathy is not treated with thiamine preparations in good time, more and more damage occurs over time, especially in the limbic system , especially in the corpora mamillaria and the hippocampus ; that is, the Wernicke encephalopathy leads to the Korsakoff syndrome, which then also happens with high probability.

Cause alcoholism

Wernicke encephalopathy often occurs in alcoholics , who mainly cover their energy needs with alcohol, as a “precursor” of Korsakov's syndrome. Although a high thiamine content [vitamin B ₁ ] is to be found in brewer's yeast , this is hardly present in the finished product beer, since the yeast is filtered off again during the brewing process; This is different with Hefeweizen . Thus, on the one hand, the thiamine intake is reduced.

In addition (even with an otherwise balanced diet), alcohol also damages the nervous system as a cell poison .

Interaction between thiamine deficiency and alcoholism

If there is little or no alcohol consumption, Wernicke encephalopathy is easily curable through increased thiamine intake and hardly leads to Korsakoff syndrome. With high alcohol consumption, in addition to possibly insufficient thiamine intake (see above), thiamine absorption (due to an alcohol-related inhibition of apical thiamine transport) and enzyme activity are disturbed. Damage to the nervous system and the deficient thiamine metabolism therefore existed long before the diagnosis of Wernicke encephalopathy, and in order to avoid the result of Korsakoff syndrome, thiamine intake within 24 hours may be necessary and oral administration inadequate.

See also

• Wernicke encephalopathy # Therapy

Therapy and prognosis

Korsakov patients can benefit from suitable treatment (with complete abstinence from alcohol, in a quiet environment) and learn new things in the process. The "best treatment of Korsakoff's syndrome" is, however, timely recognition of the (presumed) previous Wernicke encephalopathy and its adequate therapy.

The prognosis of " organic amnestic syndrome" - the non-alcohol-related Korsakoff syndrome ICD  F04 - is, according to ICD "depends on the course of the underlying lesion." In general, with appropriate treatment, the life expectancy of Korsakov patients does not differ from that of healthy people.

See also

• Delirium tremens
• Encephalopathy :
  • Hepatic encephalopathy
  • Wernicke encephalopathy
    • Wernicke-Korsakoff Syndrome
• Polyneuropathy

literature

• MD Kopelman, AD Thomson, I. Guerrini, EJ Marshall: The Korsakoff syndrome: clinical aspects, psychology and treatment. In: Alcohol and alcoholism. Volume 44, Number 2, 2009 Mar-Apr, pp. 148-154, ISSN  1464-3502 . doi : 10.1093 / alcalc / agn118 . PMID 19151162 . (Literature review with a focus on the treatment of the alcoholic Korsakoff syndrome).
• EV Sullivan, A. Pfefferbaum: Neuroimaging of the Wernicke-Korsakoff syndrome. In: Alcohol and alcoholism. Volume 44, Number 2, 2009 Mar-Apr, pp. 155-165, ISSN  1464-3502 . doi : 10.1093 / alcalc / agn103 . PMID 19066199 . PMC 2724861 (free full text). (Review of the literature to differentiate between Wernicke encephalopathy and Korsakoff syndrome and to assess the course by neuroimaging ).
• AD Thomson, I. Guerrini, EJ Marshall: The evolution and treatment of Korsakoff's syndrome: out of sight, out of mind? In: Neuropsychology review. Volume 22, Number 2, June 2012, pp. 81-92, ISSN  1573-6660 . doi : 10.1007 / s11065-012-9196-z . PMID 22569770 . (Discussion with a focus on the transition from Wernicke encephalopathy to Korsakoff syndrome in alcoholics and non-alcoholics).

Individual evidence

1. ↑ F10- . DIMDI. Retrieved June 23, 2019.
2. ↑ ^{a b} E51.1 . DIMDI. Retrieved June 23, 2019.
3. ↑ ^{a b} E51.- . DIMDI. Retrieved June 23, 2019.
4. ↑ F11.- . DIMDI. Retrieved June 23, 2019.
5. ↑ ^{a b} F04 . DIMDI. Retrieved June 23, 2019.
6. ↑ ^{a b} P. Sivolap: The Current State of SS Korsakov's Concept of Alcoholic Polyneuritic Psychosis. In: Neuroscience and Behavioral Physiology, Vol. 35, No. 9, 2005, pp. 978-982 (English translation of a Russian publication on the occasion of Korsakov's 150th birthday, published in Zhurnal Nevrologii i Psikhiatrii 2004).
7. ↑ Korsakoff syndrome . In: Lexikonredaktion of the Bibliographisches Institut (Ed.): Meyers Großes Taschenlexikon in 24 volumes . tape 12 . Klas - Las. Mannheim / Vienna / Zurich 1983, ISBN 3-411-02112-8 , pp. 167 .
8. ↑ ^{a b c} Kopelman et al., Abstract "Results" ( #Literature )
9. ↑ Kopelman et al., Abstract "Aims" ( #Literature )
10. ↑ E51.2 . DIMDI. Retrieved June 23, 2019.
11. ↑ Sullivan & Pfefferbaum, abstract throughout ( #Literature )
12. ↑ ^{a b c d} Thomson et al., Abstract ( #Literature )
13. ^ G. Löffler, PE Petrides, PC Heinrich: Biochemie & Pathobiochemie. 9th edition, Springer, Heidelberg 2014, ISBN 978-3-642-17971-6 , p. 723
14. ↑ Kopelman et al., Abstract "Conclusions" ( #Literature )

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !