Wernicke-Korsakoff Syndrome (Thiamine Deficiency) Can Occur In Non-alcoholics As Well As In Alcoholics

Posted on February 15, 2020 by Tom Wade MD

The genesis of this post is a recent patient I encountered whose friends requested a second opinion for chronic severe memory loss. His memory loss is profound and interferes with his ADLs.

I don’t participate in the patient’s insurance program, so all evaluation will need to be done by his primary care physician and consultants who are on the patient’s insurance panel.

I reviewed his records and the evaluations ordered by his primary care physician. The evaluation planned is excellent and includes the usual search for all of the reversible causes of memory loss.

As I reviewed his data, one possibility occurred to me based on my observation of his Montreal Cognitive Assessment. It was much more abnormal than I would have guessed based on my interactions with him.

I believe the patient  should be treated for thiamine deficiency on spec. The reason is, is that there is no foolproof way to nail down the diagnose either by lab testing or by imaging (MRI). His physician has ordered an MRI of the brain.

The treatment is IV thiamine 250 mg q8hrs for three days and then 250 mg q 12 hours for three days.

At the time I saw him I was not thinking of Korsakoff’s Syndrome and thus did not examine him for ophthalmoplegia nor for ataxia.

However, even if those findings are absent I believe, based on my reading, that empiric IV thiamine treatment is reasonable.

His memory problems have been going on for two years, according to his friends.

Thus, even if his problem is chronic thiamine deficiency, treatment with IV thiamine might not benefit him.

I proposed IV thiamine treatment to his primary care team because several of his friends are adamant that his memory has markedly worsened in the last two months.

Therefore I believe that empiric IV thiamine treatment is indicated.

He now requires a friend to pay all of his bills.

The patient drives and has had no accidents or tickets but he can only find his way to a few places. His friends have to drive him to all his doctor’s appointments and have done so for at least a year.

The goal of IV thiamine is to hopefully allow him to be able to continue to safely live independently in his condominium.

There are other possible causes in his history such as likely severe traumatic brain injury in his youth. But there is no effective treatment for this etiology if it is the cause of his progressive symptoms.

In this post I link to articles on Wernicke-Korsakoff Syncrome, specifically to the following:

  1. General Reviews Of Wernicke-Korsakoff Syndrome
    1. Korsakoff’s syndrome: a critical review [PubMed Abstract] [Full Text HTML] [Full Text PDF]
      1. Resource (1) below
    2. Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults [PubMed Abstract] [Full Text HTML] [Full Text PDF]
      1. Resource (2)
  2. Wernicke-Korsakoff Syndrome Not Related To Alcohol
    1. Systematic Review of Wernicke-Korsakoff Syndrome Not Related to Alcohol [PubMed Abstract] [Download Full Text PDF from Research Gate].
      1. Resource (3) below
    2. A Case of Non-Alcoholic Korsakoff Syndrome Resulting
      from Malnutrition due to Self-Neglect and Severe
      Depression [Abstract] [Full Text HTML] [Full Text PDF]

      1. Resource (4) below
    3. Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity [PubMed Abstract] [Full Text HTML] [Full Text PDF]
      1. Resource (5) below
  3. Imaging Of Thiamine Deficiency
    1. Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke’s encephalopathy [PubMed Abstract] [Full Text HTML] [Full Text PDF].
      1. Resource (6) below
  4. Laboratory Diagnosis Of Thiamine Deficiency
    1. Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs [PubMed Abstract] [Full Text HTML] [Full Text PDF].
      1. Resource (7) below
    2. Test ID: TDP
      Thiamine (Vitamin B1), Whole Blood from Mayo Clinic Laboratories Test Catalogue

      1. Resource (8) below

Resources

(1) Korsakoff’s syndrome: a critical review [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Neuropsychiatr Dis Treat. 2017 Nov 27;13:2875-2890. doi: 10.2147/NDT.S130078. eCollection 2017.

(2) Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Front Psychiatry. 2019 Apr 4;10:207. doi: 10.3389/fpsyt.2019.00207. eCollection 2019.

(3) Systematic Review of Wernicke-Korsakoff Syndrome Not Related to Alcohol [PubMed Abstract] [Download Full Text PDF from Research Gate].  2015 Dec;86(12):1362-8. doi: 10.1136/jnnp-2014-309598. Epub 2015 Jan 14

The above article has been cited by 29 PubMed Central Articles.

(4) A Case of Non-Alcoholic Korsakoff Syndrome Resulting from Malnutrition due to Self-Neglect and Severe Depression [Abstract] [Full Text HTML] [Full Text PDF]. Neuropsychiatry (London) (2018) 8(6), 1726–1729.

(5) Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Front Psychiatry. 2018 May 31;9:204. doi: 10.3389/fpsyt.2018.00204. eCollection 2018.

(6) Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke’s encephalopathy [PubMed Abstract] [Full Text HTML] [Full Text PDF]. World J Radiol. 2017 Feb 28;9(2):72-78. doi: 10.4329/wjr.v9.i2.72

(7) Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann N Y Acad Sci. 2018 Oct;1430(1):3-43. doi: 10.1111/nyas.13919. Epub 2018 Aug 27.

(8) Test ID: TDP
Thiamine (Vitamin B1), Whole Blood from Mayo Clinic Laboratories Test Catalogue

This entry was posted in Alcohol Use Disorder, Metabolic Diseases, Vitamin Deficiency. Bookmark the permalink.