Wernicke–Korsakoff syndrome

What is Wernicke–Korsakoff syndrome?

Wernicke–Korsakoff syndrome is a condition that is similar to dementia and is caused by drinking too much alcohol.

In Wernicke–Korsakoff syndrome the damage to the brain is caused by a thiamine deficiency. Alcohol prevents the body from getting enough thiamine (vitamin B1), which is vital for brain cells to work properly. This lack of vitamin B1 can have severe and long-lasting effects on the brain.

This condition can make alcohol-related brain damage (ARBD) more severe because it causes permanent damage to the brain and nervous system.

Some of the symptoms may be similar to dementia but it is not a type of dementia.

Wernicke–Korsakoff stages

Wernicke–Korsakoff syndrome has two separate stages:

1. Wernicke’s encephalopathy

   First, there is a brief time when a person has intense inflammation (swelling) of their brain. This is known as ‘Wernicke’s encephalopathy’. At this stage, most people experience symptoms that include being disorientated and confused.

2. Korsakoff’s syndrome

   If a person with Wernicke’s encephalopathy isn’t treated quickly, they may develop a more long-term condition called ‘Korsakoff’s syndrome’. This has many of the same symptoms of dementia, including memory loss and difficulties forming new memories.

Signs and symptoms of Wernicke–Korsakoff

Earlier signs of Wernicke’s encephalopathy include a poor appetite, feeling sick, vomiting or recent weight loss. A person may feel faint or dizzy, get pins and needles in their hands and feet, have blurred vision or see two of everything (double vision).

If a person who drinks heavily gets any of the following symptoms, they should seek urgent medical attention from their GP or call NHS 111: 

• being confused, disorientated, drowsy or less responsive
• seeing things that aren’t there (hallucinations)
• having difficulty controlling eye movements
• having poor balance, being unsteady and walking with legs wide apart
• being undernourished – for example, being thin or having lost a lot of weight recently.

Some people with Wernicke’s encephalopathy may only have one or two of these symptoms. This can make an emergency difficult to spot. 

If a person is still intoxicated or experiencing withdrawal symptoms, it can be even harder to recognise. However, most people will be disoriented and confused. This is called ‘delirium' and is a medical emergency.

Treating Wernicke–Korsakoff syndrome

Wernicke–Korsakoff syndrome should be treated in hospital. This is so a person can receive regular thiamine injections and medications to control withdrawal symptoms. 

About a quarter of the people affected by Wernicke–Korsakoff’s syndrome who get treatment make a good recovery. About half make at least some recovery but still need support to manage their lives. 

For some people the damage is mostly permanent. Recovery might not be possible because there has been too much damage to the brain, or it may also be because the person continues to drink alcohol. 

Long-term support for Korsakoff’s syndrome

For people with Korsakoff’s syndrome who do not fully recover, they will need specialist long-term residential care if they are unable to live independently.

It can be difficult to find a care home that specialises in caring for people with Korsakoff’s syndrome. There may not be one available locally. It might sometimes be necessary to place a person temporarily in non-specialist care home. However, this can cause problems if the home is not set up to meet their specific needs. If they are younger, they may find it difficult living with older people. These homes also tend not to provide rehabilitation support.