Wernicke–Korsakoff syndrome

Find out about Wernicke–Korsakoff syndrome, a condition caused by drinking too much alcohol, including information on symptoms, diagnosis and treatment.

What is Wernicke–Korsakoff syndrome?

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

Very rarely, Wernicke–Korsakoff syndrome can be caused by factors other than alcohol. The majority of cases are caused by alcohol, and alcohol-related ‘dementia’ is the focus of this information. 

In Wernicke–Korsakoff syndrome the damage to the brain is caused in a very specific way. 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.

Wernicke–Korsakoff syndrome has two separate stages. First there will be a brief time when a person has intense inflammation (swelling) of their brain. This is known as ‘Wernicke’s encephalopathy’. If this condition isn’t treated quickly, the person may develop a more long-term condition called ‘Korsakoff’s syndrome’. This has many of the same symptoms of dementia.

About a quarter of the people affected by Wernicke–Korsakoff syndrome who get treatment make a good recovery. About half make a partial recovery and still need support to manage their lives. About a quarter of people with the condition make no recovery and may need long-term care  in a specialist residential care home.

What is Wernicke’s encephalopathy?

Wernicke’s encephalopathy develops if a person’s brain doesn’t get enough thiamine (vitamin B1). This is almost always caused by a person drinking too much alcohol.

Alcohol prevents thiamine from being absorbed properly in the gut, stops it from being used properly in the body, and increases the amount of thiamine that the body loses in the urine.

Wernicke’s encephalopathy can be difficult to identify –particularly if a person is still intoxicated with alcohol. The symptoms can sometimes be mistaken for alcohol withdrawal.

The symptoms of Wernicke’s encephalopathy include:

  • being disorientated, confused or having mild memory loss
  • having difficulty controlling eye movements
  • having poor balance, being unsteady and walking with their legs wide apart
  • being undernourished – for example, being very underweight or having lost a lot of weight in the previous months.

It is unusual for someone with Wernicke’s encephalopathy to have all of these symptoms. However, most people will be disoriented and confused.

Because a person with Wernicke’s encephalopathy is in a very serious condition, diagnosis is often carried out in a hospital. The doctor will look for symptoms of the condition and may also carry out a brain scan to confirm their diagnosis.

As with other forms of ARBD, a diagnosis can be more challenging if the doctor doesn’t know how  much alcohol the person drinks. 

The treatment of Wernicke’s encephalopathy is for the person to immediately stop drinking alcohol and be given several injections of high doses of thiamine (and other B vitamins).   

After a person has had this treatment, they maybe referred o a service that can help them to stop drinking alcohol. See our page on alcohol-related 'dementia' for information on support and rehabilitation.

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What is Korsakoff's syndrome?

Korsakoff’s syndrome is a long-term condition that develops when Wernicke’s encephalopathy is left untreated, or is not treated soon enough. Over time, the damage to the brain becomes more difficult to recover from.

Because Korsakoff’s syndrome often follows on from untreated Wernicke’s encephalopathy, many people refer to it as Wernicke–Korsakoff syndrome.

The main symptoms of Korsakoff's syndrome are confusion and memory loss – particularly memory of events that happened after the person developed the condition.

Because the person is less able to form new memories, they may also repeat the same question several times. For some people with the condition, memories of the more distant past can also become lost or distorted.

Other symptoms of Korsakoff’s syndrome can include:

  • difficulty understanding new information or learning new skills
  • changes in personality – the person may become apathetic (lacking emotional reactions), become very talkative, or do the same things over and over
  • lack of insight into the condition – even a person with large gaps in their memory may believe their memory is working normally
  • confabulation – a person’s brain may fill in the gaps in their memory with things that didn’t happen. For example, a person who has been in hospital for several weeks may talk about having just visited a person or a place earlier that day (this is more common in the early stages of the condition). It is important to remember that the person thinks this is a real memory. It may seem as if they are purposefully lying – but often this isn’t the case  
  • problems with concentration, planning, making decisions or solving problems.

A person may be diagnosed with Korsakoff’s syndrome if they show some of the symptoms and have a history of drinking too much. A brain scan can be helpful but is not always necessary. People with Korsakoff’s syndrome are often diagnosed in hospital after they have been admitted for other medical reasons.

As with Wernicke’s encephalopathy, the main treatment for Korsakoff’s syndrome is to give the person high doses of thiamine immediately. They may also need to be given other types of nutrition and hydration to get their body working properly.

In the longer term, the person will most likely need the same kinds of support and rehabilitation as a person with alcohol-related ‘dementia’. They may  benefit from learning ways to help them cope with their memory problems. 

View our page on alcohol-related 'dementia' for information on support and rehabilitation.