Korsakov's syndrome treatment. Korsakoff amnestic syndrome: causes, symptoms, treatment. Restoring memory functions

Amnestic (Korsakovsky) syndrome is a condition in which the clinical picture is dominated by a memory disorder for events of the present, while it is preserved for events of the past. Clinically, this disorder is manifested by a triad of symptoms: 1) fixation amnesia, retrograde amnesia (from the moment of development of fixation amnesia; 2) amnestic disorientation in time and place (due to the inability to remember the place of stay and the current date); 3) confabulations (false memories) and pseudo-reminiscences (displacement in memory of the time of real incidents).

This condition was first described by S. S. Korsakov in his dissertation work “On alcoholic paralysis”:

Mental disorder (with alcohol paralysis) was expressed either in the form of irritable weakness, then in the form of confusion, or in the form of a characteristic memory disorder... It was to varying degrees and unequal in its manifestation: in some cases it was limited only to pronounced irritable weakness of the mental sphere, in in others, it took on the character of confusion of consciousness with hallucinations or illusions; in others, finally, it took on the character of a peculiar weakening of mental abilities without pronounced confusion, but with a particularly noticeable loss of memory

Korsakoff's syndrome is often an integral part of Wernicke's encephalopathy. One of the manifestations of encephalopathy is nystagmus, which occurs as a result of damage to the brain stem at the level of the nucleus of the abducens and oculomotor nerves, which impairs oculomotor function. Also with this disease there is damage to the cerebellum, which is manifested by ataxia. In this case, patients often experience confusion. This triad of symptoms is reversible, however, against the background of their regression, fixation amnesia may come to the fore, which means the onset of Korsakoff's syndrome

Some authors describe the anamnestic syndrome as a chronic form of Wernicke encephalopathy. This is partly true, but only if we are talking about Korsakov psychosis, which is a consequence of alcoholism. Korsakov's syndrome it can manifest itself for a variety of reasons (nutrient deficiencies and certain diets; starvation - in persons suffering from anorexia nervosa, schizophrenia, terminal cancer, as well as in prisoners of war; malignant tumors of the stomach, inflammatory diseases intestines; systemic diseases - malignant tumors, disseminated tuberculosis, acquired immunodeficiency syndrome (AIDS), uremia, stem cell transplantation, etc.).

Etiology and pathogenesis

S.S. Korsakov himself believed that the main cause of this disease was a disorder of the associative apparatus. Memorization process new information occurs due to the ability to connect new information with existing information through the construction of associative connections. But what if the building of these connections is incomplete or completely broken? Perhaps this is precisely the reason for the occurrence of fixation and retrograde amnesia, and this also explains the preservation of memory for past events.

According to modern concepts, the main role in the pathogenesis of anamnestic syndrome is assigned to vitamin B1 (also known as thiamine). It is its deficiency that leads to disruption of metabolic processes in brain cells, because thiamine is a cofactor that is involved in essential biochemical processes. As a result of these processes, brain cells, through the utilization of glucose, receive the required amount of energy in the form of ATP. Due to a lack of energy (with a decrease in thiamine concentration), the activity of alpha-ketoglutarate dehydrogenase decreases, which in turn leads to the accumulation of glutamate. IN large quantities This neurotransmitter has a toxic effect on brain cells.

The cause of Korsakoff's syndrome is damage to the limbic system of the brain, in particular the so-called “Pipetz circle”. The medial structures of the thalamus, hippocampus, and amygdala are affected, and the connections between them are damaged. The limbic system performs a motivational-emotional function that allows us to satisfy our biological needs. Memory and emotions are very important to perform this function. Emotions teach us to distinguish bad from good, and memory protects us from mistakes. It is thanks to the limbic system that short-term memory is able to transform into long-term memory.

Clinical manifestations

To better understand the clinical picture of Korsakoff's syndrome, below I will present examples of two clinical cases described by British neurologist Oliver Sacks.

In 1975, a certain Jimmy G., forty-nine years old, approached Dr. Sachs; he had accompanying papers with him, in which the doctor discovered a “mysterious note”: “Helplessness, dementia, confusion and disorientation.” Jimmy said hello, said his first and last name, place of birth, year of birth, described his hometown, even drew a map showing the houses where his family lived. He mentioned that he was interested in mathematics and natural sciences. He spoke with particular enthusiasm about his service in the navy. Jimmy's story was so vivid and complete the smallest details, which gave the impression that he was not talking about the distant, albeit very pleasant past, but about the events that were happening to him right now. Of course, this transition from the past tense (when the patient talked about school) to the present tense (to the story about serving in the navy) did not escape the doctor, and he had a suspicion:

– What year is it now, Mr. G.?

Of course, forty-five, but what?

And you, Jimmy, how old are you then?...

Like nineteen. Next year there will be twenty...

Here,” he handed him the mirror. “Take a look and tell me what you see...

- Lord, what's going on? What's wrong with me?...Is this a dream, a nightmare? I'm out of my mind? It's a joke?

Jimmy was very excited by what he saw in the mirror and scared, but he immediately forgot about it as soon as the doctor diverted his attention.

