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Michael D. Kopelman - One of the best experts on this subject based on the ideXlab platform.
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Advance Access publication 16 January 2009 The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment
2015Co-Authors: Michael D. Kopelman, Allan D. Thomson, Irene Guerrini, Jane E. MarshallAbstract:Abstract—Aims:TheKorsakoff syndrome is a preventablememory 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: Althoug
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The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment
Alcohol and Alcoholism, 2009Co-Authors: Michael D. Kopelman, Allan D. Thomson, Irene Guerrini, E. Jane MarshallAbstract: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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confabulation extending across episodic personal and general semantic memory
Cognitive Neuropsychology, 1997Co-Authors: Michael D. Kopelman, Nicola Ng, Olivier Van Den BroukeAbstract:This paper compares a patient, AB, who showed florid confabulation with two other patients, one of whom had bilateral frontal lesions, and the other bilateral temporal lobe pathology. AB' s confabulation followed a Wernicke episode, and she had a clinical diagnosis of an Alcoholic Korsakoff syndrome, implying diencephalic pathology. However, cervical carcinoma was also found, and the persistence of her confabulation was attributed to metabolic or other non-metastatic complications of carcinoma, affecting cortical function. In the late stages of her illness, she also developed bilateral posterior parietal-occipital metastases. AB was assessed on three measures of confabulation-Dalla Barba' s 1993a Confabulation Battery, the Autobiographical Memory Interview, and an Informal Interview. She showed “spontaneous" confabulation extending across episodic, personal semantic, and general semantic memory. In this, she contrasted with the frontal lobe lesion patient, who showed confabulation only in personal semanti...
Hans J. Markowitsch - One of the best experts on this subject based on the ideXlab platform.
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Cognitive Estimation and Affective Judgments in Alcoholic Korsakoff Patients
2013Co-Authors: Esther Fujiwara, Hp Steingass, Josef Kessler, Elke Kalbe, Hans J. MarkowitschAbstract:Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions (‘size, ’ ‘weight, ’ ‘quantity, ’ and ‘time’) and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients ’ results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome
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Decision-making deficits of Korsakoff patients in a new gambling task with explicit rules: Associations with executive functions
Neuropsychology, 2005Co-Authors: Matthias Brand, Josef Kessler, Esther Fujiwara, Elke Kalbe, Sabine Borsutzky, Hans J. MarkowitschAbstract:Decision-making deficits reflected by risky decisions in gambling tasks have been associated with frontal lobe dysfunctions in various neurologic and psychiatric populations. The question remains whether decision-making impairments are related to executive functions. The authors developed a new gambling task, the Game of Dice Task, with explicit and stable rules for reinforcement and punishment, to investigate relations between executive functions and risk-taking behavior in an explicit decision-making situation. A sample of 35 Alcoholic Korsakoff patients and 35 healthy controls was examined with the Game of Dice Task and a neuropsychological test battery. Results show that Korsakoff patients are strongly impaired in this explicit decision-making task and that these disturbances are correlated with specific executive functions.
Markowitsch, Hans J. - One of the best experts on this subject based on the ideXlab platform.
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Confabulations in Alcoholic Korsakoff patients
'Elsevier BV', 2008Co-Authors: Borsutzky Sabine, Brand Matthias, Fujiwara Esther, Markowitsch, Hans J.Abstract:Borsutzky S, Fujiwara E, Brand M, Markowitsch HJ. Confabulations in Alcoholic Korsakoff patients. NEUROPSYCHOLOGIA. 2008;46(13):3133-3143.Besides forgetting, memory is also prone to distortions, errors and illusions. Confabulation is one type of memory distortion that may occur in cases of brain damage. Although confabulations are described anecdotally in patients with Alcoholic Korsakoff syndrome (KS), there are few systematic investigations of the presence and nature of these types of false memories in KS. Moreover, it is unclear whether KS patients' confabulations evenly affect all types of memories, or whether certain memory domains are more susceptible. Our study attempted to clarify two questions: first, whether confabulations are a critical feature of the cognitive impairment associated with long-term KS in a large sample of patients (N=42). Second, we investigated which memory domain is most likely affected by confabulations in KS. To elicit confabulations, we used a Confabulation Interview containing questions from different memory domains. We found that KS patients overall confabulated more compared to a group of healthy subjects. Furthermore, we found that patients confabulated most within the episodic/autobiographical memory domain. Our results imply that besides pronounced memory deficits typically associated with KS, confabulation can also be regarded as a clinical feature of the disease. The preponderance of episodic confabulation obtained here by using a standardized test, confirms anecdotic reports that KS patients confabulate in everyday life mainly with respect to their personal past and present. Thus, for a detailed description of the memory profile of KS patients, the screening of confabulation tendencies may be a useful supplementary clinical tool
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Judgment and memory performance for emotional stimuli in patients with Alcoholic Korsakoff syndrome
