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Gao DP, Weng QY, Zhang YY, Ou YX, Niu YF, Lou Q, Xie DL, Cai Y, Yang JH. Memantine alleviates cognitive impairment and hippocampal morphology injury in a mouse model of chronic alcohol exposure. Pharmacol Biochem Behav 2024:173827. [PMID: 39038728 DOI: 10.1016/j.pbb.2024.173827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol abuse and dependence. The pathophysiology of ARCI, pivotal for refined therapeutic approaches, is not fully elucidated, posing a risk of progression to severe neurological sequelae such as Korsakoff's syndrome (KS) and Alcohol-Related Dementia (ARD). This study ventures into the underlying mechanisms of chronic alcohol-induced neurotoxicity, notably glutamate excitotoxicity and cytoskeletal disruption, and explores the therapeutic potential of Memantine, a non-competitive antagonist of the N-methyl-d-aspartate (NMDA) receptor known for its neuroprotective effect against excitotoxicity. Our investigation centers on the efficacy of Memantine in mitigating chronic alcohol-induced cognitive and hippocampal damages in vivo. Male C57BL/6J mice were subjected to 30 % (v/v, 6.0 g/kg) ethanol via intragastric administration alongside Memantine co-treatment (10 mg/kg/day, intraperitoneally) for six weeks. The assessment involved Y maze, Morris water maze, and novel object recognition tests to evaluate spatial and recognition memory deficits. Histopathological evaluations of the hippocampus were conducted to examine the extent of alcohol-induced morphological changes and the potential protective effect of Memantine. The findings reveal that Memantine significantly improves chronic alcohol-compromised cognitive functions and mitigates hippocampal pathological changes, implicating a moderating effect on the disassembly of actin cytoskeleton and microtubules in the hippocampus, induced by chronic alcohol exposure. Our results underscore Memantine's capability to attenuate chronic alcohol-induced cognitive and hippocampal morphological harm may partly through regulating cytoskeleton dynamics, offering valuable insights into innovative therapeutic strategies for ARCI.
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Affiliation(s)
- Da-Peng Gao
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Qiu-Yan Weng
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Yun-Yun Zhang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Yang-Xin Ou
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Yan-Fang Niu
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Qiong Lou
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Dong-Lin Xie
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China
| | - Yu Cai
- Department of Pharmacy, Zhejiang Pharmaceutical University, 666 Siming Rd, Ningbo, Zhejiang 315500, PR China.
| | - Jian-Hong Yang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, 247 Renmin Rd, Ningbo, Zhejiang 315020, PR China.
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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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Mazzacane F, Ferrari F, Malvaso A, Mottese Y, Gastaldi M, Costa A, Pichiecchio A, Cavallini A. Acute amnestic syndrome in fornix lesions: a systematic review of reported cases with a focus on differential diagnosis. Front Neurol 2024; 15:1338291. [PMID: 38333604 PMCID: PMC10850356 DOI: 10.3389/fneur.2024.1338291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Acute amnestic syndrome is an uncommon clinical presentation of neurological disease. Differential diagnosis encompasses several syndromes including Wernicke-Korsakoff and transient global amnesia (TGA). Structural lesions of the fornix account for a minority of cases of acute amnestic syndromes. Etiology varies from iatrogenic injury to ischemic, inflammatory, or neoplastic lesions. A prompt diagnosis of the underlying pathology is essential but challenging. The aim of this review is to systematically review the existing literature regarding cases of acute amnestic syndrome associated with non-iatrogenic lesions of the fornix. Methods We performed a systematic literature search on PubMed, Scopus, and Web of Science up to September 2023 to identify case reports and case series of patients with amnestic syndrome due to fornix lesions. The systematic review was conducted according to PRISMA guidelines. The research was limited to articles written in English. Cases of fornix damage directly ascribable to a surgical procedure were excluded. Results A total of 52 publications reporting 55 cases were included in the review. Focusing on acute/subacute onset, vascular etiology was highly prevalent, being responsible for 78% of cases, 40/55 (74%) of which were due to acute ischemic stroke. The amnestic syndrome was characterized by anterograde amnesia in all patients, associated with retrograde amnesia in 27% of cases. Amnesia was an isolated presentation in most cases. Up to two thirds of patients had persistent memory deficits of any severity at follow-up. Discussion Acute amnestic syndrome can be rarely caused by fornix lesions. In most cases of acute/subacute presentation, the etiology is ischemic stroke, mainly caused by strokes involving the subcallosal artery territory. The differential diagnosis is challenging and a distinction from common mimics is often difficult on a clinical basis. A high index of suspicion should be maintained to avoid misdiagnosis and provide adequate acute treatment to patients with time-dependent disease, also employing advanced neuroimaging. More research is needed to better understand the outcome and identify prognostic factors in patients with amnestic syndrome due to fornix lesions.