This case is a clear manifestation of fixation and retrograde amnesia. The cause of this condition, as Dr. Sachs later learned, turned out to be alcoholism:

“Serving in the Navy, my brother believed, gave him a foundation in life, and problems began after he was discharged ashore in 1965.”

This manifestation of Korsakov’s syndrome fits one of Sergei Sergeevich’s descriptions presented above: “... took on the character of a peculiar weakening of mental abilities without pronounced confusion, but with a particularly noticeable decline in memory.”

Jimmy finds himself trapped in his own past. His memory seemed to be in a loop, locked in a time loop; there are no new impressions, no new information, and all he can do is replay the same memories over and over again, which is probably why these memories are so vivid.

Thanks to his past, Jimmy still remained a full-fledged person; the disease did not destroy his personality, but rather froze it. Since the construction of associative connections was disrupted, Jimmy had to find another path to reality and he found it:

“I saw that Jimmy had found himself and connected with reality in the fullness of spiritual attention and an act of faith.”

Another case is very different from the one described above. This time the anamnestic syndrome will be dominated by confusion, it will be difficult to talk about any specific type of amnesia, because, as Oliver Sacks writes, “memory ... is completely destroyed.”

Mr. Thompson, a patient of Dr. Sachs, upon meeting, does not recognize the attending physician at all; he attributes many personalities to Dr. Sachs, but never remembers him. He is also completely unoriented in either space or time:

“Within five minutes, Mr. Thompson mistakes me for a dozen different people. Guess gives way to hypotheses, hypotheses to confidence, and all this is lightning fast, without a single hitch, without the slightest hesitation. He has no idea who I am, he doesn’t even know who he is or where he is. The fact that he is a former grocer with severe Korsakoff's syndrome and is being held in a neurological facility is not available to him."

Mr. Thompson, unlike Jimmy, does not have any clear memories, his memory does not record the present and he does not have a past to cling to. Deprived of his own history, he seems to compensate for this with his “desperate verbosity.” His stories are always bright and lively, but there is not a word of truth in them: fictional people, places, events (confabulation)

“He never stops... like he’s chasing something and can’t catch up.” This phrase quite accurately describes Mr. Thompson's condition.

His stories help him imagine himself as someone, feel like a whole person, he is like an actor who can’t stop playing and changes roles one after another. Mr. Thompson has no choice but to chase himself.

Restoring memory functions

I would also like to mention that Korsakoff's syndrome is not an incurable disease; there are many described cases of recovery. The recovery process is also not without interesting aspects. With the onset of the disorder, complete memory loss is described, but during the recovery process it is noted that memory is restored unevenly. The ability to remember time takes the longest to recover. These patients already remember faces, conversations, places, but they cannot remember what happened when, or the sequence of events. Korsakov also wrote that during the recovery process, patients recalled events that occurred during the illness, the very events that were not recorded in memory. He believed that the matter was in the so-called “traces of impressions”:

“First of all, what is striking is that although the patient is not at all aware that he still has traces of the impressions that he receives, nevertheless these traces remain and in one way or another influence the course of ideas, albeit in unconscious mental activity.”

For example, as Korsakov describes, you come to a patient for the first time, he offers his hand, says hello, then you leave for two minutes, returns, and the patient no longer greets you, although he claims that he is seeing you for the first time. Obviously, such cases are examples of implicit (hidden) memory. An analogy can be drawn with intuition. The human brain perceives a huge amount of different information and not all of it reaches our consciousness, but some of it is still remembered, and certain associations can snatch these memories from the depths of information; when this happens, we talk about intuition. In patients with Korsakoff's syndrome, as mentioned above, associative connections are not built, so nothing can “awaken” these memories. However, in many patients with fixation and retrograde amnesia, emotional memory remains intact. They don't remember people they've met for the first time, but they do remember the impression they made on them. When meeting the same people, they immediately develop sympathy for some and antipathy for others. Perhaps it is precisely thanks to the preservation of emotional memory that patients with Korsakov syndrome have a chance of recovery and the opportunity to return to reality.

Prepared by: Ashirova V.G.

Sources:

1) S.S. Korsakov “General psychopathology” – ed. Bean, 2003, p. 480
2) Oliver Sacks “The Man Who Mistook His Wife for a Hat” – ed. AST, 2015, p. 352
3) T.B. Dmitrieva, V.N. Krasnov, N.G. Neznanov, V.Ya. Semke, A.S. Tiganov “Psychiatry: national manual” – ed. GEOTAR-Media, 2009, p. 1000
4) Wernicke-Korsakoff Syndrome – Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD; Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento County Mental Health Treatment Center (Updated: Apr 18, 2016).
5) E.D. Chomsky “Neuropsychology” – ed. Peter, 2005, p. 496
6) V.V. Shulgovsky “Fundamentals of Neurophysiology” – published by Aspect Press, 2000, p. 2777) A.A. Skoromets, A.P. Skoromets, T.A. Skoromets “Nervous diseases” – ed. MEDpress-inform, 2010, p. 560

The harmful effects of alcohol-containing products on the body have been known for a long time. Abuse of alcoholic beverages for quite a long time leads to the development of various pathologies. Quite often in alcoholics it is detected Korsakov's amnestic syndrome, expressed in memory disorders. The patient loses the ability to remember current events, while memory of the past is still present.

