Korsakoff syndrome

Also called Alcohol-related brain damage, Wernicke-Korsakoff syndrome

Permanent memory damage from thiamine deficiency, usually caused by alcohol. Largely preventable, and constantly missed.

What it is

This is one of the most preventable forms of brain damage there is, and one of the most often missed.

Heavy alcohol use depletes thiamine, vitamin B1, which the brain needs. The acute phase is Wernicke's encephalopathy: confusion, unsteadiness and eye movement problems. Treated urgently with high-dose injected thiamine, it can be reversed.

Untreated, it becomes Korsakoff syndrome, and that is permanent. Severe short-term memory loss, with older memories often intact, and confabulation, where the person fills gaps with plausible invented detail without any intent to deceive.

The tragedy is the treatment window. Injected thiamine is cheap and safe, and it is not given nearly often enough.

Signs you might notice

In the acute phase: confusion, unsteady walking, abnormal eye movements. Any one of them, in someone who drinks heavily, should trigger treatment.

In the chronic phase: inability to form new memories, while conversation and older knowledge stay surprisingly intact.

Confabulation, which sounds like lying and is not.

Apathy and lack of initiation, mistaken for choice.

Relatively preserved social skills, which masks the severity and makes people appear more capable than they are.

How it can affect day-to-day life

People with Korsakoff are frequently assessed as having capacity because they present so well in conversation, and then cannot act on any decision because they cannot retain it. Read mental capacity for why that distinction matters legally.

They fall between services: too young for older people's care, not the right fit for mental health, and often excluded from substance services once drinking stops.

With the right environment, function can improve considerably over one to two years. That is not widely known and it changes what should be offered.

Supporting someone well

Give thiamine early and by injection where indicated. If you take one clinical point from this entry, take that one.

Do not challenge confabulation. It is not a lie, and correcting it causes distress without improving accuracy.

Use routine, written prompts and consistent environments relentlessly. Procedural memory often works when episodic memory does not, so learning by doing succeeds where explaining fails.

Assess capacity decision by decision, and test whether the person can retain and use the information, not whether they can discuss it.

Expect slow improvement and do not write anybody off at six months.

Fiducia Life provides the external structure this needs: my day, all about me and a life story, in a form the person can look at themselves rather than being told again.

Where to get help

A GP or the alcohol service can refer to neurology or neuropsychiatry.

Acute confusion in a heavy drinker is an emergency. Say the word Wernicke's at the hospital.

Alcohol Change UK and local alcohol services support both the person and the family.