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Affiliation(s)
- F. Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - F. Ferrari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - A. Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Y. Mottese
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - M. Gastaldi
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - A. Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Cavallini
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
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Kruithof PJ, McGovern W, Haighton C. "I Genuinely Believe This Is the Most Stigmatised Group within the Social Care Sector"-Health and Social Care Professionals' Experiences of Working with People with Alcohol-Related Brain Damage: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:10. [PMID: 38276798 PMCID: PMC10815022 DOI: 10.3390/ijerph21010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Appropriate diagnosis, treatment and care contribute to better service engagement, improvements to wellbeing, cost savings and reductions in morbidity and mortality for people with alcohol-related brain damage. In Northeast England, large amounts of alcohol are consumed; this is reflected in the number of alcohol-related deaths in the region. However, the pathway for people with alcohol-related brain damage to receive diagnosis, treatment and care is unknown and could be unwittingly influenced by stigma. Qualitative, in-depth, semi-structured interviews were completed with 25 health and social care professionals from organizations involved with people with alcohol-related brain damage recruited via snowball sampling. Interviews were recorded, transcribed verbatim, coded, and analysed. People with alcohol-related brain damage were found to be stigmatised by both society and professionals, inhibiting their entry into services. Therefore, alcohol-related brain damage remains underdiagnosed and misdiagnosed. There was found to be no dedicated service; silos with revolving doors and underfunded generic care with long waiting lists typically exclude those with alcohol-related or neurological problems. Reducing stigmatising processes associated with alcohol-related brain damage could counteract professionals' reluctance to provide care.
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Affiliation(s)
| | | | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (P.J.K.); (W.M.)
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Habas E, Farfar K, Errayes N, Rayani A, Elzouki AN. Wernicke Encephalopathy: An Updated Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:193-200. [PMID: 37533659 PMCID: PMC10393093 DOI: 10.4103/sjmms.sjmms_416_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/27/2022] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Wernicke's encephalopathy (WE) and Korsakoff Syndrome (KS) are distinct neurological disorders that may have overlapping clinical features. Due to the overlap, they are collectively known as Wernicke-Korsakoff syndrome. WE is related to diencephalic and mesencephalic dysfunction due to thiamine. WE typically manifests as confusion, ophthalmoplegia, nystagmus, and gait ataxia (Wernicke's triad), although they may not consistently occur together. Although WE mostly occurs in alcoholics, other etiologies, such as post-bariatric surgery, must be considered. Early diagnosis and therapy by intravenous thiamine are essential to prevent WE complications and to reduce morbidity and mortality. Therefore, physicians' and patients' awareness of WE is essential for early diagnosis and therapy. Accordingly, this narrative review aimed to provide an update on WE by reviewing articles published between April 2015 to April 2022 about the etiology, pathophysiology, diagnosis, and WE management updates. EMBASE, PubMed, Google Scholar, Google, and Scopus search engines were used to conduct the literature search.