The Russian psychiatrist S.S. Korsakov studied and described this condition, and the syndrome later received his name.

Initially, it was believed that such memory impairments occur as a result of long-term alcohol consumption. large quantities. But further research of this issue by other psychiatrists showed that the main reason for the development of the pathology described by Sergei Korsakov is a lack of vitamin B1, which can lead to various disorders of the entire central nervous system and individual areas of the brain, including age-related degenerative processes.

Modern psychiatry considers Korsakov's syndrome as an independent nosological unit, which is a special type of amnesia.

Manifestations of Korsakov's syndrome

According to medical reference books and a large psychological encyclopedia, the main symptom of this disease is the inability of a sick person to remember and reproduce new information (fixation amnesia). Everything that happened before the illness was well preserved in memory. A person’s consciousness does not record events that happened with his participation very recently or are happening at the moment. Clinically this manifests itself as follows:

the patient is poorly oriented in space if he finds himself in a new place. While in a hospital, a person is unable to find the room or bed he needs, but at home such problems do not arise. This is because long-term memory works relatively normally. Moving to a new place or simply rearranging furniture can become severe stress for the patient, which can give impetus to the rapid progression of the disease;
disorientation in time. If a person has been diagnosed, then most likely he will not be able to correctly name today's date, month and year. He simply does not understand where he is and what is happening to him;
in a conversation, the patient mentions events that have never happened to him (confabulation). The patient's stories can be fantastic; you can hear from him that yesterday he fought with monsters in another universe or sailed in a submarine. Those around him consider this to be fiction or an outright lie, but the patient himself has no idea that he is telling a lie;
events that have ever taken place in a person’s life are shifted in time space (pseudo-reminiscences). In this way, memory gaps are involuntarily filled. The person’s stories are quite ordinary in nature; he can say that yesterday he went to the theater to see new production or went out of town. But in fact, these events happened much earlier;
replacing gaps in memory with events from movies or books. The patient has some information, but he does not know when and how he received it. For example, he can pass off a poem he once memorized as his own work. Over time, the sick person perceives other people's thoughts as his own.
Concentration of attention is difficult, willpower is reduced.

Korsakoff's syndrome is often accompanied by retrograde or anterograde amnesia. Emotional condition the patient is unstable. Lethargy, indifference and apathy are replaced by complacency and euphoria.

Reasons for formation

The development of Korsakoff's syndrome is caused by a lack of thiamine (vitamin B1) in the body. This trace element is involved in the mechanism of formation of nerve impulses and their transmission between individual nerve cells. Disturbances in these metabolic processes lead to the deep structures of the brain suffering.

Such vitamin deficiency, as mentioned above, most often develops as a result of prolonged alcohol consumption, since the body’s absorption of this vital microelement is disrupted. First, the alcoholic develops acute encephalopathy, which, if left untreated, in most cases leads to the development of Korsakoff's syndrome.

Other causes of Korsakoff amnestic syndrome are:

Severe head injuries affecting different parts of the brain.
Age-related degenerative processes such as Alzheimer's type dementia and Pick's disease.
Diseases of the nervous system caused by various infections.
Encephalitis of various types.
Intoxication of the body, including heavy metals.
Gastrointestinal disorders and vomiting, ongoing long time.
Constant malnutrition due to alcoholism, the fight against excess weight with the help of debilitating diets or fasting.
How by-effect during chemotherapy.
Consequence surgical operations on the temporal lobes, they are performed to treat epilepsy.

All these neurological diseases affect limbic structures, organic damage to which can cause serious disruption in brain function.

A case of the development of amnestic syndrome after a patient was bitten by a centipede, which is found in Japan, was also described. Insect venom penetrates various parts of the brain and blocks the processes responsible for the normal functioning of memory.

Korsakov's amnestic syndrome may not progress long years, and with timely and competent treatment, regression of the main symptoms is observed. However, if the disease is ignored, Korsakov's psychosis develops. The patient in this state is completely unable to navigate in time and space, and no longer recognizes the people around him. He has delusional thoughts and ideas, which are immediately erased from memory, and isolated hallucinations may also occur.

Diagnostic methods

A diagnosis such as can be made after detecting signs of vitamin B1 deficiency. A blood test and testing of basic liver functions can indicate a thiamine deficiency. In addition, a general examination of the patient is carried out. However, to make a clinical diagnosis, it is necessary to have a stable symptom - impaired memory function due to prolonged use of alcoholic beverages. Psychological tests for memorizing phrases or individual words help identify memory problems.

For treatment to be successful, it is important at the diagnostic stage to differentiate from other pathological processes in the nervous system, which can also be caused by alcoholism. In addition, it is important to rule out other disorders that are causing memory problems that are not related to drug use. alcoholic drinks. These include: dementia, organic brain damage, depressive disorders, etc.

