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Palm A, Talaslahti T, Vataja R, Ginters M, Kautiainen H, Elonheimo H, Suvisaari J, Lindberg N, Koponen H. Criminal behavior in alcohol-related dementia and Wernicke-Korsakoff syndrome: a Nationwide Register Study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01804-0. [PMID: 38613687 DOI: 10.1007/s00406-024-01804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Chronic heavy alcohol use may lead to permanent brain damage, cognitive impairment, and dementia. While the link between alcohol use and crime is strong, virtually no research exists on the criminal behavior of patients with the alcohol-related neurocognitive disorders of Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD). METHODS The study population included all persons diagnosed with WKS (n = 1149) or ARD (n = 2432) in Finland in 1998-2015. Data on diagnoses, mortality, and crime were obtained from Finnish nationwide registers. Crime incidences were calculated 4 years before and after diagnosis. Crime types, incidences, and mortality were compared between disorders and with the general population. RESULTS Altogether 35.6% of WKS patients and 23.6% of ARD patients had committed crimes in the 4 years preceding diagnosis, most commonly property and traffic crimes, followed by violent crimes. The incidence of criminal behavior decreased significantly after diagnosis; in WKS patients, the standardized criminality ratio (SCR), the ratio of observed to expected number of crimes (95% CI), was 3.91 (3.72-4.10) in 4 years before and 2.80 (2.61-3.00) in 4 years after diagnosis. Likewise, in ARD patients, the SCRs were 2.63 (2.51-2.75) before and 0.84 (0.75-0.92) after diagnosis. No significant difference emerged in mortality between persons with and without a criminal history. CONCLUSIONS Persons with alcohol-related neurocognitive disorders frequently engage in criminal behavior prior to diagnosis, especially multiple offending. In the 4 years before and after diagnosis, crime rates declined in a linear fashion, with a marked reduction after diagnosis.
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Affiliation(s)
- Anniina Palm
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland.
- University of Helsinki, Helsinki, Finland.
| | - Tiina Talaslahti
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | | | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Palm A, Vataja R, Talaslahti T, Ginters M, Kautiainen H, Elonheimo H, Suvisaari J, Lindberg N, Koponen H. Incidence and mortality of alcohol-related dementia and Wernicke-Korsakoff syndrome: A nationwide register study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5775. [PMID: 35789035 PMCID: PMC9546078 DOI: 10.1002/gps.5775] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epidemiological data on alcohol-related cognitive disorders are scarce. Up-to-date population-based incidence and mortality rates for Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD) are necessary to understand the burden of these diseases. METHODS We collected diagnostic data from the Finnish Hospital Discharge Register and mortality data from Statistics Finland for all persons aged ≥40 years who had received a diagnosis of WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the incidences and mortality in relation to the age-, sex- and calendar year-matched general population. Causes of death were ascertained from death certificates. RESULTS For WKS, the incidence per 100,000 person-years (95% confidence interval (CI)) was 3.7 (3.4-3.9) in men and 1.2 (1.1-1.3) in women. For ARD, the incidence was 8.2 (7.9-8.6) in men and 2.1 (1.9-2.3) in women. The incidence of WKS peaked in people aged 50-59 years and the incidence of ARD in people aged 70-79 years. The standardized mortality ratio (95% CI) was 5.67 (5.25-6.13) in WKS patients and 5.41 (5.14-5.70) in ARD patients. Most of the excess mortality resulted from alcohol-related causes. CONCLUSIONS To our knowledge, this is the first study describing population-based incidence and mortality rates, sex-segregated data and causes of death in patients with WKS or ARD. Our results establish a point of reference for the incidence of WKS and ARD and show the high mortality and poor prognosis of these disorders.
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Affiliation(s)
- Anniina Palm
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
| | - Risto Vataja
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
| | - Tiina Talaslahti
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
| | - Milena Ginters
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
| | - Hannu Kautiainen
- Primary Health Care UnitKuopio University HospitalHelsinkiFinland,Folkhälsan Research CenterHelsinkiFinland
| | | | - Jaana Suvisaari
- Finnish Institute for Health and WelfareHelsinkiFinland,Mental Health UnitHelsinkiFinland
| | - Nina Lindberg
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
| | - Hannu Koponen
- Department of PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University HospitalHelsinkiFinland
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Westermeyer JJ, Soukup B, Mayer J, Lee K. Identifying, Assessing, and Treating Korsakoff Syndrome Patients: Updated Perspectives. J Nerv Ment Dis 2021; 209:592-599. [PMID: 34397759 DOI: 10.1097/nmd.0000000000001351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Objectives consist of updating published reports on the recognition, assessment, and care of patients with Wernicke-Korsakoff syndrome (WKS). Methods included defining relevant terms, describing core clinical phenomena, conducting meaningful reviews for latter-day WKS publications, and selecting instructive case examples. Findings covered epidemiology, precipitants, neuroimaging studies, alternate learning strategies in WKS, adjunctive treatments, and promising research. In conclusion, patients, their family members, clinicians, and public health experts should benefit from this updated knowledge. Countries with substantial alcohol consumption should consider emulating Holland in designating WKS research centers, founding regional clinical facilities, and funding multidisciplinary expert teams.
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Affiliation(s)
| | | | | | - Kathryn Lee
- Minneapolis VA Health Care Center, Minneapolis
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The contribution of mamillary body damage to Wernicke's encephalopathy and Korsakoff's syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2021; 180:455-475. [PMID: 34225949 DOI: 10.1016/b978-0-12-820107-7.00029-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Histopathological alterations of the mamillary bodies are the most conspicuous and the most consistent neuropathological features of several disorders that occur after severe thiamine deficiency, such as Wernicke's encephalopathy and Korsakoff's syndrome. Moreover, they are among the few abnormalities that are visible to the naked eye in these disorders. With a lifetime prevalence of approximately 1.3%, Wernicke's encephalopathy is by far the most frequent cause of damage to the mamillary bodies in humans. Still, there is a persisting uncertainty with regard to the development and the clinical consequences of this damage, because it is virtually impossible to study in isolation. As a rule, it always occurs alongside neuropathology in other subcortical gray matter structures, notably the medial thalamus. Converging evidence from other pathologies and animal experiments is needed to assess the clinical impact of mamillary body damage and to determine which functions can be attributed to these structures in healthy subjects. In this chapter, we describe the history and the current state of knowledge with regard to thiamine deficiency disorders and the contribution of mamillary body damage to their clinical presentations.
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Late-onset Cases of Korsakoff Amnestic Syndrome With CNS Comorbidities: Suggestions for Long-term Management. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Day GS, Ladak S, Del Campo CM. Improving thiamine prescribing at an academic hospital network using the computerized provider order entry system: a cohort study. CMAJ Open 2020; 8:E383-E390. [PMID: 32414885 PMCID: PMC7239638 DOI: 10.9778/cmajo.20200029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oral thiamine therapy is frequently prescribed to patients at risk for thiamine deficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network. METHODS We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. 1, 2010, to Dec. 31, 2011) and after (Nov. 21, 2013, to Apr. 30, 2017) changes to the computerized provider order entry system promoting the use of higher dosages (≥ 200 mg) of parenterally administered thiamine. Patients receiving thiamine as part of total parenteral nutrition were excluded from analyses, as thiamine prescribing was automated and unlikely to be affected by the intervention. RESULTS A total of 6105 thiamine prescriptions were written for 2907 patients before the intervention and 12 787 thiamine prescriptions for 8032 patients after the intervention. The proportion of prescriptions for parenteral treatment increased from 55.5% (3386/6105) to 92.5% (11 829/12 787) after the intervention (p < 0.001). Increases in prescribing of parenteral thiamine treatment were sustained or enhanced across the 3.4-year observation period and were realized across all hospital services. Prescriptions for higher dosages of thiamine increased from 1.1% (65/6105) to 61.4% (7845/12 787) after the intervention (p < 0.001). INTERPRETATION Changes to the computerized provider order entry system were associated with sustained increases in the proportion of prescriptions for high-dose parenteral thiamine therapy. Similar approaches may be leveraged to align prescriber behaviour with well-accepted practice parameters in other areas of medicine.
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Affiliation(s)
- Gregory S Day
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont.
| | - Safiya Ladak
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont
| | - C Martin Del Campo
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont
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Day E, Callaghan R, Kuruvilla T, George S, Webb K, Bentham P. Pharmacy-based intervention in Wernicke's encephalopathy. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.109.025775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodClinical audit methodology was used to compare the treatment of alcohol misusers at risk of Wernicke's encephalopathy in an acute medical setting, and to assess the impact of providing information about best practice to prescribing doctors. All patients prescribed thiamine during an admission to an acute hospital trust over a 6-month period were identified, and data about their treatment episode were collected retrospectively. Hospital pharmacists then provided all prescribers with a flowchart summarising current prescribing guidelines, and prescribing patterns were re-audited 6 months later.ResultsOver two audit periods, half of the patients prescribed thiamine whose case notes we examined had symptoms suggestive of Wernicke's encephalopathy, and another 30% were at high risk. Prescribing adhered to hospital guidelines only in 14% of cases, with the pharmacy-led intervention associated with a small but significant increase in the number of patients receiving adequate treatment for Wernicke's encephalopathy.Clinical implicationsWernicke's encephalopathy is relatively common in alcohol-dependent individuals admitted to hospital, and it is easily and cheaply managed. However, even when potential cases are identified, prescribing guidelines are followed in a minority of cases, even with prompting by a hospital pharmacist. This may be related to the limited research base concerning the optimum dosing schedule of thiamine, or fears about possible anaphylaxis when using parenteral preparations.
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Abstract
“Contrary to popular belief, partial recovery from Korsakoff's Psychosis is the rule and 21% recover more or less completely. However the extent to which the patient will recover cannot be predicted with confidence during the acute stages of the illness. Failure to appreciate these facts about the natural history of the mental illness may result in the premature confinement of the patient to a mental hospital” (Victoret al, 1971).
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McIntosh C, Kippen V, Hutcheson F, McIntosh A. Parenteral thiamine use in the prevention and treatment of Wernicke–Korsakoff syndrome. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.3.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodA pre-/post-intervention audit of 163 case notes was conducted to assess the efficacy of printing information about the identification and treatment of the Wernicke–Korsakoff syndrome on the hospital alcohol detoxification sheet.ResultsParenteral thiamine was indicated in 42 of 163 patients; 26 had symptoms suggestive of Wernicke's encephalopathy and 16 were at risk. The intervention increased the chance of appropriate parenteral treatment by an odds ratio of 5.9 (95% CI 1.3–27.8). Admission to a specialist alcohol unit increased the chance of appropriate treatment by an odds ratio of 7.0 (95% CI 1.52–32.25). The mean number of doses rose from 3.08 to 4.62.Clinical ImplicationsA simple intervention may lead to improved treatment of patients with Wernicke–Korsakoff syndrome.
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11
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Gerridzen IJ, Moerman-van den Brink WG, Depla MF, Verschuur EML, Veenhuizen RB, van der Wouden JC, Hertogh CMPM, Joling KJ. Prevalence and severity of behavioural symptoms in patients with Korsakoff syndrome and other alcohol-related cognitive disorders: a systematic review. Int J Geriatr Psychiatry 2017; 32:256-273. [PMID: 27918121 DOI: 10.1002/gps.4636] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/06/2016] [Accepted: 11/08/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Experiences from clinical practice suggest that behavioural symptoms in patients with Korsakoff syndrome (KS) are a frequent problem. Knowledge about behavioural symptoms is important in understanding and managing these symptoms. The aim of this study is to review the prevalence and severity of behavioural symptoms in KS. METHODS Relevant articles were identified by searching Medline (PubMed), PsycINFO, Embase and CINAHL up to 4 June 2014. Two reviewers independently selected the studies, extracted their baseline data and assessed methodological quality using a standardized checklist. RESULTS Fifteen studies fulfilled the inclusion criteria. A diversity of diagnoses was used indicating that KS and other alcohol-related cognitive disorders and terms were used interchangeably. None of the studies were primarily designed to estimate the prevalence or severity of behavioural symptoms in patients with KS. Most studies had serious methodological limitations. The reported prevalence estimates of behavioural symptoms in the included studies varied strongly. Most prevalent were depressive symptoms and disorders (2-50%, median 27%) and agitation and aggression (10-54%, median 27%). None of the reported, mean severity estimates met pathological thresholds. The highest severity estimates were found for apathy. CONCLUSIONS Good quality studies on behavioural symptoms in patients with KS are lacking. Observational research designed to provide reliable estimates of the prevalence and severity of behavioural symptoms in patients with KS is needed. This could improve understanding and managing these symptoms and help care staff to better support the needs of this specific patient group. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ineke J Gerridzen
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Nursing Home Markenhof, Atlant Care Group, Beekbergen, The Netherlands
| | | | - Marja F Depla
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Els M L Verschuur
- Nursing Home Markenhof, Atlant Care Group, Beekbergen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ruth B Veenhuizen
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
In this review, we present a survey on Korsakoff's syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD) is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN) to the development of WE or to the progression of WE to KS. Future research on the postmortem histopathological analysis of brain tissues of KS patients is crucial for the advancement of our knowledge of KS, especially for associating its symptoms with lesions in various thalamic nuclei. A necessary requirement for the advancement of studies on KS is the broad acceptance of a comprehensive definition and definite diagnostic criteria. Therefore, in this review, we propose such a definition of KS and draft outlines for prospective diagnostic criteria.
