There is a 70% reduction of thiamine absorption in malnourished patients who are abstaining from drinking alcohol. Absorption is further reduced if these patients continue to drink.
Only 10% of patients present with the classical triad of Wernicke's:
Ophthalmoplegia - this is usually of the external recti muscles
Confusion or impairment of the short term memory.
Other symptoms include:
It is important to know this because delayed management or incorrect treatment has a mortality rate of 17%. Incorrect treatment includes giving glucose before thiamine. Of the patients that survive, 85% will have permanent brain damage in the form of Korsakoff’s psychosis and 25% will need long term institutionalisation in order to receive full time care
- Anterograde amnesia
This is an inability to formulate new memories - memories prior to the onset of Korsakoff's syndrome remain intact
- The preservation of immediate memory
- The preservation of implicit memory
The person is able to learn new motor skills or show an improvement in complex tasks, even if they do not remember learning these skills
Korsakoff’s syndrome is also associated with a loss of spontaneity, drive, and emotional expression. The chronic form of this syndrome is known as Korsakoff's psychosis.
It is possible to improve some aspects of short term memory by:
- Encouraging the patient to stop drinking alcohol
- Improving the patient’s diet
- Advising regular vitamin supplements, including thiamine
General amnesia is usually irreversible in patients with Korsakoff’s syndrome. Patients can learn to live independently, but most need residential care.