Wernicke-Korsakoff Syndrome: Causes, Symptoms & Treatment

Wernicke-Korsakoff syndrome is connected with alcohol abuse and can lead to death or permanent brain damage if not treated quickly. This disease is reversible in the earlier stage, but it eventually becomes permanent, creating a form of irreversible dementia. Wernicke-Korsakoff syndrome is caused by a deficiency in vitamin B1, also called thiamine.

What Is Wernicke-Korsakoff Syndrome?

Wernicke-Korsakoff syndrome is a brain disorder caused by a lack of thiamine. This syndrome consists of two parts: Wernicke encephalopathy, also called Wernicke syndrome, and Korsakoff syndrome. These two conditions have different symptoms but are really two stages of the same disease. The most important distinction between these two stages is that Wernicke encephalopathy is reversible, while Korsakoff syndrome is permanent and impossible to reverse.

Wernicke-Korsakoff Syndrome Causes and Risk Factors

The most common cause of Wernicke-Korsakoff syndrome in modern countries is heavy alcohol use. The only other common cause is severe nutritional deficiencies, typically due to starvation.

Alcohol Use

Alcohol use causes poorer nutrition, decreases the absorption of thiamine and depletes thiamine levels in the body. These effects all work together to cause a thiamine deficiency that can lead to Wernicke-Korsakoff syndrome. A thiamine deficiency without using alcohol is very uncommon.

Nutritional Deficiencies: Thiamine (Vitamin B1)

While alcohol use is the main cause of Wernicke-Korsakoff syndrome, it can be caused by a lack of thiamine in food. Food sources of thiamine are so abundant that this is only a problem for people facing starvation or those with a serious eating disorder. Decreased thiamine levels are also possible in people with prolonged, heavy vomiting, which can be caused by chemotherapy or a complication of pregnancy called hyperemesis gravidarum.

Wernicke-Korsakoff Syndrome Symptoms and Diagnosis

The symptoms of Wernicke-Korsakoff syndrome differ based on the stage of disease, but they include:

• Vision problems
• Difficulty moving eyes
• Decreased coordination
• Problems walking
• Clumsiness
• Fast heart rate
• Low blood pressure
• Decreased body temperature
• Weakness
• Memory problems
• Hallucinations
• Confabulations (made-up memories)

Wernicke’s Encephalopathy

Wernicke encephalopathy is the first stage of Wernicke-Korsakoff syndrome and causes inflammation in the brain. Wernicke encephalopathy is reversible if it is treated quickly and can prevent further brain damage caused by the lack of thiamine. It is often described as the “acute” phase of Wernicke-Korsakoff syndrome. While Wernicke encephalopathy is more temporary phase of the disease, it can be dangerous, resulting in death in 17% of people who are untreated.

Wernicke encephalopathy can cause many symptoms, but three core symptoms are referred to as a “triad” of symptoms that often occur in Wernicke encephalopathy. These include:

• Mental changes, especially confusion
• Decreased muscle coordination, also called ataxia
• Eye movement abnormalities

Other symptoms of Wernicke encephalopathy can include:

• Lethargy
• Decreased attention span
• Lack of concern for life
• Problems walking
• Problems standing up
• Coma

These other symptoms may accompany Wernicke encephalopathy, but the triad of symptoms combined with low thiamine levels is how it is typically diagnosed.

Korsakoff’s Syndrome

About 80%–90% of people with Wernicke encephalopathy will develop Korsakoff syndrome if untreated. This condition is an irreversible form of dementia and can cause short-term memory loss. This makes learning or retaining new information impossible.

Those with Korsakoff syndrome will also develop gaps in their long-term memory and subconsciously make up new memories to fill these gaps. These made-up memories are called confabulations and aren’t lies; the person with Korsakoff syndrome believes these false memories are true. Hallucination can also occur in those with Korsakoff syndrome.

Memory problems associated with Korsakoff syndrome do not impair the ability to converse normally. They will only be noticeable by not being able to remember new information or recall old memories. Those with Korsakoff syndrome often do not know they have it, as they do not notice the impairment and cannot form the new memory needed to understand that they have this condition.

Wernicke-Korsakoff Diagnosis

A diagnosis is typically made based on neurological symptoms and low levels of thiamine. A history of alcohol abuse or severe nutritional deficiencies also helps support this diagnosis. This condition is often underdiagnosed due to its subtle and sometimes varied presentations.

Diagnosing Wernicke-Korsakoff syndrome involves: 

• Clinical testing
• A medical history exam
• Specific testing

Wet Brain

“Wet brain” is a non-medical term used to refer to Wernicke-Korsakoff syndrome. Those who use the term “wet brain” sometimes wonder if there is a difference between Wernicke-Korsakoff syndrome and wet brain. Technically, there could be a small difference between the two terms.

Wernicke-Korsakoff syndrome describes a brain disease caused by a lack of thiamine. Wet brain describes brain damage caused by thiamine deficiency exclusively due to alcohol use. In most developed countries, the major cause of thiamine deficiency is alcohol use, making these two terms essentially synonymous in the U.S.

