Chapter 16 - Wernicke–Korsakoff Syndrome and Dementia

Abstract

Wernicke–Korsakoff syndrome (WKS) and alcohol-related dementia (ARD) are classified as “alcohol-related brain damage” comprising the neuropsychiatric manifestations of chronic and excessive use of alcohol. WKS encompasses an acute (Wernicke’s encephalopathy, WE) episode that can be rapidly fatal, and a chronic phase of prolonged dementia and neurological problems (Korsakoff’s syndrome, KS) if the patient survives or has a sub-threshold WE episode. WE is difficult to recognize clinically because of its insidious onset in the context of alcohol intoxication and/or withdrawal. Any condition associated with reduced dietary intake of foods containing thiamine, accelerated metabolism (i.e., cancer), malabsorption in the gastrointestinal tract, or some types of medications may cause a thiamine-deficient state. Secondly, the classically described triad of acute WKS (ataxia, confusion, and ophthalmoplegia) is observable only in a third of patients. The majority of people who develop WKS have subsyndromal manifestations of the acute form (WE) followed by long-term neurological and cognitive sequelae of KS and ARD. ARD is distinguished from other forms of dementia (e.g., vascular or Alzheimer’s dementia), because early diagnosis and treatment may be associated with a reversal of cognitive decline. In this chapter, the historical perspectives, etiopathological, clinical, and therapeutic aspects of these clinical conditions are reviewed.