Treatment and prevention

It is quite difficult to treat. The success of therapy will depend on many factors, including:

degree of social adaptation of the patient;
his age;
health status;
duration of alcohol consumption;
degree of brain damage.

The main problem is that a person who begins to develop Korsakoff's syndrome does not realize it. Memory lapses can also remain invisible to others, since the patient masks them with long statements and florid thoughts. Even after diagnosis, patients often refuse treatment, considering themselves completely healthy people.

Treatment carried out after diagnosis is aimed at eliminating the cause that caused it. If memory defects are the result of alcoholism, then the basis of therapy is drugs containing thiamine and other trace elements that can minimize brain damage.

Nootropic drugs can significantly improve memory, increase the patient’s attentiveness and learning ability. If anxiety and increased excitability are present, the patient may be prescribed antipsychotic drugs in small doses.

Risks and forecasts

It is almost impossible to completely get rid of a disease such as Korsakoff syndrome, since brain damage is often irreversible. But with timely treatment, it is possible to stop the development of the disease, as well as significantly improve the patient’s condition.

IN Lately the number of patients with Korsakoff's syndrome has noticeably decreased, since thiamine is used in the treatment of alcoholism at all its stages. As a result, it is possible to prevent the development of vitamin B1 deficiency, which is the main cause of amnestic syndrome.

In addition to people leading an antisocial lifestyle and abusing alcohol, people who may be exposed to the following factors are also at risk:

treatment of cancer using chemotherapy;
dialysis;
radical dietary restrictions caused by the desire to lose weight or religious beliefs;
old age;
genetic predisposition.

Since the disease is based on a certain pattern of behavior, for example, alcoholism or poor nutrition, Korsakoff's syndrome is highly preventable. First of all, it is necessary to limit the consumption of alcoholic beverages, as well as introduce foods containing B vitamins into the diet. The latter is important for all people, since thiamine is necessary for the implementation of vital functions. important processes, but it is not synthesized in the body.

Korsakoff's syndrome is a disorder of memory for current events caused by alcohol abuse, alcoholic encephalopathy and thiamine (vitamin B1) deficiency.

Memory loss and confabulation (disorientation in time and space), personality disorders are the main symptoms.

Korsakoff's syndrome has been defined as "an abnormal mental condition, in which memory is affected along with other cognitive functions." Sergei Korsakov first defined this syndrome (1887) as a disorder associated with memory impairment. He noticed this condition in alcohol abusers and some non-alcoholic patients.

Korsakoff's syndrome is often a progression, although not always necessary. Wernicke encephalopathy is caused by a deficiency of thiamine (vitamin B1), usually due to chronic alcoholism.

Associated with serious mental symptoms such as confusion, ataxia (loss of motor control), eye problems such as nystagmus (involuntary eye movements).

Causes

It occurs when a person is not treated on time. It arises due to the combination of the following:

Thiamine or vitamin B1 deficiency – deficiency may be caused by nutritional deficiency, genetic defects in thiamine metabolism, alcoholism, cancer gastrointestinal tract, AIDS, dialysis, tumors of the nervous system.

However, Kosakoff psychosis mainly occurs due to substance deficiencies caused by alcoholism.

Alcohol Toxicity to Brain Nerves – Occurs in individuals with chronic alcoholism, poor diet, or when vitamins are not prescribed for alcoholics undergoing rehabilitation.

Symptoms

One of the main symptoms of Korsakoff's syndrome is retrograde amnesia (memory loss before the onset of amnesia) and anterograde amnesia (inability to form new memories). Early memories are usually better retained than later ones. Usually does not affect consciousness.

Other symptoms include:

Consolidation (inventing stories) is observed in the initial stages, but is less pronounced over several months to several years.
Lack of interest or participation; anxiety.
Hallucinations.

Diagnostics

Korsakoff's syndrome is diagnosed based on the patient's history and clinical features. Getting information from family, friends is relatively helpful for correct diagnosis. Medical examinations, tests, are performed on people suspected of having Korsakoff's syndrome when they emerge from a state of confusion.

Other deficiencies such as magnesium deficiency, folic acid, must also be eliminated.

Complete abstinence from alcohol is necessary. Recovery is often delayed.

Treatment of Wernicke encephalopathy

There are no studies on the use of vitamin B complex in the treatment of Wernicke encephalopathy. Dose knowledge is based on uncontrolled trials and empirical practice.

One randomized controlled trial assessed the effectiveness of controlled dosing regimens of thiamine on working memory in alcohol-dependent individuals (n = 107, thiamine 5 mg, 20 mg, 50 mg, 100 mg, 200 mg IM daily for 2 days). It was found that the 200 mg dose was significantly more effective than the 5 mg dose.