'Informa UK Limited', 2008Co-Authors: Labudda Kirsten, Markowitsch, Hans J., Todorovski Saso, Brand MatthiasAbstract:Labudda K, Todorovski S, Markowitsch HJ, Brand M. Judgment and memory performance for emotional stimuli in patients with Alcoholic Korsakoff syndrome. JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY. 2008;30(2):224-235.In this study we investigated whether Alcoholic Korsakoff patients are impaired in categorizing neutral and emotional stimuli according to their valence and whether memory performance for this material is reduced. In a group of Korsakoff patients and a comparison group two experimental tasks-one containing emotional and neutral pictures and the other containing words-were administered. Results showed that patients had difficulties in affective judgments due to problems in classifying neutral stimuli. Memory for emotional and neutral material was impaired to a similar degree. Thus, the facilitating effect of emotional valence on memory performance is absent in Korsakoff patients
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Cognitive performance of detoxified Alcoholic Korsakoff syndrome patients remains stable over two years
'Informa UK Limited', 2008Co-Authors: Fujiwara Esther, Brand Matthias, Borsutzky Sabine, Steingass Hans-p., Markowitsch, Hans J.Abstract:Fujiwara E, Brand M, Borsutzky S, Steingass H-P, Markowitsch HJ. Cognitive performance of detoxified Alcoholic Korsakoff syndrome patients remains stable over two years. JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY. 2008;30(5):576-587.Excessive alcohol consumption is assumed to promote cognitive decline, eventually increasing the risk of dementia. However, little is known about the time course of cognitive functions in patients with chronic Alcoholic Korsakoff syndrome (KS). Therefore, we assessed neuropsychological performance in 20 detoxified chronic KS inpatients at time 1 (T1) with a follow-up after two years (T2). The neuropsychological tests assessed verbal and visual short- and long-term memory, working memory, basic executive functions, language, general knowledge, and visual-spatial abilities. Surveys with caregivers and medical records provided information about current and previous disease-related parameters, drinking history, additional pathologies, as well as psychosocial and cognitive therapy within the two-year period. At both sessions, the majority of the KS patients' results were inferior to those of normal subjects. Comparing T1 and T2 revealed no significant decline in any of the investigated functions. Instead, general knowledge, visual long-term memory, and verbal fluency improved slightly after two years, though they still remained within pathological range. Comparing most improved and most deteriorated patients, better outcome occurred more frequently in men than women and was associated with higher premorbid education and fewer detoxifications in the past. In this sample of detoxified KS patients there was no indication of accelerated cognitive decline or onset of dementia-like symptoms over two years
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Decision-making deficits of Korsakoff patients in a new gambling task with explicit rules: Associations with executive functions
'American Psychological Association (APA)', 2005Co-Authors: Brand M, Fujiwara E, Kalbe E, Kessler J, Borsutzky S, Markowitsch, Hans J.Abstract:Brand M, Fujiwara E, Borsutzky S, Kalbe E, Kessler J, Markowitsch HJ. Decision-making deficits of Korsakoff patients in a new gambling task with explicit rules: Associations with executive functions. NEUROPSYCHOLOGY. 2005;19(3):267-277.Decision-making deficits reflected by risky decisions in gambling tasks have been associated with frontal lobe dysfunctions in various neurologic and psychiatric populations. The question remains whether decision-making impairments are related to executive functions. The authors developed a new gambling task, the Game of Dice Task, with explicit and stable rules for reinforcement and punishment, to investigate relations between executive functions and risk-taking behavior in an explicit decision-making situation. A sample of 35 Alcoholic Korsakoff patients and 35 healthy controls was examined with the Game of Dice Task and a neuropsychological test battery. Results show that Korsakoff patients are strongly impaired in this explicit decision-making task and that these disturbances are correlated with specific executive functions
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Cognitive estimation in patients with probable Alzheimer's disease and Alcoholic Korsakoff patients
'Elsevier BV', 2003Co-Authors: Brand Matthias, Kalbe Elke, Fujiwara Esther, Huber Michael, Markowitsch, Hans J.Abstract:Brand M, Kalbe E, Fujiwara E, Huber M, Markowitsch HJ. Cognitive estimation in patients with probable Alzheimer's disease and Alcoholic Korsakoff patients. Neuropsychologia. 2003;41(5):575-584.Cognitive estimation is an important function in daily living. In early studies it was proposed that estimation deficits are associated with frontal lobe damage and executive dysfunctions. In this study, we assessed Alzheimer patients and patients with Alcoholic Korsakoff's syndrome with a newly developed cognitive estimation task. We compared their performance with respect to different dimensions of estimation ('size', 'weight', 'quantity', and 'time') and to various error types. Compared to healthy controls, both patient groups were strongly impaired in all tested estimation dimensions, with Alzheimer patients performing generally worse than Korsakoff patients, except for the dimension "time". Alzheimer as well as Korsakoff patients produced so-called 'bizarre errors' and errors in the choice of the correct unit of measurement. In both patient groups cognitive estimation correlated highly with general knowledge. The production of bizarre errors and unit errors correlated with general knowledge as well as with working memory and executive functions. Results support the main assumptions of a model of cognitive estimation, described in the discussion, that specific parts of the semantic memory system as well as executive functions, in form of a plausibility check of the generated answer, are involved in the process of cognitive estimation. (C) 2002 Elsevier Science Ltd. All rights reserved
Risto Vataja - One of the best experts on this subject based on the ideXlab platform.
