Trip Answers

Question answered:13/03/07 Warning! this question is over two years old.

Thomson et al note in their article on the management of Wernicke’s encephalopathy (WE):

 

“Failure to treat WE adequately leads to a chronic form of the disease (Korsakoff psychosis, KP) characterized by severe short-term memory loss. Because of the close relationship between WE and KP, reference is often made to the Wernicke–Korsakoff syndrome (WKS) as if it were a single entity.” [1]

 

The charity Alcohol Concern has produced a facts sheet on Wernicke-Korsakoff’s syndrome which considers the persistence of impairment:

 

“There has not been very much research carried out about the rehabilitation of patients with alcoholic dementia or Korsakoff’s syndrome. However there is research that shows that problems with memory, awareness and understanding can improve, to various degrees, in many sufferers with time. The physical or chemical processes that lead to this improvement are not understood, but studies of Korsakoff’s sufferers and an animal model of Wernicke-Korsakoff syndrome suggest that undamaged parts of the brain that deal with memory, awareness and understanding can compensate for the damaged areas and lost abilities. This compensatory ability of the brain is huge at birth but declines with age. Drinking alcohol, smoking, head injury and severe infections may further reduce the brain’s reserve.

 

While the amnesia itself may not respond to treatment, stopping drinking and an intensive programme of vitamin therapy followed by tailored therapeutic rehabilitation can lead to significant improvements. Some sufferers may be able to live independently, however others will need long-term residential care or structured support in the community.” [2]

 

An article posted on the Insititute of Alcohol Studies web site on alcohol related brain damage adds:

 

“A patient with alcohol related brain damage can present in a variety of ways. These include Wernicke's Encephalopathy which is an extremely acute and reversible condition, difficult to recognise and treat as most people experience this at home and receive no treatment. Sufferers reach a catastrophically low level of the vitamin Thiamine in their system and as a result begin to have small bleeds into the areas of the brain most related to memory. ..This is a rare presentation as most individuals do not have all the clinical signs.
If untreated this can lead on to Korsakoff's Psychosis/amnestic syndrome. This is the more permanent deficit state seen either following untreated Wernicke's Encephalopathy or presenting to services. The individual has sparing of most of their cognitive functions but a very dramatic deficit in their short-term memory. The main treatment for this is intensive neuropsychological rehabilitation and total avoidance of alcohol. The individual may be so incapacitated by their short-term memory that they are unable to live outside an institution and may, for example, forget crucial new information such as the death of a spouse. This condition can be permanent or can slowly recover with some recovery occurring in up to 75 per cent of sufferers.” [3]

 

References
1. Thomson A, Cook C and Touquet R et al. The Royal College of Physicians report on Alcohol: guidelines for managing wernicke’s encephalopathy in the accident and emergency department. Alcohol & Alcoholism Vol. 37, No. 6, pp. 513–521, 2002. (http://alcalc.oxfordjournals.org/cgi/reprint/37/6/513).
2. Alcohol Concern. Factsheet 6: Wernicke-Korsakoff syndrome. (http://www.alcoholconcern.org.uk/files/20030808_114420_Wernicke-Korsakoff.pdf).
3. Insitute of Alcohol Studies. Alcohol related brain damage. Alcohol Alert Issue 2 2003.(http://www.ias.org.uk/resources/publications/alcoholalert/alert200302/al200302_p16.html).

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