Clinical assessment of patients at risk for thiamine deficiency is shown in Table 2.

table 2

Clinical assessment of patients at risk of deficiency

Early signs and symptoms of thiamine deficiency

Loss of appetite

Nausea, vomiting

Fatigue, weakness, apathy

Dizziness, diplopia

Insomnia, anxiety, difficulty concentrating

Late signs and symptoms

Classic triad: oculomotor abnormalities, cerebellar dysfunction (ataxia), confusion

Quiet global confusion with disorientation in time, place

Confabulation, hallucination

Beginning of coma

Wernicke's encephalopathy criteria. 2 of the following must be present

Dietary deficiencies

Oculomotor abnormalities

Cerebellar dysfunction

Altered mental status or mild memory impairment

Recommendations for the treatment of encephalopathy and CS were determined from the following evidence obtained from case reports. Cases of CS have been described in patients taking high doses of oral thiamine.

To learn more Signs and treatment of Asperger's syndrome

Parenteral thiamine doses between 100 mg-250 mg do not always prevent death. 56%-84% of patients with Wernicke encephalopathy develop Korsakoff syndrome if symptoms persist for a long time.

This poor outcome is not necessarily due to permanent brain damage that was present at the time of disease onset.

Other studies suggest that doses are suboptimal and may not restore vitamin status, improve clinical signs, or prevent death.

There are case reports where patients require a dose of 1 g of thiamine in the first hours to achieve a clinical response.

Table 3

Immediate treatment of Wernicke encephalopathy

IV = intravenous

Prevention

Its occurrence can be prevented using the following steps:

People who consume alcohol should ensure adequate intake of thiamine in their diet. They are prescribed thiamine supplements
Alcohol patients should register for a support group. It is very important that the patient has the support of family and friends.
Patients with symptoms of Wernicke's encephalopathy need proper diagnosis and treatment.

Which doctor should I see for Korsakoff's syndrome?

Korsakoff syndrome is usually diagnosed by a primary care physician, who may refer the patient to a neurologist.

Is there complete recovery from the syndrome?

Because patients with Korsakoff syndrome suffer from brain damage, they may not fully recover. Partial recovery is possible for most people if they remain. However, if the disorder is treated while the patient is in the Wernicke encephalopathy stage, it is much more effective.

Korsakoff syndrome is a psychopathology that is a type of amnesia and is manifested by loss of short-term memory, retention of long-term memory, disorientation in space and time, and the presence of false memories. The pathology is caused by a lack of thiamine in the body, alcohol abuse, traumatic head injury, and organic brain damage. Severe deficiency of vitamin B1 leads to damage to the hypothalamus and severe amnestic disorders.

The disease was first described by the Russian professor of psychiatry S.S. Korsakov in 1887, which is how it got its name. The scientist determined that the cause of encephalopathy and polyneuritis is chronic alcoholism. Other researchers, several years after Korsakov’s discovery, proved that this disorder develops with various organic lesions of the brain.

Patients with Korsakoff's syndrome do not remember current events and stop thinking and reasoning sensibly. They retain memory of the past, and their orientation in time, space and the surrounding reality is disturbed. Patients tell fictitious life stories that never happened. With this pathology, along with memory impairment, polyneuropathies occur, leading to dulling of all types of sensitivity, the development of paralysis and paresis.

Korsakoff's syndrome is a relatively stable, chronic condition. This is one of the most common diseases that affects older people who abuse strong alcoholic beverages. It is characterized by memory impairment and increasing dementia, lasts up to 15 years and leads to intellectual disability. Impaired memory is not restored, brain activity decreases, and mood changes dramatically.

With severe mechanical damage to the head, Korsakov's syndrome appears and disappears suddenly. A transient form of pathology can also develop with TBI, carbon monoxide poisoning, and postoperative psychosis. The prognosis is considered favorable if the patient has not reached 60 years of age.

Etiology

Causes of the disease:

alcohol addiction,
violation of absorption of vitamins and microelements,
hypovitaminosis B1,
severe traumatic injuries,
neoplasms in the brain,
frequent vomiting during pregnancy,
endocrinopathies - hyperglycemia,
hormonal disorders,
discirculatory processes in the brain,
acute infections,
intoxication - drug addiction, substance abuse, poisoning with various poisons,
hypoxia,
senile processes,
surgical treatment of epilepsy.

Vitamin B1 ensures the normal functioning of neurons and is involved in the synthesis of mediators that transmit nerve impulses.

Thiamine deficiency leads to various pathomorphological changes:

necrotic damage to neurons,
proliferation of capillaries in the lesion,
destruction of the myelin sheath of nerve fibers,
the appearance of microhemorrhages.

These processes are manifested by mnestic disorders. Patients cannot remember the name of a person they just met, but they have no difficulty playing chess with him. In this case, the game proceeds according to the situation, without thinking about new moves. Such a patient is unlikely to be able to repeat the moves made. When higher integrative centers of the brain are damaged, nonspecific mechanisms that retain certain events in memory cease to function normally.

There are also factors predisposing to the development of this disease. These include: hemodialysis, chemotherapy, strict diets, genetic predisposition. These factors make the prognosis of the disease less favorable.

Symptoms

Korsakoff's syndrome is a striking symptom complex. If you see it once, you won’t confuse it with anything else. The first to form is a pathology of memory for continuous events. First, recently remembered information is erased from the patients’ memory, and then old, long-studied information. Narrow information is lost in memory, but general information is retained in it for a long time.