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Korsakoff Syndrome in Non-Alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity
Frontiers Media S.A., 2018Co-Authors: Georgios Nikolakaros, Timo Kurki, Janina Paju, Sokratis G. Papageorgiou, Risto Vataja, Tuula IlonenAbstract:Background: Non-Alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-Alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce.Methods: We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-Alcoholic Wernicke's encephalopathy and subsequent chronic memory problems.Results: All patients had abnormal neuropsychological test results, predominantly in memory. Thus, the neuropsychological findings were compatible with Korsakoff syndrome. However, the neuropsychological findings were not uniform. The impairment of delayed verbal memory of the first patient was evident only when the results of the memory tests were compared to her general cognitive level. In addition, the logical memory test and the verbal working memory test were abnormal, but the word list memory test was normal. The second patient had impaired attention and psychomotor speed in addition to impaired memory. In the third patient, the word list memory test was abnormal, but the logical memory test was normal. All patients had intrusions in the neuropsychological examination. Executive functions were preserved, except for planning and foresight, which were impaired in two patients. Conventional MRI examination was normal. DTI showed reduced fractional anisotropy values in the uncinate fasciculus in two patients, and in the corpus callosum and in the subgenual cingulum in one patient.Conclusions: Non-Alcoholic Korsakoff syndrome can have diverse neuropsychological findings. This may partly explain its marked underdiagnosis. Therefore, a strong index of suspicion is needed. The presence of intrusions in the neuropsychological examination supports the diagnosis. Damage in frontotemporal white matter tracts, particularly in the uncinate fasciculus, may be a feature of non-Alcoholic Korsakoff syndrome in psychiatric patients
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Non-Alcoholic Korsakoff syndrome in psychiatric patients with a history of undiagnosed Wernicke's encephalopathy
Journal of the Neurological Sciences, 2016Co-Authors: Georgios Nikolakaros, Tuula Ilonen, Timo Kurki, Janina Paju, Sokratis G. Papageorgiou, Risto VatajaAbstract:Wernicke's encephalopathy is often undiagnosed, particularly in non-Alcoholics. There are very few reports of non-Alcoholic patients diagnosed with Korsakoff syndrome in the absence of a prior diagnosis of Wernicke's encephalopathy and no studies of diffusion tensor imaging in non-Alcoholic Korsakoff syndrome. We report on three non-Alcoholic psychiatric patients (all women) with long-term non-progressive memory impairment that developed after malnutrition accompanied by at least one of the three Wernicke's encephalopathy manifestations: ocular abnormalities, ataxia or unsteadiness, and an altered mental state or mild memory impairment. In neuropsychological examination, all patients had memory impairment, including intrusions. One patient had mild cerebellar vermis atrophy in MRI taken after the second episode of Wernicke's encephalopathy. The same patient had mild hypometabolism in the lateral cortex of the temporal lobes. Another patient had mild symmetrical atrophy and hypometabolism of the superior frontal lobes. Two patients were examined with diffusion tensor imaging. Reduced fractional anisotropy values were found in the corona radiata in two patients, and the uncinate fasciculus and the inferior longitudinal fasciculus in one patient. Our results suggest that non-Alcoholic Korsakoff syndrome is underdiagnosed. Psychiatric patients with long-term memory impairment may have Korsakoff syndrome and, therefore, they should be evaluated for a history of previously undiagnosed Wernicke's encephalopathy.
E. Jane Marshall - One of the best experts on this subject based on the ideXlab platform.
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The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment
Alcohol and Alcoholism, 2009Co-Authors: Michael D. Kopelman, Allan D. Thomson, Irene Guerrini, E. Jane MarshallAbstract: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.