What initial investigations are recommended for a patient suspected of having Korsakoff Syndrome?

Initial investigations for a patient suspected of having Korsakoff syndrome should focus on identifying and managing Wernicke's encephalopathy, the acute phase preceding Korsakoff syndrome. This includes offering parenteral thiamine promptly to people with suspected Wernicke's encephalopathy, especially if they are intoxicated or malnourished, to prevent progression to Korsakoff syndrome. Thiamine treatment should be given for a minimum of 5 days, followed by oral thiamine therapy.

Additionally, assess nutritional status and risk factors such as alcohol dependence, malnourishment, or decompensated liver disease. Blood tests to exclude alternative causes of cognitive impairment and liver function tests to evaluate alcohol-related liver disease may be appropriate. Referral to specialist services for further assessment and management is recommended if cognitive impairment persists.

Neuroimaging or specialist cognitive assessments may be considered to exclude other causes of cognitive decline if the diagnosis is unclear, but the primary initial focus is on thiamine administration and nutritional assessment.

In summary, the key initial investigations and actions are:

• Immediate administration of parenteral thiamine followed by oral thiamine to prevent or treat Wernicke's encephalopathy ¹,².
• Assessment of nutritional status and risk factors for malnourishment or liver disease ¹,².
• Basic blood tests including liver function tests to exclude other causes ¹.
• Referral to specialist services for cognitive assessment if symptoms persist ²,³.