With Korsakov's syndrome, two types of amnesia occur - retrograde and fixation. Retrograde amnestic disorder is characterized by loss of memories of the onset of the illness and retention of distant memories from childhood. Fixation amnesia is characterized by the inability to retain current events in memory. Patients quickly forget the essence of the conversation, do not remember their interlocutor, greet the same people many times, and immediately forget about what they read in the book. They cannot answer what they had for breakfast or what they were doing a couple of hours ago. They firmly retain events that occurred before the disease in their memory and reproduce them correctly and accurately. Usually all types of memory suffer: verbal, figurative, emotional.

In addition to memory impairment, patients develop disorientation in time and space. Disorientation can vary and depends on two factors: when the disease began and what part of the brain is damaged. Patients lack a critical assessment of their pathology, they lose orientation even in familiar surroundings, there is confusion of thinking, and negative emotions in their mood or complacent carelessness predominate.

One of the main symptoms of the pathology is paramnesia. This is the replacement of real memories by patients with fantastic ones with an exaggeration of their own role in them, for example, saving the world from otherworldly creatures.

Manifestations of paramnesia:

The gaps in their memory are filled with fictitious fantastic stories - replacing some real events with others. The patient says that he is a famous astronaut or the discoverer of an alien settlement.
Events that the patient has forgotten are replaced in his memory by random information from own life. The patient himself considers this to be real; there is no point in challenging his opinion.
Patients often fill in gaps in their memory with information from books, movies, and television programs.

Sudden changes in mood are also characteristic of this disease. Emotional instability is especially pronounced in alcohol dependence. The mood of patients changes several times a day: they can be friendly and aggressive, complacent and restless, loving and hating. Symptoms of asthenic syndrome often develop: fatigue, lethargy, weakness, depression, melancholy, apathy, irritability. Increasing weakness and fatigue do not disappear even after a long rest. Indifference and indifference to current events are especially pronounced in older people. Young people remain more active and do not lose interest in life.

Psycho-emotional disorders in Korsakoff syndrome are combined with somatic ones: tachycardia, dizziness, loss of appetite, weight loss, myalgia, arthralgia, cardialgia, insomnia, loss of muscle strength, fear of bright lights and loud sounds. Patients gradually decrease in physical activity and lose interest in current events. A decrease in volitional activity is manifested by the desire of patients to be inactive and rest. At night they experience motor agitation to the point of confusion.

With Korsakov's syndrome, neurogenic dermatoses with skin itching and impaired sense of touch, paresthesia, and convulsions can develop. The syndrome is often accompanied by polyneuropathy with impaired sensation in the legs and the development of paresis.

Patients with alcohol addiction stop thinking logically, their intelligence decreases, their judgments and stereotypes become contradictory.

The course of Korsakoff's syndrome depends on its underlying cause:

Alcohol amnestic syndrome occurs acutely and lasts a long time - up to 15 years or more. Inpatient treatment of such patients often does not lead to complete reversal. A personality defect gradually forms, dementia, delirium, apathy or euphoria increases.
Intoxication and hypoxia of the brain leads to the acute development of the syndrome. Treatment lasts about three years and often ends in recovery. Possible development of intellectual disability.
Korsakoff syndrome in TBI is characterized by an acute onset and a decrease in the severity of the disease, weakening or disappearance of symptoms for a certain period. But under the influence additional factors previously disappeared manifestations of the syndrome reappear. A favorable outcome is extremely rare.
In elderly people with symptoms of atherosclerosis, the syndrome has a progressive course, despite long-term hospital treatment. Amnesia in patients progresses, intellectual disability worsens.

To make a correct diagnosis, specialists need to listen and examine the patient, collect an anamnesis of life and illness, and conduct a full neurological examination with psychological memory tests. The results of blood tests, determination of thiamine levels, and magnetic resonance imaging of the brain are necessary.

Treatment

Patients with Korsakoff's syndrome are treated in a hospital, since they often simply forget to take medications at home. Therapeutic measures are aimed at removing toxins from the body, restoring brain function and social rehabilitation. Patients are prohibited from drinking alcohol. If patients cannot do this, they are coded for alcoholism.

To fulfill therapeutic purposes, specialists prescribe the following groups of drugs:

"Trental", "Cavinton" to improve cerebral microcirculation,
"Reopoliglyukin", colloidal and crystalloid solutions to combat intoxication,
"Piracetam", "Vinpocetine" and other nootropic drugs for stimulating neuronal metabolism,
Neuroleptics "Haloperidol", "Azaleptol" in small doses,
Vitamin therapy – vitamin B1, cocarboxylase, vitamins B5, PP, C, B2, B6.

Patients need to follow a daily routine, eat right, eat protein foods, take vitamins, exercise physical therapy, exercise your memory, memorize poetry, solve mathematical examples and problems. Psychotherapists and psychologists help such patients adapt and give practical advice to their families. Has a beneficial effect on the condition of patients home furnishings and aromatherapy.

Treatment of Korsakov's syndrome is long-term. First, vision improves, polyneuropathy is restored, then coordination and cognitive functioning. Correct therapy can provide patients with 10-15 years of normal life.