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Affiliation(s)
- Elmukhtar Habas
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kalifa Farfar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nada Errayes
- Department of Epidemiology, University of Lincoln, Lincoln, UK
| | | | - Abdel-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
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Palm A, Talaslahti T, Vataja R, Ginters M, Kautiainen H, Elonheimo H, Suvisaari J, Lindberg N, Koponen H. Antipsychotic Use and Mortality in Persons with Alcohol-Related Dementia or Wernicke-Korsakoff Syndrome: A Nationwide Register Study in Finland. J Clin Med 2023; 12:4263. [PMID: 37445298 DOI: 10.3390/jcm12134263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Research on the use of psychotropic drugs in people with alcohol-related neurocognitive disorders is virtually nonexistent. We examined the prevalence of antipsychotic drug use and its effect on mortality among patients with Wernicke-Korsakoff syndrome (WKS) or alcohol-related dementia (ARD). METHODS In this nationwide register study, we collected data on the medication use and mortality of all persons aged ≥40 diagnosed with WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the prevalence of antipsychotic use within one year of diagnosis and the adjusted cumulative mortality of antipsychotic users versus non-users in relation to the age-, sex-, and calendar year-matched general population. RESULTS Of the WKS and ARD patients, 35.9% and 38.5%, respectively, purchased one or more antipsychotic drugs in the year following diagnosis. The adjusted cumulative mortality of the antipsychotic users was significantly lower than that of non-users in both the WKS and ARD groups, where the adjusted hazard ratios (95% CI) were 0.85 (0.72-0.99) and 0.73 (0.65-0.81), respectively. WKS and ARD patients using antipsychotics were less likely to die of alcohol-related causes than antipsychotic non-users, but the difference was significant only in the ARD group. CONCLUSIONS This population-based study shows that antipsychotic use is common in patients with WKS or ARD. In contrast to other dementia studies, our results indicate that the mortality of antipsychotic users is significantly lower than that of non-users. The lower mortality could be explained by decreased alcohol use and better healthcare coverage in antipsychotic users.
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Affiliation(s)
- Anniina Palm
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Tiina Talaslahti
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, 70210 Kuopio, Finland
- Folkhälsan Research Center, 00250 Helsinki, Finland
| | - Henrik Elonheimo
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
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A Clinician's View of Wernicke-Korsakoff Syndrome. J Clin Med 2022; 11:jcm11226755. [PMID: 36431232 PMCID: PMC9693280 DOI: 10.3390/jcm11226755] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to improve recognition and treatment of Wernicke-Korsakoff syndrome. It is well known that Korsakoff syndrome is a chronic amnesia resulting from unrecognized or undertreated Wernicke encephalopathy and is caused by thiamine (vitamin B1) deficiency. The clinical presentation of thiamine deficiency includes loss of appetite, dizziness, tachycardia, and urinary bladder retention. These symptoms can be attributed to anticholinergic autonomic dysfunction, as well as confusion or delirium, which is part of the classic triad of Wernicke encephalopathy. Severe concomitant infections including sepsis of unknown origin are common during the Wernicke phase. These infections can be prodromal signs of severe thiamine deficiency, as has been shown in select case descriptions which present infections and lactic acidosis. The clinical symptoms of Wernicke delirium commonly arise within a few days before or during hospitalization and may occur as part of a refeeding syndrome. Wernicke encephalopathy is mostly related to alcohol addiction, but can also occur in other conditions, such as bariatric surgery, hyperemesis gravidarum, and anorexia nervosa. Alcohol related Wernicke encephalopathy may be identified by the presence of a delirium in malnourished alcoholic patients who have trouble walking. The onset of non-alcohol-related Wernicke encephalopathy is often characterized by vomiting, weight loss, and symptoms such as visual complaints due to optic neuropathy in thiamine deficiency. Regarding thiamine therapy, patients with hypomagnesemia may fail to respond to thiamine. This may especially be the case in the context of alcohol withdrawal or in adverse side effects of proton pump inhibitors combined with diuretics. Clinician awareness of the clinical significance of Wernicke delirium, urinary bladder retention, comorbid infections, refeeding syndrome, and hypomagnesemia may contribute to the recognition and treatment of the Wernicke-Korsakoff syndrome.
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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: 11] [Impact Index Per Article: 5.5] [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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Mateos-Díaz AM, Marcos M, Chamorro AJ. Wernicke-Korsakoff syndrome and other diseases associated with thyamine deficiency. Med Clin (Barc) 2022; 158:431-436. [PMID: 35039171 DOI: 10.1016/j.medcli.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022]
Abstract
Wernicke-Korsakoff syndrome is the best known consequence of thiamine deficiency, frequently associated with patients with chronic and excessive alcohol consumption, but it can be produced by any cause that produces thiamine deficiency. The disease is underdiagnosed so it is essential to have a high clinical suspicion, mainly in patients who do not have alcohol consumption as a risk factor. For this, the diagnosis continues to be eminently clinical, with the difficulty of high clinical variability. Complementary tests are used to support the diagnosis and rule out other causes that can produce similar symptoms, with magnetic resonance imaging being the most cost-effective imaging test. Treatment is based on the administration of thiamine, which should be started early, and parenterally at the appropriate doses, in all patients with compatible symptoms, without waiting to confirm the diagnosis.
