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PSYC 315 - Korsakoff's Syndrome

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Sharon Bola

on 20 November 2014

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Transcript of PSYC 315 - Korsakoff's Syndrome

Korsakoff's Syndrome
Sharon Bola, Samara Ferra, Shikha Khurana, Samantha Reid
PSYC 315
Amnesia Group
Outcome: Decline
- Abel went through an alcohol withdraw period.
- Abel was encouraged to take vitamin supplements along with a more balanced diet.
- Improvements were sufficient and continuous and he was released.
- After 4 months the patient relapse, had more severe memory gaps, and a more evident decrease in conversational interest and skills.
- Test gave insight of aggravated memory problems, and thiamine deficit.
- Retention of new information and skills was greatly compromised and memory gaps were so detrimental that the Abel had to be admitted into a care facility (Mayer, 2001).
- Eventually, he recovered from his alcohol abuse problem, however, the disorder was very advanced
- Abel has not show signs of improvement and requires continuous help for daily activities(Harris & Turkington, 2009).
Outcome: Improved
Neuropsychological Assessment
The patient was referred to a neuropsychologist, Dr. Smith, for assessment and was subjected to a number of psychological tests. Results:
Treatments
Conclusion: Abel's intelligence, short-term memory, working memory, implicit memory, and semantic memory were intact; however, he exhibited severe anterograde amnesia in all aspects of memory; minor retrograde amnesia; and impaired executive function. This particular combination is typical of Korsakoff’s syndrome, so an additional test was administered and Abel's brain was scanned using MRI.
- Abel went through alcohol withdraw period.
- He was put in a rehabilitation program for alcoholism.
- A healthy diet was encouraged along with some extra vitamins.
- Abel does not have insight about his condition, but seems disoriented in time and space.
- Abel presents mild anterograde amnesia.
- He has improved, however, recent memory is not as strong and there are obvious problems with perception of time sequence.
- Intelligence levels seem to be normal and there are not severe personality changes.
- The continuous improvement of Abel is promising in regards to the possible partial recovery.
- Minimal help will be needed by the patient to manage his life in his own home (Harris & Turkington, 2009).


- Had Abel reached out for help when his drinking became an issue or when he first started showing symptoms of Korsakoff's Syndrome, Dr. Merali could have better treated the disease or perhaps even prevented it

- Since Abel is deficient in Vitamin B1, large doses of thiamine (vitamin B1) will help stop some of the symptoms associated with Korsakoff Syndrome. Although it will not completely reverse the memory loss, stopping the consumption of alcohol and taking the recommended doses of thiamine will stop the disorder from becoming immediately life threatening.

- It is unlikely that Abel will show much recovery considering only 20% of patients show much recovery within the first year

- Many patients with Korsakoff's Syndrome do not show any sign of recovery after 10-20 years
Kolb & Whishaw (2009)

Dr. Smith administered the Confabulation Interview, similar to that used by Borsutzky, Fujiwara, Brand, & Markowitsch (2008), which was used to assess levels of confabulation in general semantic memory, personal semantic memory, episodic memory, personal future, and orientation. The results indicated that compared to the average range, Abel exhibited significantly more confabulations in all domains; however, he confabulated the most in episodic memory, which is consistent with the results of various studies involving Korsakoff’s Syndrome patients.
Treatments
Initially, Dr. Merali administered 100 mg of Thiamine to Abel
50mg was administered intravenously
50mg was administered intramuscularly
Abel must also be properly hydrated and receive adequate vitamins/nutrition (Thiamine replacement should be given with other vitamins like folic acid, magnesium, and multivitamin supplements).

Glucose is then administered into his body (and should be done with or after thiamine replacement - administering the glucose without the thiamine can worsen already low thiamine levels).
Schaefer (1996)

Overall...
- Abel will need 5-500mg of Thaimine orally 2 to 3 times a day for 3 to 5 days or longer
- Abel should continuously consume vitamin B1 supplements/introduce a vitamin B1-enriched diet until he sees improvement (if he ever does see improvement)
- Abel needs to stop consuming alcohol and should enroll in an alcoholics anonymous program if he finds the urge to drink alcohol overpowering
- If Abel does not see improvement, then at-home care may need to be provided because of his amnesia
Kolb & Whishaw (2009)
Schaefer (1996)
T1-weighted images of the healthy (left panel) and WKS (right panel) men. Note the shrunken mammillary bodies (arrows) in the WKS (B and D) compared with the control (A and C) (2009).
MRI Scans
Abel’s MRI scans were very similar to those of a Wernicke-Korsakoff Syndrome (WKS) patient involved in a study conducted by Sullivan and Pfefferbaum (2009) depicted below:
Surface rendered brains (top) and rendered ventricular system (bottom, green) of a 59-year-old healthy man (A and C) and a 53-year-old man with WKS (B and D). Note the shrinking of the cortical gyri and widening of the sulci (B) and expansion of the ventricles (D) of the WKS compared with the control (A and C) (Sullivan & Pfefferbaum, 2009).
Patient comes in with serious bleeding to the head

Doctor – "Hi, Abel. I’m Doctor Merali. That looks pretty bad, let me take a look. I’m just going
to clean you up and then run some routine tests to get a better idea. So how did this injury happen?"