Wernicke-Korsakoff Syndrome Treatment

Wernicke-Korsakoff syndrome is mainly treated with thiamine replacement therapy, alcohol misuse treatment and rehabilitative support.

Thiamine Replacement Therapy

Firstly, the thiamine deficiency causing the disease is reversed by providing thiamine. This is often done through an IV to reverse the deficit quickly. If Wernicke-Korsakoff syndrome is at a point where it can be reversed, giving thiamine is the only way to reverse it.

Alcoholism Treatment

The second step in treating Wernicke-Korsakoff syndrome is to look at the cause of low thiamine levels. This step doesn’t technically treat Wernicke-Korsakoff syndrome, but it does help prevent it from recurring. In the U.S., this step most often involves stopping the use of alcohol. If alcohol use is severe enough to cause Wernicke-Korsakoff syndrome, it is normally associated with alcoholism that requires professional addiction treatment.

Rehabilitation and Supportive Care

In those with permanent effects, rehab and supportive care are needed to enhance the quality of life of those with Wernicke-Korsakoff syndrome. This could include physical, occupational or speech therapy, depending on the patient’s needs. Counseling can also be used to cope with the emotional challenges of diagnosing and treating the syndrome. These tools help people regain as much independence as possible but do not reverse any effects caused by Wernicke-Korsakoff syndrome.

Wernicke-Korsakoff Prognosis and Long-Term Effects

The prognosis of Wernicke-Korsakoff syndrome differs greatly based on when it is detected and if it is treated quickly. In cases where it is found early and thiamine is given, the symptoms of Wernicke’s encephalopathy, including confusion and motor difficulties, can often be completely reversed. However, Korsakoff’s syndrome, the later stage, often becomes a permanent condition that cannot be reversed with any treatments.

Recovery and Stabilization

Recovery and stabilization in Wernicke-Korsakoff syndrome greatly depend on early intervention and sustained thiamine treatment. Prompt thiamine replacement can greatly improve all the symptoms of Wernicke’s encephalopathy. However, once the disease has progressed to Korsakoff’s syndrome, recovery becomes impossible, and the goal shifts to preventing more damage. A key to long-term stabilization is to treat the condition’s underlying cause; typically, this cause is alcohol abuse.

Complications and Risks

Complications of Wernicke-Korsakoff syndrome are mainly due to the cognitive damage it creates. This leads to difficulties in day-to-day living and increased dependence on caregivers. People can risk injury due to their lack of coordination or impaired judgment. Additionally, severe cases of Wernicke’s encephalopathy can lead to life-threatening conditions such as coma or death if not treated promptly.

Wernicke-Korsakoff Syndrome Life Expectancy

Wernicke-Korsakoff syndrome can lead to a decreased life expectancy, with about 50% dying within eight years of being diagnosed. This is partially due to the side effects of Wernicke-Korsakoff syndrome rather than the disease itself. Severe alcoholism is often the cause of this disease and can decrease life expectancy, even without Wernicke-Korsakoff syndrome. Because Wernicke-Korsakoff syndrome only typically occurs in the late stages of alcoholism, it is hard to know how big of a role the syndrome plays in decreasing life expectancy.

Wernicke-Korsakoff Prevention 

Preventing Wernicke-Korsakoff syndrome requires stopping or reducing alcohol use and getting proper nutrition. Heavy drinking is the main cause of Wernicke-Korsakoff syndrome in the U.S. If you stop using alcohol and have normal nutritional intake, you will have almost no risk of getting this condition.

Nutrition and Thiamine Intake

Proper nutrition and thiamine intake are crucial for preventing Wernicke-Korsakoff syndrome; however, it doesn’t require much attention. In countries without serious food insecurity, thiamine is abundant and can be found in sources such as whole grains, meat and fish. Most people in the U.S. will not need to plan to eat thiamine-rich foods specifically. However, if you use alcohol heavily, you can still develop Wernicke-Korsakoff syndrome if you focus on eating thiamine-rich foods.

Awareness and Detection

Quickly recognizing the symptoms of Wernicke-Korsakoff syndrome is important to getting treatment and preventing brain damage that is permanent. Because an early sign of the syndrome is confusion, recognizing Wernicke-Korsakoff syndrome will typically fall to someone around the person who has it, not the person.

Intervention for Alcohol Misuse

Addressing alcohol misuse is the single most important way to prevent Wernicke-Korsakoff syndrome. Typically alcohol abuse is quite serious if it is severe enough to cause this condition and will require professional help and support for treatment. Getting professional help is also important because the effects of continuing to use alcohol can be devastating if it may potentially cause Wernicke-Korsakoff syndrome.

Using alcohol heavily increases the risk that Wernicke-Korsakoff syndrome will one day develop. If you or someone you know uses alcohol heavily, the best way to avoid this permanent form of brain damage is to get help for their alcohol use disorder. An alcohol addiction this severe will normally require alcohol rehab for the person to recover successfully.

The Recovery Village Cherry Hill at Cooper has a proven record of helping people in New Jersey and beyond achieve lasting freedom from alcohol addiction. We invite you to contact a Recovery Advocate to learn more about how we can help you achieve lasting sobriety and avoid the dangers of Wernicke-Korsakoff syndrome.