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Affiliation(s)
- Nicolaas Jm Arts
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray.,Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Wolfheze
| | - Serge Jw Walvoort
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray
| | - Roy Pc Kessels
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray.,Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
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Sachdeva A, Chandra M, Choudhary M, Dayal P, Anand KS. Alcohol-Related Dementia and Neurocognitive Impairment: A Review Study. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e27976. [PMID: 27818965 PMCID: PMC5086415 DOI: 10.5812/ijhrba.27976] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/01/2015] [Accepted: 07/05/2015] [Indexed: 12/02/2022]
Abstract
Context Alcohol consumption has escalated rapidly in many countries over the past decade. Evidence suggests a correlation between alcohol use and cognitive decline. We have systematically reviewed the concept and controversies, epidemiology, nosology, neuropathology and neurobiology, neuropsychology and management updates of alcohol-related dementia (ARD) in this paper. Evidence Acquisition We retrieved papers for this review by searching the PubMed database for terms “alcohol and dementia”, “alcohol and cognitive impairment”, and “alcohol and wernicke-korsakoff” mentioned in the title of the published papers. A total of 131 studies showed up. Appropriate studies were shortlisted and included (n = 72). Cross-references if relevant were considered from the selected studies. Eligible articles were fully read by the authors and the results were compiled. Results The prolonged and excessive use of alcohol may lead to structural and functional brain damage, leading to ARD. The cognitive deficits are most frequently observed in domains of visuospatial functions, memory and executive tasks, with a potential of partial recovery if abstinence is maintained. However, there are doubts regarding the etiopathogenesis, nosological status, prevalence and diagnostic criteria for ARD, due to difficulty in assessment and various confounding factors. Conclusions With growing cohort of young and middle-aged people, there is a probable risk of upsurge of ARD. Presently, there are dilemmas over the diagnosis of independent ARD. Thus, there is a need to develop evidence-based guidelines for diagnosis and management of ARD through further systematic studies.
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Affiliation(s)
- Ankur Sachdeva
- Department of Psychiatry, ESIC Medical College and Hospital, Maharishi Dayanand University, Haryana, India
- Corresponding author: Ankur Sachdeva, Department of Psychiatry, ESIC Medical College and Hospital, Maharishi Dayanand University, Haryana, India. Tel: +91-1126593236; +91-9899528355, Fax: +91-1292413032, E-mail:
| | - Mina Chandra
- Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Mona Choudhary
- Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Prabhoo Dayal
- National Drug Dependence Treatment Centre (WHO Collaborating Centre), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
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Day GS, Ladak S, Curley K, Farb NAS, Masiowski P, Pringsheim T, Ritchie M, Cheung A, Jansen S, Methot L, Neville HL, Bates D, Lowe D, Fernandes N, Ferland A, Martin del Campo C. Thiamine prescribing practices within university-affiliated hospitals: a multicenter retrospective review. J Hosp Med 2015; 10:246-53. [PMID: 25652810 DOI: 10.1002/jhm.2324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/12/2014] [Accepted: 12/21/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with suspected thiamine deficiency should receive treatment with parenteral thiamine to achieve the high serum thiamine levels necessary to reverse the effects of deficiency and to circumvent problems with absorption common in the medically ill. OBJECTIVE To quantify rates of parenteral administration of thiamine across university-affiliated hospitals and to identify factors associated with higher rates of parenteral prescribing. DESIGN Multicenter, retrospective observational study of thiamine prescriptions. METHODS Prescriptions for thiamine were captured from computerized pharmacy information systems across participating centers, providing information concerning dose, route, frequency, and duration of thiamine prescribed from January 2010 to December 2011. SETTING Fourteen university-affiliated tertiary care hospitals geographically distributed across Canada, including 48,806 prescriptions for thiamine provided to 32,213 hospitalized patients. RESULTS Parenteral thiamine accounted for a statistically significant majority of thiamine prescriptions (57.6%, P < 0.001); however, oral thiamine constituted a significant majority of the total doses prescribed (68.4%, z = 168.9; P < 0.001). Protocols prioritizing parenteral administration were associated with higher rates of parenteral prescribing (61.3% with protocol, 45.8% without protocol; P < 0.001). Patients admitted under psychiatry services were significantly more likely to be prescribed oral thiamine (P < 0.001). CONCLUSIONS Although parenteral thiamine accounted for a statistically significant majority of prescriptions, oral thiamine was commonly prescribed within academic hospitals. Additional strategies are needed to promote parenteral thiamine prescribing to patients with suspected thiamine deficiency.
