Korsakov's syndrome F10.6

In 1887, the Russian neurologist Sergei Korsakov (1854-1900) was the first to describe the syndrome named after him in long-term alcoholics. Wernicke's encephalopathy was first described by Carl Wernicke in 1881 (Lubadda 2006 / Vetter 2007).

Parenteral thiamine has been available since 1936 (Hinze-Selch 2000).

Korsakow syndrome (KS) is a chronic condition with an organic amnestic syndrome characterized by impaired memory, concentration, orientation, anterograde amnesia and a tendency to confabulate (Herold 2025).

KS is preceded by an acute phase, which is referred to as Wernicke's encephalopathy (Lubadda 2006).

KS occurs in just under 25% of alcoholics (Lubadda 2006). In untreated patients with Wernicke's encephalopathy, KS occurs in up to 80% of cases (O'Malley 2022).

The cause is a deficiency of thiamine (vitamin B1). Thiamine is not supplied in sufficient quantities or cannot be absorbed sufficiently. This is often found in:

• Years of excessive alcohol consumption (Lubadda 2006)
• Repeated delirium tremens after alcohol withdrawal (O'Malley 2022)
• Malnutrition
• Malnutrition in e.g. anorexia nervosa (Lubadda 2006)
• Thalamic hemorrhage
• Thalamic infarction
• Tumors of the paramedian posterior thalamus
• Subarachnoid hemorrhage (O'Malley 2022)
• Malabsorption syndrome of the ileum (Hartje 2006)

Thiamine is required by nerve cells. In the body, thiamine is converted to thiamine diphosphate. This, together with other enzymes, is important for the breakdown of glycose (Lubadda 2006).

A thiamine deficiency causes damage to the mitochondria, which can lead to an overproduction of free radicals and even cell death (Lubadda 2006).

Neuropathologically, KS is characterized by bilateral damage to diencephalic structures, particularly in the area of the thalamus and the corpus mamillare. In some cases, the septal region, hippocampus, hypothalamus and frontal brain are also affected (Hartje 2006).

• Acute phase (so-called Wernicke's encephalitis):
  • Nystagmus
  • Stance and gait ataxia
  • hallucinations
  • Drive disorders
  • disturbances of consciousness
  • Disorientation (Lubadda 2006)
• Chronic phase (Korsakow syndrome):
  • Confabulations (early symptom)
  • Patients forget that they have memory problems and deny them when asked (Kasper 2015)
  • Disorders of the anterograde and retrograde memory
  • Deficits particularly in the area of semantic and episodic memory
  • Impairment of everyday functions (Lubadda 2006)
  • Temporal disorientation
  • Emotional changes (O'Malley 2022)

The diagnosis of KS is usually made clinically (O'Malley 2022)

In patients with CS, damage is found in the diencephalon, primarily the mamillary bodies, the anterior nuclei and the medio-dorsal nuclei of the thalamus. More recent studies have pointed to damage in the area of the cerebral cortex (prefrontal cortex) and the basal forebrain, as well as damage to certain nuclei in the brain stem (Lubadda 2006).

The treatment of KS depends on the underlying disease. Appropriate therapy is particularly important in the first two years after the first symptoms appear (Möller 2017). 59-60.

• If thiamine deficiency is suspected: administration of high doses of thiamine i.v.
• Cholinesterase inhibitors for cholinergic deficiency (Möller 2017)
• Magnesium
• Supportive care (O'Malley 2022)

According to a study by J. Cutting, up to 64% of people suffering from KS may experience a reduction in symptoms, but their cognitive performance remains significantly lower than before the onset of the disease (Lubadda 2006).

1. Hartje W, Poeck K (2006) Clinical Neuropsychology. Georg Thieme Verlag Stuttgart / New York 265-266
2. Herold G et al (2025) Internal medicine. Herold Verlag 936
3. Hinze-Selch D, Weber MM, Zimmermann U, Pollmächer T (2000) Thiamine treatment in psychiatry and neurology. Fortschr Neurol Psychiatr 68 (3) 113-120
4. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 182
5. Labudda K, Brand M, Markowitsch H J (2006) Cognitive deficits in patients with alcohol-induced Korsakow syndrome. NeuroGeriatrics 3 (3) 120-129

6. Möller H J, Laux G, Kapfhammer H P (2017) Psychiatry, psychosomatics, psychotherapy. Springer Verlag Germany 59-60

7. O'Malley G F, O'Malley R, Birnbaumer D M (2022) Korsakoff psychosis (Korsakoff amnestic syndrome; Korsakow psychosis)MSD manual edition for medical professionals. doi: https://www.msdmanuals.com/de/profi/spezielle-fachgebiete/illegale-drogen-und-rauschmittel/korsakoff-psychose?query=wernicke-korsakoff-syndrom
8. Vetter B (2007) Psychiatry: A systematic textbook. Schattauer Publishers Stuttgart / New York 266