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Affiliation(s)
- Ana-María Mateos-Díaz
- Servicio de Medicina Interna, Hospital Virgen del Puerto, Plasencia, Cáceres, España
| | - Miguel Marcos
- Servicio de Medicina Interna, Hospital Universitario de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, España
| | - Antonio-Javier Chamorro
- Servicio de Medicina Interna, Hospital Universitario de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, España.
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Novo-Veleiro I, Herrera-Flores J, Rosón-Hernández B, Medina-García JA, Muga R, Fernández-Solá J, Martín-González MC, Seco-Hernández E, Suárez-Cuervo C, Mateos-Díaz AM, Monte-Secades R, Machado-Prieto B, Puerta-Louro R, Prada-González C, Fernández-Rial Á, Sabio-Repiso P, Vázquez-Vigo R, Antolí-Royo AC, Gomila-Grange A, Felipe-Pérez NC, Sanvisens-Bergé A, Antúnez-Jorge E, Fernández-Rodríguez CM, Alvela-Suárez L, Fidalgo-Navarro A, Castro J, Polvorosa-Gómez MA, Del Valle-Sánchez M, López-Castro J, Chamorro AJ, Marcos M. Alcoholic Liver Disease Among Patients with Wernicke Encephalopathy: A Multicenter Observational Study. Drug Alcohol Depend 2022; 230:109186. [PMID: 34864357 DOI: 10.1016/j.drugalcdep.2021.109186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND data regarding the association between Wernicke encephalopathy (WE) and alcoholic liver disease (ALD) are scarce in spite of alcohol consumption being the main risk factor for WE. AIMS to describe the frequency of ALD in a cohort of patients diagnosed with WE and alcohol use disorders (AUDs) and to compare the characteristics of WE patients with and without ALD. METHODS we conducted an observational study in 21 centers through a nationwide registry of the Spanish Society of Internal Medicine. WE Caine criteria were applied and demographic, clinical, and outcome variables were analyzed. RESULTS 434 patients were included in the study, of which 372 were men (85.7%), and the mean age was 55 ± 11.8 years. ALD was present in 162 (37.3%) patients and we found a higher percentage of cases with tremor, flapping and hallucinations in the ALD group. A total of 22 patients (5.0%) died during admission (7.4% with ALD vs 3.7% without ALD; P = 0.087). Among the ALD patients, a relationship between mortality and the presence of anemia (Odds ratio [OR]=4.6 Confidence interval [CI]95% 1.1-18.8; P = 0.034), low level of consciousness (OR=4.9 CI95% 1.1-21.2; P = 0.031) and previous diagnosis of cancer (OR=10.3 CI95% 1.8-59.5; P = 0.009) was detected. Complete recovery was achieved by 27 patients with ALD (17.8%) and 71 (27.8%) without ALD (P = 0.030). CONCLUSION the association of WE and ALD in patients with AUDs is frequent and potentially linked to differences in clinical presentation and to poorer prognosis, as compared to alcoholic patients with WE without ALD.
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Affiliation(s)
- Ignacio Novo-Veleiro
- Department of Internal Medicine, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Herrera-Flores
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | | | | | - Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Elena Seco-Hernández
- Department of Internal Medicine, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Ana-M Mateos-Díaz
- Department of Internal Medicine, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
| | - Rafael Monte-Secades
- Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Begoña Machado-Prieto
- Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Álvaro Fernández-Rial
- Department of Internal Medicine, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | | | - Rocío Vázquez-Vigo
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Ana-C Antolí-Royo
- Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain
| | - Aina Gomila-Grange
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Arantza Sanvisens-Bergé
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Lucía Alvela-Suárez
- Department of Internal Medicine, HM Rosaleda Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Joaquín Castro
- Hospital Santa Bárbara, Puerto Llano, Ciudad-Real, Spain
| | | | | | | | - Antonio-J Chamorro
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Miguel Marcos
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain.