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Affiliation(s)
- Gregory S Day
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Peake RWA, Godber IM, Maguire D. The effect of magnesium administration on erythrocyte transketolase activity in alcoholic patients treated with thiamine. Scott Med J 2014; 58:139-42. [PMID: 23960051 DOI: 10.1177/0036933013496944] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Chronic alcoholic patients are at increased risk of developing deficiencies of thiamine and magnesium. Thiamine is an essential co-factor for a number of enzymes involved in carbohydrate metabolism and requires optimal levels of magnesium for biological function. However, whilst thiamine supplementation is well established for the treatment of alcoholic patients, the importance of magnesium is often overlooked. We describe the effect of concurrent thiamine and magnesium administration on the activity of the thiamine-dependent enzyme erythrocyte transketolase in a cohort of chronic alcoholic patients. METHODS Baseline erythrocyte transketolase activities were measured on blood samples collected from 36 chronic alcoholic patients presenting acutely to the Accident and Emergency department. Patients received either intravenous Pabrinex (thiamine) supplemented with magnesium sulphate (n = 18) or Pabrinex only (n = 18). Post-treatment bloods were collected for re-assessment of erythrocyte transketolase activity. The change in transketolase activities (pre-vs. post-treatment) between the two patient groups were compared by Mann-Whitney U test. RESULTS The increase in transketolase activity following treatment in the cohort receiving Pabrinex supplemented with magnesium sulphate was significantly greater (p = 0.018) than that produced in the cohort receiving Pabrinex alone. CONCLUSION In the acute management of a sample of chronic alcoholic patients, those receiving magnesium sulphate with Pabrinex have higher increases in erythrocyte transketolase activity compared with those receiving Pabrinex alone. We conclude that concurrent magnesium administration with Pabrinex may be required for enabling full efficacy of Pabrinex treatment, as demonstrated by its positive effect on erythrocyte transketolase activity.
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Affiliation(s)
- R W A Peake
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
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Day E, Bentham PW, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev 2013; 2013:CD004033. [PMID: 23818100 PMCID: PMC7163251 DOI: 10.1002/14651858.cd004033.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Autopsy studies suggest that Wernicke-Korsakoff syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but uncertainty remains about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. This is an update of a review first published in 2004 and last updated in 2008. OBJECTIVES • To assess the efficacy of thiamine in preventing and treating the manifestations of WKS due to excess alcohol consumption. • To determine the optimum form, dose and duration of thiamine treatment for this indication. SEARCH METHODS ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 6 September 2012 using the term thiamine OR aneurine. ALOIS contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trial databases and grey literature sources. SELECTION CRITERIA Any randomised trials comparing thiamine with alternative interventions or comparing different thiamine regimens (varying in formulation, dose or duration of administration). DATA COLLECTION AND ANALYSIS All abstracts were independently inspected by two reviewers (ED and PWB), and relevant articles were retrieved and assessed for methodological quality using criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomly assigned participants (n = 107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5 mg/day) with each of the other four doses. A significant difference favoured 200 mg/day compared with the 5-mg/day dose in determining the number of trials needed to meet inclusion criteria on a delayed alternation test (mean difference (MD) -17.90, 95% confidence interval (CI) -35.4 to -0.40, P = 0.04). No significant differences emerged when the other doses were compared with 5 mg/day. The pattern of results did not reflect a simple dose-response relationship. The study had methodological shortcomings in design and in the presentation of results that limited further analysis. AUTHORS' CONCLUSIONS Evidence from randomised controlled clinical trials is insufficient to guide clinicians in determining the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.
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Affiliation(s)
- Ed Day
- Department of Psychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
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Ridley NJ, Draper B, Withall A. Alcohol-related dementia: an update of the evidence. ALZHEIMERS RESEARCH & THERAPY 2013; 5:3. [PMID: 23347747 PMCID: PMC3580328 DOI: 10.1186/alzrt157] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The characteristics of dementia relating to excessive alcohol use have received increased research interest in recent times. In this paper, the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS) are reviewed. Neuropathological and imaging studies suggest that excessive and prolonged use of alcohol may lead to structural and functional damage that is permanent in nature; however, there is debate about the relative contributions of the direct toxic effect of alcohol (neurotoxicity hypothesis), and the impact of thiamine deficiency, to lasting damage. Investigation of alcohol-related cognitive impairment has been further complicated by differing definitions of patterns of alcohol use and associated lifestyle factors related to the abuse of alcohol. Present diagnostic systems identify two main syndromes of alcohol-related cognitive impairment: ARD and WKS. However, 'alcohol-related brain damage' is increasingly used as an umbrella term to encompass the heterogeneity of these disorders. It is unclear what level of drinking may pose a risk for the development of brain damage or, in fact, whether lower levels of alcohol may protect against other forms of dementia. Epidemiological studies suggest that individuals with ARD typically have a younger age of onset than those with other forms of dementia, are more likely to be male, and often are socially isolated. The cognitive profile of ARD appears to involve both cortical and subcortical pathology, and deficits are most frequently observed on tasks of visuospatial function as well as memory and higher-order (executive) tasks. The WKS appears more heterogeneous in nature than originally documented, and deficits on executive tasks commonly are reported in conjunction with characteristic memory deficits. Individuals with alcohol-related disorders have the potential to at least partially recover - both structurally and functionally - if abstinence is maintained. In this review, considerations in a clinical setting and recommendations for diagnosis and management are discussed.
