Symptoms of Korsakoff's Psychosis
The cardinal symptom of Korsakoff's psychosis is anterograde amnesia (inability to form new memories) accompanied by confabulation (making up stories to fill memory gaps), while other cognitive functions remain relatively preserved. 1
Core Clinical Manifestations
Memory Impairments
- Anterograde amnesia: Severe inability to form new memories after onset of the condition 2, 1
- Retrograde amnesia: Loss of memories formed before onset, often extending back 20-25 years 3
- Temporal confusion: Inability to properly sequence memories or place them in correct chronological order 2
- Source memory deficits: Difficulty identifying the origin or context of memories 2
Confabulation
- Spontaneous creation of false memories to fill gaps in memory
- Often presented with conviction despite being obviously incorrect
- May decrease over time as the syndrome progresses 1
Preserved Cognitive Functions
- Relatively intact immediate/short-term memory
- Intelligence often remains within normal range 3
- Procedural memory (skills, habits) typically preserved
- Language functions generally intact
Additional Symptoms
Neurological Manifestations
- May present with residual signs from preceding Wernicke encephalopathy:
- Ataxia (unsteady gait)
- Ocular abnormalities (nystagmus, ophthalmoplegia)
- Peripheral neuropathy 1
Cognitive and Behavioral Changes
- Executive dysfunction (problems with planning, organization, and decision-making)
- Apathy and lack of initiative
- Reduced insight into condition
- Emotional and affective disturbances
- Social-cognitive impairments 1
Diagnostic Considerations
Korsakoff's psychosis typically follows an episode of Wernicoff's encephalopathy, most commonly in the context of chronic alcohol use, though it can occur in other conditions causing thiamine deficiency 1. The diagnosis requires:
- Presence of memory impairment disproportionate to other cognitive deficits
- History of thiamine deficiency (usually from alcohol use disorder)
- Exclusion of other causes of amnesia
Clinical Course
Korsakoff's psychosis is typically persistent, though some improvement may occur with early thiamine replacement and abstinence from alcohol. The memory impairment tends to be permanent in most cases, though the severity can vary 1.
Differential Diagnosis
Korsakoff's psychosis must be differentiated from:
- Dementia (which shows more global cognitive decline)
- Hepatic encephalopathy (which has fluctuating consciousness levels) 4
- Other causes of amnesia (traumatic brain injury, stroke, etc.)
- Primary psychiatric disorders with psychotic features 4
Early recognition of symptoms is crucial as prompt thiamine replacement may prevent progression of Wernicke's encephalopathy to Korsakoff's psychosis, significantly improving morbidity and mortality outcomes 5.