What is Wernicke–Korsakoff syndrome?

Drinking excessively brings with it a large number of potential risks. As well as the possibility of developing an alcohol addiction, alcohol abuse is the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, and the fifth-biggest risk factor among all ages.

One major risk is alcohol-related brain damage, also known as alcohol-related brain impairment, which is caused by heavy drinking over a long period of time. This can take three major forms – Wernicke’s encephalopathy, Korsakoff’s syndrome and alcoholic dementia – which can variously affect areas such as movement, balance, memory and concentration.

Wernicke’s encephalopathy and Korsakoff’s syndrome can occur separately but when they occur together, this is known as Wernicke–Korsakoff syndrome (WKS).

What is Wernicke–Korsakoff syndrome?

The National Institute of Neurological Disorders and Stroke (NINDS) supports research on neurological disorders including Wernicke’s encephalopathy, Korsakoff’s amnesic syndrome, and Wernicke-Korsakoff syndrome.

It says that Wernicke’s encephalopathy and Korsakoff’s syndrome are related disorders and that some scientists believe them to be different stages of the same disorder -Wernicke-Korsakoff syndrome. In this model, Wernicke’s encephalopathy represents the acute phase of the disorder and Korsakoff’s syndrome represents the disorder progressing to a chronic or long-lasting stage.

In order to understand Wernicke-Korsakoff syndrome, therefore, we will have to look at Wernicke’s encephalopathy and Korsakoff’s syndrome individually.

Wernicke’s encephalopathy and Korsakoff’s syndrome

Wernicke’s encephalopathy is a degenerative brain disorder caused by the lack of a vitamin known as thiamine (vitamin B1). It is usually caused by alcohol misuse, which is just one reason why alcohol rehab may be a good idea if you are struggling with a drinking problem.

A deficiency in thiamine can lead to intense swelling, causing damage to the thalamus and hypothalamus parts of the brain. This in turn can lead to a number of symptoms including confusion, problems with vision, low blood pressure and lack of muscle coordination.

Korsakoff syndrome, which is also sometimes referred to as Korsakoff’s amnesic syndrome, generally follows on from Wernicke’s encephalopathy – particularly if that condition is left untreated, or not treated quickly enough. It is also associated with both a vitamin B1 deficiency and alcoholism. The condition can cause damage to nerve cells and supporting cells in the brain and spinal cord, as well as the part of the brain involved with memory.

Causes of Wernicke–Korsakoff syndrome

Wernicke–Korsakoff syndrome is caused by a deficiency in vitamin B1, or thiamine. This vitamin is an essential nutrient used by the body to convert food into energy, fuelling functions of the heart, nerves and brain.

We cannot produce this substance ourselves and so must take it from the food we eat – certain foods such as whole grain pasta flour and wheat, eggs, beef and pork are all high in thiamine. Heavy and prolonged drinking can cause inflammation of the stomach lining and digestive tract, which can prevent the body from absorbing vitamins.

According to the Alcohol and Drug Foundation (ADF), up to 80% of alcohol addicts develop a thiamine deficiency. This does not always lead to Wernicke’s encephalopathyor Wernicke–Korsakoff syndrome but it can be the first step towards the syndrome, as well as other serious health conditions such as beriberi.

Early stages of B1 deficiency can go unnoticed as signs such as decreased appetite, constipation and fatigue can be associated with many other conditions, including alcohol use disorder and mild alcohol withdrawal symptoms.

If the vitamin deficiency leads to Wernicke’s encephalopathy and this is not successfully treated, it can lead to full-blown Wernicke–Korsakoff syndrome. It’s also worth noting that, while the syndrome is most commonly caused by alcohol abuse, it can be caused by other conditions affecting the intake and absorption of vitamin B1, such as dietary deficiencies, prolonged vomiting, eating disorders or the effects of chemotherapy.

Symptoms of Wernicke–Korsakoff syndrome

The symptoms of WKS involved can vary depending on the stage the patient is at with the disorder. Wernicke’s encephalopathy often comes on quickly but symptoms may still be missed, especially if the person is still drinking or undergoing alcohol detox.

They can include:

• Disorientation, confusion and mild memory loss
• Difficulty controlling eye movements
• Poor balance and muscle coordination
• Low blood pressure
• Being underweight or losing weight rapidly

In the most serious cases, Wernicke’s encephalopathy can also cause hypothermia, and coma and be potentially life-threatening.

If the condition continues to develop into Korsakoff’s amnesic syndrome and, therefore, Wernicke–Korsakoff syndrome, the main symptoms are confusion and memory loss. The main features of Korsakoff’s syndrome are problems in acquiring new information or establishing new memories, as well as retrieving previous memories.

Other symptoms could include:

• Changes in personality such as becoming apathetic, repetitive or talkative
• Filling in gaps in the memory with things that didn’t happen
• Problems with concentration and decision-making

Treatment for Wernicke–Korsakoff syndrome

The initial treatment for people with WKS is to get them to stop drinking immediately (if they still are) and to give the person high doses of thiamine. If this is done during the Wernicke’s encephalopathy stage, it can prevent them from developing Korsakoff’s amnesic syndrome and full-blown Wernicke–Korsakoff syndrome in the first place.

Once stabilised the person will also receive proper nutrition and hydration and may also be put forward for addiction treatment such as supervised detoxification and a programme of rehabilitation. Without proper treatment and therapy it can be very difficult for a dependent drinker to quit the bottle and make a long-term recovery.

Addiction is characterised by a compulsion to continue using the substance despite knowing there may be negative consequences and many people will return to substance misuse even after undergoing a serious health crisis.

According to NINDS, most symptoms of Wernicke’s encephalopathy can be reversed with treatment. Stopping drinking can also prevent further damage to the brain and nerves but improvement in memory impairment caused by WKS can be slow and will often be incomplete.

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John Gillen - Author - Last updated: December 22, 2023

John is one UK’s leading professionals in the addiction recovery industry. Pioneering new treatment techniques such as NAD+ and ongoing research into new therapy techniques such as systematic laser therapy, John is committed to providing the very best treatment for people throughout the UK and Europe. During his extremely busy schedule, John likes to regularly update our blog section with the latest news and trends in the industry to keep visitors to our site as well informed as possible on everything related to addiction treatment.

Dr Adel Ghaly - Clinical Reviewer - Last reviewed: December 18, 2023

MB BCh, Psychological Medicine (Substance Misuse Psychiatry) from 2002

Dr Adel Ghaly is a registered Doctor who is a specialist psychiatrist. Dr Ghaly gained an MB BCh in 1982 from Assiut University and has since become a substance misuse specialist and psychiatrist. After gaining his qualification in Psychological Medicine (Substance Misuse Psychiatry) in 2002, Dr Ghaly has worked in hospitals and as a specialist trainer recognised by the GMC.