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Affiliation(s)
- Nicole J Ridley
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Anzac Parade, Kensington, NSW, 2052 Australia ; Department of Psychology, Macquarie University, Balaclava Rd, North Ryde, NSW, 2109, Australia
| | - Brian Draper
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Anzac Parade, Kensington, NSW, 2052 Australia ; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, University of New South Wales, Anzac Parade, Kensington, NSW, 2052 Australia
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Quality of Life of Patients With Korsakoff's Syndrome and Patients With Dementia: A Cross-Sectional Study. J Am Med Dir Assoc 2012; 13:778-81. [DOI: 10.1016/j.jamda.2012.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/20/2022]
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Thomson AD, Guerrini I, Marshall EJ. The evolution and treatment of Korsakoff's syndrome: out of sight, out of mind? Neuropsychol Rev 2012; 22:81-92. [PMID: 22569770 PMCID: PMC3545191 DOI: 10.1007/s11065-012-9196-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/30/2012] [Indexed: 12/20/2022]
Abstract
Wernicke's Encephalopathy is an acute neuro-psychiatric condition caused by an insufficient supply of thiamine (Vitamin B1) to the brain. If undiagnosed or inadequately treated, it is likely to proceed to Korsakoff's Syndrome. Wernicke's Encephalopathy can result from dietary deficiency alone and this form is usually successfully treated, with little chance of Korsakoff's Syndrome supervening. On the other hand, thiamine deficiency associated with alcohol misuse/dependence may require up to 1 gram of thiamine IV in the first 24 hours to be treated successfully. The reasons for this difference in treatment will be discussed. Thiamine diphosphate acts as a co-factor for a number of thiamine-dependent enzymes. Thiamine deficiency leads to a reduction in the activity of these enzymes, and this leads to alterations in mitochondrial activity, impairment of oxidative metabolism, decreased energy status and eventually selective neuronal death. The damage caused by the combination of thiamine deficiency and alcohol metabolism probably interferes with adequate thiamine transport at a number of sites in the body, including the blood-brain barrier, as well as causing damage to the apoenzymes which then require higher concentrations of thiamine to work normally. The accumulated damage is likely to render the use of oral thiamine therapeutically inadequate since the body is unable to produce high enough concentrations of thiamine in the blood to traverse the blood-brain barrier. Some individuals are probably genetically predisposed to develop Wernicke's. Long before individuals with alcohol misuse or dependence develop Wernicke's Encephalopathy the neurons and other cells of the body are functioning sub-optimally because of the inadequate supply of thiamine and the neurotoxic effect of alcohol. This relative deficiency initiates a series of pathological changes which accumulate and further interfere with the supply of thiamine and its utilisation at a time when the requirements are increased. The best treatment for Korsakoff's Syndrome is timely recognition of Wernicke's Encephalopathy and appropriate intervention and prevention.
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Affiliation(s)
- A. D. Thomson
- />Molecular Psychiatry Laboratory, Rockefeller Building, University College London, 21 University Street, London, UK
- />Institute of Psychiatry, King’s College London, London, UK
| | - Irene Guerrini
- />Bexley Substance Misuse Service, South London & Maudsley NHS Foundation Trust, London, UK
| | - E. Jane Marshall
- />Institute of Psychiatry, King’s College London, London, UK
- />South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ UK
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Thomson AD, Guerrini I, Bell D, Drummond C, Duka T, Field M, Kopelman M, Lingford-Hughes A, Smith I, Wilson K, Marshall EJ. Alcohol-related brain damage: report from a Medical Council on Alcohol Symposium, June 2010. Alcohol Alcohol 2012; 47:84-91. [PMID: 22343345 DOI: 10.1093/alcalc/ags009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A D Thomson
- Molecular Psychiatry Laboratory, Rockefeller Building, University College London, 21 University Street, London, UK
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FEENEY GERALDFX, CONNOR JASONP. Wernicke-Korsakoff syndrome (WKS) in Australia: no room for complacency. Drug Alcohol Rev 2009; 27:388-92. [DOI: 10.1080/09595230802090048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol 2009; 44:148-54. [PMID: 19151162 DOI: 10.1093/alcalc/agn118] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The Korsakoff syndrome is a preventable memory disorder that usually emerges (although not always) in the aftermath of an episode of Wernicke's encephalopathy. The present paper reviews the clinical and scientific literature on this disorder. METHODS A systematic review of the clinical and scientific literature on Wernicke's encephalopathy and the alcoholic Korsakoff syndrome. RESULTS The Korsakoff syndrome is most commonly associated with chronic alcohol misuse, and some heavy drinkers may have a genetic predisposition to developing the syndrome. The characteristic neuropathology includes neuronal loss, micro-haemorrhages and gliosis in the paraventricular and peri-aqueductal grey matter. Lesions in the mammillary bodies, the mammillo-thalamic tract and the anterior thalamus may be more important to memory dysfunction than lesions in the medial dorsal nucleus of the thalamus. Episodic memory is severely affected in the Korsakoff syndrome, and the learning of new semantic memories is variably affected. 