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Peck NM, Bania TC, Chu J. Low rates of thiamine prescribing in adult patients with alcohol-related diagnoses in the emergency department. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:704-710. [PMID: 33780650 DOI: 10.1080/00952990.2021.1889575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Alcohol use disorder (AUD) is associated with thiamine deficiency and Wernicke-Korsakoff Syndrome (WKS). Thiamine supplementation for the prevention of WKS in patients with suspected AUD in the Emergency Department (ED) is generally recommended. As alcohol-related diagnoses are frequent reasons for visits to EDs, ED thiamine prescribing practices are relevant to the overall management and prevention of WKS in patients with AUD.Objective: To determine the prescription rates of thiamine to patients with alcohol-related diagnoses in the ED.Methods: This was a retrospective chart review conducted at two New York City urban teaching hospitals from January 1 to December 31, 2017. All patients 18 years or older who were given an alcohol-related diagnosis (all F10 ICD-10-CM codes) upon disposition were included. Collected data included details of thiamine prescribing practices, patient demographics and patient disposition.Results: A total of 7,529 patient visits with an alcohol-related diagnosis were identified. The overall median age of included patients was 44; 5747 (76.3%) patient visits were by men; 310 (4.1%) patient visits resulted in admission. Out of all patient visits, thiamine was ordered during 167 (2.2%) visits, with thiamine administered parenterally during 129 (77.2%) visits and orally in 38 (22.8%) visits. Out of patient visits specifically associated with an F10.2 (Alcohol Dependence) diagnosis, thiamine was ordered during 105 (17.8%) visits.Conclusion: We found a very low rate of thiamine prescribing during patient visits associated with alcohol-related diagnoses. This may be a missed opportunity to reduce morbidity and mortality among AUD ED patients.
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Affiliation(s)
- Nathan M Peck
- Department of Emergency Medicine, Mount Sinai West Hospital, Mt Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore C Bania
- Department of Emergency Medicine, Mount Sinai West Hospital, Mt Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason Chu
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Abstract
OBJECTIVE B vitamins are essential for the functioning of the nervous system. Vitamin B1 (thiamine) deficiency is associated with neuropsychiatric syndromes such as Wernicke's encephalopathy (WE), which, if untreated, has an estimated mortality of 17-20%. Although the prevalence of thiamine deficiency in the general population is difficult to estimate, it is being increasingly recognized in oncology, especially in the inpatient setting. We describe three cases of thiamine deficiency (TD) in the outpatient psychiatric oncology setting. METHOD Retrospective chart review of three adult patients, who were seen in the psychiatric oncology clinic and found to have TD on laboratory testing, was done. Patient, disease, and thiamine treatment-related information were obtained, and descriptive statistics were used to analyze the data. RESULTS The average age was 59 years, mean body mass index (BMI) was 22.00 ± 4.58 (mean ± SD), and mean thiamine level was 59.10 ± 7.69 that ranged from 45 to 68 nmol/L (normal thiamine level reference: 70-180 nmol/L). None of the patients had brain imaging nor cerebrospinal fluid analysis. Risk factors such as unbalanced nutrition, prior GI surgery, renal disease, and chemotherapy were noted. SIGNIFICANCE OF RESULTS TD can have a multifactorial etiology in oncology. Identification of TD in both inpatient and outpatient setting is important. Our report highlights how early identification of TD in the outpatient setting can help prevent further clinical progression.
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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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Oudman E, Wijnia JW, Oey MJ, van Dam M, Postma A. Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports. J Neurol Sci 2021; 426:117482. [PMID: 34000679 DOI: 10.1016/j.jns.2021.117482] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Wernicke-Korsakoff syndrome (WKS) is a neurological disorder typically found in alcohol use disorder. The fact that it also occurs in nonalcoholic patients is less well known and often ignored. For the first time, this review offers a systematic investigation of the frequency and associated features of nonalcoholic WKS in the published literature. METHOD We included 11 recent systematic reports, with a total of 586 nonalcoholic WKS cases following hyperemesis gravidarum (n = 177), cancer (n = 129), bariatric surgery (n = 118), hunger strike (n = 41), soft drink diet in children (n = 33), depression (n = 21), Crohn's disease (n = 21), schizophrenia (n = 15), anorexia nervosa (n = 12), ulcerative colitis (n = 10), and incidental thiamine-deficient infant formula (n = 9). FINDINGS Vomiting and extreme weight loss were strong predictors of nonalcoholic WKS in adults. Blurred vision was a common presenting sign in about one-fourth of the patients. The classic triad of WKS is characterized by confusion, ataxia, and eye-movement disorders. All reviewed studies reported high percentages of patients presenting with an altered mental status, while both motor symptoms were variably present. INTERPRETATION The foregoing observations led to several important conclusions. First, we can see that nutritional impoverishment leads to profound brain damage in the form of WKS. Second, it seems that physicians are either unaware of or underestimate the risks for nonalcoholic WKS. Physicians must be specifically vigilant in detecting and treating WKS in patients with sudden and severe weight loss and vomiting. Third, lower doses of thiamine frequently lead to chronic Wernicke-Korsakoff syndrome. We noticed that when thiamine treatment for WKS was administered, in many cases doses were too low. In line with proven interventions we therefore recommend a parenteral thiamine treatment of 500 mg 3 times per day in adults.