Korsakoff's syndrome in alcoholism has an unfavorable prognosis. In patients, mental activity and the process of active adaptation to the conditions of the social environment are disrupted. Amnestic syndrome often gives way to alcoholic dementia. To prevent such changes, it is necessary to treat alcoholism. Complete restoration of intelligence and memory is extremely rare. Without painstaking care, patients will quickly die due to infection and the inability to self-care. With adequate treatment, memory restoration can be achieved.

Korsakoff's syndrome is a psychiatric and neurological pathology characterized by memory loss and the development of amnesia, which greatly reduces the quality of life of the affected person. Preventive measures consist of combating bad habits, proper nutrition and taking vitamins. If signs of Korsakov's syndrome appear, you should consult a doctor as soon as possible, because returning a healthy personality is quite difficult.

Video: example of interviewing a patient with Korsakoff's syndrome

Korsakov's syndrome

A person's memory provides him social adaptation. As long as a person remembers who he is, what he does in this world and everything that happened to him, then he can control his actions and communicate, and be responsible for his actions. But when a person, for one reason or another, has disturbances associated with memories, then communication with him can become painful or even dangerous.

Patients with Korsakoff's syndrome, or as they often call psychosis, belong precisely to this category of people who have problems with their memory. The need for constant care and supervision becomes the reason why the patient’s relatives are forced to place them in a boarding house.

Clinical picture and causes of Korsakoff's syndrome

When a child makes up stories about aliens, fairy-tale heroes, this can be explained by his passion for science fiction novels or fairy tales, but if an adult or elderly person turns to you with a request to help him find his home, because aliens transported him to another place or time, then it is difficult to believe in this. This is what awaits those whose loved ones are diagnosed with Korsakoff syndrome.

Korsakov's syndrome was described by the Russian psychiatrist S.S. Korsakov. The causes of the disease are varied and still poorly understood. Most often, patients have a lack of thiamine in the body, which is known as vitamin B1. A decrease in its concentration and entry into the body causes the development of human memory disorders.

Vitamin B1 or thiamine is involved in the formation of myelin sheaths, which cover nerve fibers and certain parts of the nervous system. In addition, its presence is important for the normal functioning of the limbic system of the brain and neurons. In patients with Korsakoff's syndrome, changes are observed due to a decrease in the supply of this vitamin to the blood.

Korsakoff syndrome is mainly observed in patients with alcoholism. Their absorption of vitamin B is impaired, in addition, they often eat poorly and go hungry. Since alcohol from alcoholic beverages provides enough energy for the functioning of the body, but does not provide the opportunity to restore damaged cells, since it does not contain the substances necessary for this. Alcohol breakdown products negatively affect brain cells, causing their destruction and necrosis. Korsakov's syndrome in alcoholism is often called Korsakov's amnestic syndrome. Which indicates the main symptom is memory impairment (amnesia).

There are some diseases and conditions that contribute to the development of Korsakoff syndrome; this is associated with a decrease in intake or loss of vitamin B1. These include:

Severe forms of pregnancy with constant vomiting. Insufficient intake of the vitamin causes changes in the central nervous system.
Pathologies associated with malnutrition of the brain. These may be vascular diseases (capillary proliferation), diabetes, atherosclerosis and others.
Bere-Beri disease is itself caused by a lack of thiamine in the body and is often accompanied by Korsakoff's syndrome.
Traumatic brain injuries.
Hemodialysis.

Symptoms of the disease

The main changes in this Korsakoff syndrome concern the patient’s memory; he exhibits:

Fixation amnesia. It is characterized by the fact that those areas of the brain that are responsible for short-term memory are selectively damaged. The patient remembers the events of his youth in quite detail, the people he knew before, but does not remember what has happened to him recently. All this information is replaced by events invented or taken from other sources. Therefore, such patients are practically incapable of learning. Changing their place of residence or moving to another apartment becomes a tragedy for them. Even simply rearranging objects in a room can cause psychosis and aggression.
Amnestic disorientation. Patients instantly forget information, so they are disoriented and cannot understand where they are and with whom. They may constantly ask the same questions and cannot find a toilet or refrigerator in the house to eat. In addition, they do not remember whether they ate or not. This all affects their general condition.
Paramnesias that occur with Korsakoff's syndrome are of three types:
- Confabulation. The patient tries to restore lost memory through “guessing.” For example, if he is asked what he is doing in the bathroom, then after looking around, he will calmly say that he was going to take a swim, although this bathroom is located in a neighbor’s apartment. It is much worse when memory is replaced by fantastic, fictitious events; it is impossible to explain their unreality to the patient; he completely lacks self-criticism. Therefore, most often, when they find themselves in a fantasy world, they become completely helpless. The patient can fantasize about topics with aliens, tell how he traveled to distant countries and communicated with the president. He may feel like a hero who saved, if not all of humanity, then individual people, and he sincerely does not understand why they don’t believe him. Problems with finances may arise, because according to the patient, he is rich and successful, but those around him deceive him and do not allow him to take advantage of his achievements. Although false memories can change, constant communication with such a person causes stress for those around him.
- Cryptomnesia. After reading something in a book or seeing something on TV, the patient begins to think that these events happened to him. This is a sincere misconception. Moreover, if you try to prove to him that he is mistaken, this can cause not only bewilderment, but also aggression. There are frequent cases of the development of psychosis and delirium, when it is necessary to resort to emergency medical care or place a person in a psychiatric clinic.
- Pseudoreminescence. In this case, memory lapses are replaced by memories from the past. For example, if you ask an elderly pensioner what he did in the morning, he may answer that he was at work and describe in detail a working day that happened a long time ago. In the morning, a pensioner can, out of habit, get up and go to work, although the enterprise where he previously worked has long been closed. It is difficult to keep track of him, since it is difficult to understand which period from his past is yesterday for him. We have to lock him up at home, change the locks and hide the keys.