Patient – "Oh, hmm, well you see I was walking to the park with my dog. Oh wait no, I was at home and uh, I guess I was not paying attention and, uh, walked right into a door. I mean who put that there anyway!"

Checks pupils, takes temperature, blood pressure, and weight
Results come back with high BP, low body weight.

Doctor – "Your blood pressure and weight are a little concerning; I’d like to do an additional blood test just to be sure."

The results come back with very low iron (anemia), and alcohol in system.

Doctor – "I’m a bit concerned given these results, your Thiamine levels are alarmingly low. I’d like to keep you overnight for observation because it looks like a bad concussion, so I’d just want to be sure before sending you on your way. I’d also like to run a CT scan to get a better look."

CT comes back normal. This suggests to Dr. Merali that the memory issues are not due to trauma as he does not fit the criteria for a concussion. Since Korsakoff's Syndrome preserves semantic memory, the doctor proceeds with questions that would tests episodic memory
.

Doctor – "So you mentioned your dog earlier, how long have you had him for?"

Patient – "Well about three years now, well, hmm, or has it been 4 years? No, 3 years, definitely. Wait… 3 and a half!"

Doctor - "And do you remember how this injury happened?"

Patient - "Yes I was at the grocery store, by the carrots actually, and I must have taken a nasty spill. That’s where it happened."

Doctor – "And Abel, do you remember who I am? What is my name?"

Patient – "Why, I would not know that now would I? You haven’t introduced yourself, and are you not a different doctor from yesterday?"

Doctor – "I’m Doctor Merali. No, I was the one who was treating you yesterday too; you haven’t been assigned anyone new. Abel, I’m still concerned. I have reason to believe that there may be more to the memory issues you have been having that may be unrelated to your injury. I’d like to refer you to Dr. Smith. She’s our psychologist and specializes in memory."

Diagnosis
In addition to the neuropsychological test results, Abel’s brain images were consistent with the findings of numerous studies involving Korsakoff’s syndrome patients. He exhibited atrophy of the diencephalon, including the mammillary bodies of the hypothalamus, and the thalamus; and general cortical atrophy, including “cortical thinning, sulcal widening and ventriculomegaly” (Sullivan & Pfefferbaum, 2009); therefore, a formal diagnosis of Korsakoff’s syndrome was made.
References
Borsutzky, S., Fujiwara, E., Brand, M., & Markowitsch, H. J. (2008).
Confabulations in alcoholic Korsakoff patients. Neuropsychologia, 46(13), 3133-3143. doi:10.1016/j.neuropsychologia.2008.07.005.


Mayes, A. (2001). Korsakoff's syndrome. (pp. 8162-8166) Elsevier
Ltd. doi:10.1016/B0-08-043076-7/03573-7

Harris, J. R., & Turkington, C. (2009). Korsakoff syndrome. New
York: Facts on File.

Kolb, B., & Whishaw, I. Q. (2009). Fundamentals of
Neuropsychology (Sixth ed., pp. 508-509). New York, NY: Worth Publishers.

Kopleman, M.D., Thomson, A. D., Guerrini, I., & Marshall, J. (2009,
January 16). The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment [Electronic Version]. Alcohol and Alcoholism, 44(2), 148-154. doi: http://dx.doi.org.ezproxy.library.uvic.ca/10.1093/alcalc/agn118

Schaefer, S. (1996, September). Wernicke-Korsakoff Syndrome.
Journal of the American Academy of Nurse Practitioners, 8(9), 435-436. doi: 10.1111/j.1745-7599.1996.tb00692.x

Sullivan, E. V., & Pfefferbaum, A. (2009). Neuroimaging of the
Wernicke-Korsakoff syndrome. Alcohol & Alcoholism, 44(2), 155-165. doi:10.1093/alcalc/agn103.

Age – 43
Sex – Male
Medical history – Smoker, liver problems, anemia, low weight, gastrointestinal issue
Chronic and heavy alcohol consumption of alcohol
Currently lives with – One dog but otherwise resides alone
Other – Difficulty sleeping

Abel 's Story
Patient History:
Abel Saunders
Full transcript