Korsakoff syndrome: symptoms, causes, treatment and recovery

Korsakoff syndrome comes after an acute stage. The Alzheimer's Society says that if Wernicke's encephalopathy is not treated quickly, a longer-term condition, Korsakoff's syndrome, may develop. It has many of the same symptoms as dementia, including memory loss and difficulties forming new memories.

The society lists these common features of alcohol-related brain damage, which overlap with Korsakoff syndrome. They affect thinking, memory, mood and movement.

• Memory: forgetting the details of a recent conversation or struggling to recall past events, long-term memory problems, and mixing up memories to create a false impression of what really happened, often without realising.

• Thinking: being unable to stay focused, problems with reasoning, planning and organising, and poor judgement or decision-making.

• Mood and behaviour: apathy, depression, impulsive or risky behaviour and a lack of social awareness.

• Movement and coordination, even when sober: stumbling or falling over, walking with feet wide apart and slurred speech.

Korsakoff syndrome is the long-term memory-related stage of Wernicke-Korsakoff syndrome. The Alzheimer's Society explains that thiamine is a vitamin vital for brain cells to work properly, and that a lack of it can have severe and long-lasting effects. It describes Wernicke-Korsakoff syndrome as normally caused by drinking too much alcohol, and as a severe form of alcohol-related brain damage (ARBD).

It happens when someone drinks so much alcohol that the gut can no longer absorb enough thiamine from food, the society says, and people who are addicted to alcohol tend to eat a poor diet so do not get enough vitamins. Damage can sometimes be permanent.

The first stage, Wernicke's encephalopathy, is a brief period of intense inflammation (swelling) of the brain. If it is not treated quickly, a more long-term condition, Korsakoff's syndrome, may develop, with many of the same symptoms as dementia, including memory loss and difficulties forming new memories.

The earlier signs of Wernicke's encephalopathy, according to the Alzheimer's Society, include a poor appetite, feeling sick, vomiting or recent weight loss, feeling faint or dizzy, pins and needles in the hands and feet, blurred vision and double vision.

If a person who drinks heavily gets any of the following, the society says they should seek urgent medical attention from their GP or call NHS 111. Some people have only one or two of these, which can make an emergency difficult to spot, and it is harder still if the person is intoxicated or in withdrawal.

• Being confused, disorientated, drowsy or less responsive.

• Seeing things that are not there (hallucinations).

• Difficulty controlling eye movements.

• Poor balance, being unsteady and walking with legs wide apart.

• Being undernourished, for example thin or having lost a lot of weight recently.

The Alzheimer's Society says Wernicke-Korsakoff syndrome should be treated in hospital so that a person can receive regular thiamine injections and medications to control withdrawal symptoms. Anyone who may have ARBD should not try to stop drinking by themselves without proper medical support, because they will start to feel very ill if they suddenly stop.

Recovery depends on stopping drinking and on rehabilitation. The society says that about a quarter of the people affected who get treatment make a good recovery, about half make at least some recovery but still need support to manage their lives, and for some the damage is mostly permanent. Recovery might not be possible because there has been too much damage to the brain, or because the person continues to drink.

Recovery varies. The Alzheimer's Society says about a quarter of the people affected by Wernicke-Korsakoff syndrome who get treatment make a good recovery, about half make at least some recovery but still need support to manage their lives, and for some people the damage is mostly permanent. Recovery might not be possible because there has been too much damage to the brain, or because the person continues to drink alcohol.

For alcohol-related brain damage more widely, the society says that if a person stops drinking and receives good support they may make a partial or even full recovery, and may regain much of their memory and thinking skills and their ability to do things independently.

The Alzheimer's Society says some symptoms may be similar to dementia but Wernicke-Korsakoff syndrome is not a type of dementia. Dementia is a progressive condition and will always get worse. In comparison, alcohol-related brain damage does not always get worse over time, and a person can get better if supported to stop drinking, with treatment and rehabilitation. The society describes it as more like a brain injury.

There is no single test described in the sources; the Alzheimer's Society says a specific type of ARBD is diagnosed on the basis of a person's symptoms and may be one of several conditions, including Wernicke-Korsakoff syndrome. Because the society describes Wernicke-Korsakoff syndrome as a serious medical condition that should be treated in hospital, the warning signs above matter.

People are usually diagnosed with ARBD between about 40 and 60 years of age, the society says, much younger than most people who develop progressive dementias such as Alzheimer's disease, and ARBD affects more men than women, because men are more likely to drink heavily.

For people who do not fully recover, the Alzheimer's Society says they will need specialist long-term residential care if they cannot live independently. It can be difficult to find a care home that specialises in caring for people with Korsakoff syndrome, and there may not be one locally. Temporary placement in a non-specialist home can cause problems if the home is not set up for their needs, younger people may find it difficult living with older people, and such homes tend not to provide rehabilitation support.

The ARBD Network, which the society names, is a charitable organisation that can signpost to support and rehabilitation services. WithYou is a UK-wide drug and alcohol treatment charity named in the same material. Families often need support too, and a GP, social worker or local alcohol service can help to coordinate care.

The Alzheimer's Society notes that the NHS recommends not drinking more than 14 units of alcohol a week, and that regularly drinking considerably more than this for several years or more is typical in people diagnosed with ARBD. It also says binge drinking is particularly harmful, because the brain is exposed to very high, toxic levels of alcohol.

Anyone who is concerned about their own drinking or that of someone close can speak to their GP or a local alcohol service. Eating regular meals matters too, since poor diet contributes to thiamine deficiency, but this does not replace help to cut down alcohol under medical supervision when dependence is present.

Suspected Wernicke's encephalopathy is a hospital emergency, treated through A&E and acute medical units. Longer-term care is coordinated by GP, community alcohol and mental health teams, and by local authority social care for placement.

Private residential rehabilitation and specialist neurorehabilitation exist for people who can fund them, but it is worth checking that a provider has experience of alcohol-related brain damage specifically. Funding and assessment for NHS or council-funded placements run through local commissioners.