How should I approach the diagnosis of Korsakoff Syndrome in a patient presenting with memory impairment and confabulation?

Approach to Diagnosis of Korsakoff Syndrome

In a patient presenting with memory impairment and confabulation, Korsakoff syndrome should be suspected particularly in the context of a history of chronic alcohol misuse and nutritional deficiency.

Key diagnostic considerations include:

• Clinical history focusing on alcohol use disorder and nutritional status, especially thiamine deficiency risk factors such as malnourishment or decompensated liver disease.
• Recognition of characteristic cognitive features: profound anterograde amnesia, retrograde amnesia, and confabulation.
• Exclusion of other causes of memory impairment through appropriate investigations.
• High index of suspicion for preceding or coexisting Wernicke's encephalopathy, as Korsakoff syndrome often follows untreated or inadequately treated Wernicke's encephalopathy.

Management implications: Prompt administration of parenteral thiamine is critical to prevent progression from Wernicke's encephalopathy to Korsakoff syndrome and to limit further neurological damage.

Long-term care planning should consider the degree of cognitive impairment, with supported independent living for mild cases and 24-hour care for moderate to severe cases, alongside support to maintain abstinence from alcohol.

This approach aligns with NICE recommendations emphasizing thiamine treatment in at-risk individuals and the importance of clinical vigilance for Wernicke-Korsakoff syndrome in alcohol-dependent patients.

References: ¹,²