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Long-term excessive alcohol consumption can create a host of health issues for the drinker. Alcohol-related problems can include blackouts, longer-term memory effects, and in the worst case scenario can cause permanent brain damage. In addition, it has a negative impact on the liver, kidneys, stomach, esophagus, and other internal organs – which if not resolved can lead to death.

The above problems are common in long-term alcoholics. However, there is a lesser known – but very serious - health issue called Wernicke-Korsakoff Syndrome, which happens when Wernicke encephalopathy and Korsakoff Syndrome are both present in the sufferer. This syndrome often mimics dementia and Alzheimer’s Disease, which leads researchers to believe that Wernicke-Korsakoff Syndrome continues to be under-diagnosed.

What is Wernicke-Korsakoff Syndrome?

Wernicke-Korsakoff Syndrome is a life threatening health crisis. It typically starts with the Wernicke encephalopathy, and if this disease is caught and treated quickly enough it can prevent the onset of full-blown Wernicke-Korsakoff Syndrome. Both of these diseases must be present for a diagnosis of Wernicke-Korsakoff Syndrome.

Wernicke Encephalopathy

The underlying cause of symptoms in Wernicke encephalopathy is a severe thiamine deficiency which, if co-occurring with Korsakoff Syndrome, is almost always caused by alcoholism.

Wernicke encephalopathy is a medical emergency and presents with:

  • Confusion

    mental bewilderment about common facts such as where they are, what year it is, etc.

  • Nystagmus

    rapid eye movements (side-to-side, up and down, or circular patterns)

  • Ataxia

    staggering, slurred speech, tremors, problems swallowing/eating, loss of fine motor movement

  • Ophthalmoparesis

    weakness of eye muscles (can cause the eyeball to appear to be loose)

Korsakoff Syndrome

Korsakoff Syndrome is preventable. When it appears, it typically follows a prior Wernicke encephalopathy (WE) episode.

While WE presents with mostly physical symptoms, Korsakoff Syndrome creates psychiatric symptoms including:

  • Short term memory deficits

    remembers things in the past, but not immediately prior to the current moment

  • Retrograde memory issues

    Unable to recall what happened in specific events (For example, getting into a vehicle accident and having no memory of the time leading to it or the wreck itself)

  • Anterograde memory issues

    unable to create new memories. The memories from before the amnesia began remain but anything that happens after the amnesia began cannot be retained.

Causes – How is Alcohol Involved?

Wernicke-Korsakoff syndrome always has an underlying foundation of severe, long-term malnourishment, specifically a lack of vitamin B/thiamine. In rare cases, such as starving POW's, or people in undeveloped nations, a B/thiamine deficiency can happen - but in developed nations, including the US, it appears most often in malnourished, chronic alcoholics.

Alcoholism and the behaviors that go with it frequently include a failure to eat properly. Over the long-term this leads to malnutrition. If it continues, symptoms of Wernicke encephalopathy begin – which is one half of the two requirements for diagnosis of this disorder.

NOTE: Anyone who consumes excessive amounts of alcohol for years is at risk of developing Wernicke-Korsakoff syndrome. Though it can impact men and women at any age, alcoholic men over the age of 45 are the most often affected.

Symptoms of WKS

Symptoms of WKS can mimic other disorders including Alzheimer’s disease or dementia, and include:

  • Anxiety : nervous, afraid
  • Confusion : cannot retrieve everyday facts such as name, year, day of the week, recognition of others
  • Hallucinations : auditory and visual
  • Retrograde amnesia : inability to recall memories of things that happened prior to the amnesia's start
  • Anterograde amnesia : remembers the past, but cannot form new memories after the amnesia has begun
  • Insomnia : extreme trouble falling or staying asleep
  • Confabulation : fills memory gaps with invented stories, often improbable or impossible
  • Inability to estimate : time, distance, outcomes, etc.
  • Inability to focus or concentrate
  • Low blood pressure

Diagnosis

An initial diagnosis of WKS is typically made through an examination, a medical history, and current symptoms. A physician will observe physical attributes, ask caretakers/family members questions about the patient's alcohol use, and conduct a physical exam that can include blood tests.

Once the initial diagnosis is made, or WKS is strongly suspected, the physician might order an MRI of the brain and a neurological work-up. In some but not all cases of WKS, specific areas of the brain will begin to atrophy, and this will appear as dark areas around the edges of the brain in the scan. A neurological specialist will perform more specific testing to rule out other possible causes for the symptoms and validate the finding of WKS.

How is WKS Treated?

The most immediate need for someone with Wernicke encephalopathy is to raise the vitamin B/thiamine level. This condition is a medical emergency and it is important to begin administering thiamine as soon as the disease is suspected.

If the thiamine therapy is initiated soon enough for Wernicke encephalopathy, it might stop Wernicke-Korsakoff Syndrome from starting. If it does begin, the severity of symptoms will at least be reduced. While treatment might reduce how severe the symptoms become, it is possible that some symptoms or deficits will remain. One study found that once WKS is present, 80% of patients will have residual symptoms, even after treatment is completed. This is why it is important to begin treatment as soon as Wernicke encephalopathy is suspected, to prevent it from moving into WKS.

NOTE: Due to this being a medical emergency, the initial onboarding of supplemental thiamine is given through an IV. Once the patient is stabilized and discharged, the doctor will most likely prescribe an oral supplement for thiamine and other needed nutrients.

How Can You Prevent WKS?

Two very important components exist in preventing WKS:

  • Treatment of the underlying addiction to alcohol
  • Maintaining a healthy diet to prevent malnutrition

The behaviors and thought processes of an alcoholic often stop them from making good decisions, such as eating properly. If the underlying addiction is successfully treated, it increases the possibility that WKS can be prevented through nutrition without extreme medical intervention. The bottom line, however, is that the path to preventing WKS is in maintaining a level of vitamins and minerals through a healthy diet, not becoming malnourished, and not needing medical help for a lack of nutrition. If a person addicted to alcohol does not wish to give up drinking, or has been thus far unsuccessful in treatment, proper nutrition is still possible and essential to prevent WKS.

If eating a nutritionally balanced diet is not likely, there are also over-the-counter and prescribed supplements that can be taken along with food consumption. Though it is best to get nutrients and sufficient calories from foods, supplements can make sure the vitamin and mineral levels do not drop so low that symptoms of WKS appear.

Treatment for alcoholism comes in several forms. There are residential rehabilitation facilities, outpatient meetings, self-help groups, private counselors, and medications designed to treat addiction. In addition to the risk of WKS, long-term, excessive consumption of alcohol creates other health issues as well. Successful treatment of the addiction removes the risk of WKS.

It is important to note that medical professionals are bound by HIPPA law to maintain confidentiality of their patients. If a person with an addiction to alcohol and symptoms of WKS wishes to seek addiction treatment, a doctor can provide resources and contacts that will allow you to pursue treatment.

Sources:

  • https://www.dementia.org.au/files/helpsheets/Helpsheet-AboutDementia18-AlcoholRelatedDementiaAndWernickeKorsakoffSyndrome_english.pdf

  • https://www.ncbi.nlm.nih.gov/books/NBK470344/

  • https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/korsakoff-syndrome