'Implicit' aspects of memory are preserved. These patients are often first encountered in general hospital settings where they can occupy acute medical beds for lengthy periods. Abstinence is the cornerstone of any rehabilitation programme. Korsakoff patients are capable of new learning, particularly if they live in a calm and well-structured environment and if new information is cued. There are few long-term follow-up studies, but these patients are reported to have a normal life expectancy if they remain abstinent from alcohol. CONCLUSIONS Although we now have substantial knowledge about the nature of this disorder, scientific questions (e.g. regarding the underlying genetics) remain. More particularly, there is a dearth of appropriate long-term care facilities for these patients, given that empirical research has shown that good practice has beneficial effects.
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Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6:442-55. [PMID: 17434099 DOI: 10.1016/s1474-4422(07)70104-7] [Citation(s) in RCA: 680] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. According to autopsy-based studies, the disorder is still greatly underdiagnosed in both adults and children. In this review, we provide an update on the factors and clinical settings that predispose to Wernicke's encephalopathy, and discuss the most recent insights into epidemiology, pathophysiology, genetics, diagnosis, and treatment. To facilitate the diagnosis, we classify the common and rare symptoms at presentation and the late-stage symptoms. We emphasise the optimum dose of parenteral thiamine required for prophylaxis and treatment of Wernicke's encephalopathy and prevention of Korsakoff's syndrome associated with alcohol misuse. A systematic approach helps to ensure that patients receive a prompt diagnosis and adequate treatment.
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Harper C. Thiamine (vitamin B1) deficiency and associated brain damage is still common throughout the world and prevention is simple and safe! Eur J Neurol 2006; 13:1078-82. [PMID: 16987159 DOI: 10.1111/j.1468-1331.2006.01530.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many different population groups throughout the world have thiamine deficiency and are at risk of developing severe neurological and cardiac disorders. Alcoholics are most at risk but other important clinical groups should be monitored carefully. The most severe, potentially fatal disease caused by thiamine deficiency is the neurological disorder Wernicke-Korsakoff syndrome. This can be difficult to diagnose and many cases remain undiagnosed. Treatment with thiamine generally results in a dramatic clinical improvement. Thiamine supplementation of stable food products like flour is an effective, simple and safe public health measure that can improve the thiamine status of all population groups.
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Affiliation(s)
- C Harper
- Department of Pathology, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke's Encephalopathy and Korsakoff's Psychosis. Alcohol Alcohol 2005; 41:151-8. [PMID: 16384871 DOI: 10.1093/alcalc/agh249] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
AIMS To identify the early clinical indications of thiamine deficiency and to understand the factors involved in the development of the amnesic state in alcohol-dependent individuals with thiamine deficiency. It is hoped that this will highlight the need for clinicians to treat alcohol-dependent patients prophylactically with parenteral thiamine and thus prevent the development of Korsakoff's Psychosis (KP). METHOD We have reviewed the natural history and pathophysiology of Wernicke's Encephalopathy (WE) in both human and animal studies together with any contributory factors that may predispose the individual to thiamine deficiency. A further understanding of these problems is provided by recent studies into the metabolic consequences of thiamine deficiency and alcohol misuse. CONCLUSIONS Where WE is due to thiamine deficiency alone (i.e. in the absence of alcohol misuse) KP rarely supervenes following thiamine replacement therapy. Successful treatment or prophylaxis of WE in alcohol dependence probably depends on a number of inter-related issues and is not simply a matter of early and adequate thiamine treatment. If sufficient alcohol-related neurotoxicity has occurred by the time of diagnosis, then this may be the more important or limiting factor with respect to the long-term outcome. This possible obstacle to complete recovery should not prevent every attempt being made to provide the patient with optimum brain thiamine replacement.