How does Korsakoff's syndrome occur?

If a patient begins to experience changes in the nervous tissues and brain due to a lack of vitamin B, then his life can be divided into 2 stages: before and after the development of the disease. The patient remembers normally what happened before it, but what happened after the onset of the disease completely disappears from his memory or is replaced by false memories. Against this background, patients may experience mood swings that do not reflect reality. Sometimes they become apathetic, and sometimes, not understanding the essence of what is happening, they can become agitated.

If the patient continues to take alcohol against this background, then the development of alcoholic delirium is often observed. Delirium can also be the first sign of the disease, along with nausea and vomiting. This condition can lead to loss of consciousness, deep coma and death.

If the patient lives alone, then the development of Korsakov’s syndrome in him is difficult to notice, especially since he tries to answer all the questions of others and often gets to the point if memories are replaced in accordance with the environment. Many of the patients are not detected for quite a long time, because they are quite smart and can quickly figure out how to correctly answer the question asked.

Only close people can compare the answers with real events and see what happens to the memory. But even they fail to explain to the person that he needs to see a doctor, since he is sure that everything is fine and he has no problems. You have to invite a specialist to your home so that he can assess your mental state.

Disorientation in time and space increases as the disease progresses; it is difficult for the patient to answer simple questions: what day or date is it today, when did he eat. On the street, such patients often seem to recognize people completely unknown to them, and given that they also become easily suggestible, there is a danger of becoming a victim of scammers.

The ability to take care of himself is completely absent; the patient not only cannot go to the store for shopping, but does not even always find his way around the apartment. This leads to the fact that, not finding a toilet, he can relieve himself in another place, and literally immediately forget about it. Even changing clothes is a problem for him, since it is difficult to find clean things.

False memories can make a person want to leave the house for some purpose that only he understands, and when he goes outside, a person gets lost in a familiar place. He may not recognize neighbors and acquaintances, but he can “remember” a complete stranger and follow him. Such patients require constant monitoring and care. It's hard to keep track of them because it's hard to imagine what's going on in their heads. Recently, a completely calm person can become aggressive, suspicious, and if he is also strong enough, then forcing him to perform some action becomes almost impossible.

Diagnosis of the disease

When making a diagnosis, an alcohol history is taken into account and psychological tests are performed. Currently, this Korsakov syndrome in alcoholism is less common, since when treating alcoholics, thiamine is necessarily prescribed. Such patients often have unilateral oculomotor nerve palsy and ataxia. That is, a person’s muscles work uncoordinatedly, which leads to changes in gait, loss of coordination and, consequently, injuries.

Treatment

Patients with Korsakoff's syndrome are given increased doses of thiamine, other vitamins, and agents that improve microcirculation and nutrition of nerve cells. But basically it is necessary to treat alcoholism. In young people, treatment of Korsakoff's syndrome may lead to improvement general condition and cure, but treatment is long-term, can last 1–2 years.

Forecast

The prognosis of the disease depends on the age of the patient. Usually, with early detection, the development of memory disorders can be prevented. Thus, in young patients, when the cause of Korsakoff syndrome is a traumatic brain injury, its development occurs quickly and the symptoms can be pronounced, but with timely treatment, after a while the person can fully recover. If the patient is elderly, then the accompanying processes of aging and atherosclerosis aggravate the disease.

What to do with such patients, especially if the syndrome arose against the background of alcoholism? They constantly need care, and poor coordination of movements often leads to fractures and other injuries that cause complications associated with temporary immobility of the patient. These may be congestive pneumonia, bedsores, trophic ulcers, especially since the body of such a patient is weakened due to long-term use alcohol.

Such patients require constant care. We must ensure that he does not leave the house and does not get lost, that he eats on time and goes to bed. We have to help him find his bed, accompany him to the toilet, remind him of the same information over and over again, which he instantly forgets.

If at a young age there is a chance to cure a patient, then older patients gradually fade away due to chronic diseases. A big problem for relatives is also chronic alcoholism, which requires a change in their usual environment, which can have a bad effect on the patient himself.

The need for medical care and round-the-clock supervision is the reason for placing such patients in a nursing home or a special boarding house. This allows relatives and friends to be confident that he will receive the necessary help.