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Affiliation(s)
- Allan D Thomson
- Molecular Psychiatry Laboratory, Windeyer Institute of Medical Sciences, Department of Mental Health Sciences, Royal Free and University College, London Medical School, London UK
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Thomson AD, Marshall EJ. The treatment of patients at risk of developing Wernicke's encephalopathy in the community. Alcohol Alcohol 2005; 41:159-67. [PMID: 16384870 DOI: 10.1093/alcalc/agh250] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To review the process of identifying alcohol-dependent patients at risk of developing Wernicke's encephalopathy (WE) in the community, and prophylactic treatment options. METHODS Non-systematic literature review of the diagnosis of thiamine deficiency and of its treatment in the community. The role of supplementation of beer and bread with thiamine was evaluated. RESULTS The diagnosis of thiamine deficiency is not always made, and treatment apparently may sometimes be inadequate. CONCLUSIONS Alcohol-dependent patients in the community who are at risk of developing WE should be given thiamine 250 mg, intramuscularly, daily for 3-5 days as part of a community detoxification programme. Further work is essential to determine the optimum dose of thiamine required to prevent permanent brain damage (Korsakoff's Psychosis). Neurotoxicity, due to the metabolism of excessive alcohol in patients with chronic and severe alcohol dependence, must be considered as an important factor in determining the long-term outcome of treatment.
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Affiliation(s)
- Allan D Thomson
- Molecular Psychiatry Laboratory, Windeyer Institute of Medical Sciences, Department of Mental Health Sciences, Royal Free and University College, London Medical School, London UK
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Sivolap YP. The Current State of S. S. Korsakov's Concept of Alcoholic Polyneuritic Psychosis. ACTA ACUST UNITED AC 2005; 35:977-82. [PMID: 16270181 DOI: 10.1007/s11055-005-0154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Indexed: 10/25/2022]
Affiliation(s)
- Yu P Sivolap
- Department of Psychiatry and Medical Psychology, I. M. Sechenov Moscow Medical Academy, Russia
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Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse. Cochrane Database Syst Rev 2004:CD004033. [PMID: 14974055 DOI: 10.1002/14651858.cd004033.pub2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autopsy studies suggest that Wernicke-Korsakoff Syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but there is uncertainty about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. OBJECTIVES To determine the quality of evidence for the efficacy of thiamine in preventing and treating the manifestations of WKS as a consequence of alcohol excess, and if so in which form it should be given, at what dose and for how long. SEARCH STRATEGY Trials were identified from the latest updated search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 3 February 2003 using the terms "(thiamin* or aneurin*) and (Korsakoff* or Wernicke* or alcohol*). The CDCIG Specialized register contains up-to-date records from all major health care databases (Medline, Embase, PsycInfo, Cinahl and others) as well as from many trials databases. SELECTION CRITERIA All randomized trials in which treatment with thiamine or thiamine-containing products was administered and compared with alternative interventions for people with, or at risk of developing, WKS secondary to alcohol abuse. DATA COLLECTION AND ANALYSIS All abstracts were independently inspected by two reviewers (ED & PB) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. MAIN RESULTS Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomized participants (n=107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5mg/day) with each of the other four doses. There was a significant difference in favour of the 200mg/day compared with the 5 mg/day dose in the number of trials taken to reach criterion on a delayed alternation test (MD -17.90, 95% CI -35.4 to -0.40, p=0.04). No significant differences emerged in comparing the other doses with 5 mg/day. The pattern of results did not present a simple dose-response relationship. The study had methodological shortcomings in design and the presentation of results that limited further analysis. REVIEWER'S CONCLUSIONS There is insufficient evidence from randomized controlled clinical trials to guide clinicians in the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.
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Affiliation(s)
- E Day
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Birmingham, UK, B15 2QZ
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Burnill R, Daly C. Treating alcohol dependence in a district general hospital. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2002; 63:416-20. [PMID: 12187602 DOI: 10.12968/hosp.2002.63.7.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A strategy for managing alcohol problems within the general hospital setting should involve improved recognition of acute physical complications of alcohol withdrawal and dependence. Research shows that opportunistic interventions at this stage can reduce alcohol consumption by 25% in excessive drinkers. Support should be available from a local community alcohol service.
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Naik PC, Brownell LW. Treatment of psychiatric aspects of alcohol misuse. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 1999; 60:173-7. [PMID: 10476238 DOI: 10.12968/hosp.1999.60.3.1061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Psychiatric disorders and alcohol misuse often coexist. This article outlines the clinical management of these comorbid disorders. It discusses and suggests therapeutic recommendations.
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Affiliation(s)
- P C Naik
- University of Birmingham, Lyndon Resource Centre, Solihull, West Midlands
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A neuroradiological and neuropsychological comparison of Korsakoff Syndrome with and without a Wernicke's Encephalopathy. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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