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Affiliation(s)
- Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands.
| | - Jan W Wijnia
- Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Misha J Oey
- Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Mirjam van Dam
- Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
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15
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Wang Q, Charmchi Z, George IC. Restrictive diet in a patient with irritable bowel syndrome leading to Wernicke encephalopathy. BMC Gastroenterol 2021; 21:179. [PMID: 33879093 PMCID: PMC8056557 DOI: 10.1186/s12876-021-01758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background We present a case of a woman with a past medical history of irritable bowel syndrome (IBS) and anxiety, who presents with ophthalmoplegia, ataxia and memory loss, characteristic of Wernicke encephalopathy. Case presentation A 64-year-old woman presented with double vision, unsteady gait and memory loss. These symptoms began after 3 months on an unfortified restricted diet, which she initiated to alleviate IBS symptoms. Magnetic resonance imaging of the brain demonstrated hyperintense T2-weighted signal in the dorsomedial aspect of bilateral thalami, periaqueductal grey matter and around the third ventricle. The patient’s visual symptoms improved significantly after thiamine supplementation, although her memory deficits persisted. Conclusion Although WE is often associated with chronic alcohol abuse, this case demonstrates the importance of recognizing WE in any patient with a restricted diet and subsequent timely initiation of thiamine.
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Affiliation(s)
- Qiang Wang
- Department of Neurology, Kings County Hospital Center, SUNY Downstate Medical Center and Maimonides Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Zeinab Charmchi
- Department of Neurology, Kings County Hospital Center, SUNY Downstate Medical Center and Maimonides Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ilena C George
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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Caballeria E, Oliveras C, Nuño L, Balcells-Oliveró M, Gual A, López-Pelayo H. A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions. Psychol Med 2020; 50:2113-2127. [PMID: 32840195 DOI: 10.1017/s0033291720002925] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.
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Affiliation(s)
- Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Laura Nuño
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Mercedes Balcells-Oliveró
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
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van Dam MJ, van Meijel B, Postma A, Oudman E. Health problems and care needs in patients with Korsakoff's syndrome: A systematic review. J Psychiatr Ment Health Nurs 2020; 27:460-481. [PMID: 31876326 DOI: 10.1111/jpm.12587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Patients with Korsakoff's syndrome suffer from a broad range of comorbid somatic and/or psychiatric conditions. The various health problems in patients with Korsakoff's syndrome limit their ability to perform daily activities and also negatively affect their social functioning. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with Korsakoff's syndrome have complex somatic and psychiatric comorbid conditions co-occurring with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review demonstrates that patients with Korsakoff's syndrome should receive integrated care. Integrated care for patients with Korsakoff's syndrome should be based on accurate multidimensional and multidisciplinary diagnostics in which nurses and nurse assistants have a prominent role due to their central position in the care process patients with Korsakoff's syndrome. ABSTRACT: Introduction The literature shows that Korsakoff's syndrome is associated with a wide range of severe comorbid somatic and psychiatric health problems that lead to care needs in several domains of functioning. Aim To provide a comprehensive overview of Korsakoff patients' health conditions and related care needs. Method Following the PRISMA guidelines, we searched MEDLINE, PsycInfo, Cochrane Library and CINAHL up to January 2019. After applying our inclusion criteria, two reviewers independently selected the studies, extracted the data and assessed methodological quality. Results Twelve articles were included. The commonest somatic comorbid conditions were liver disease, cardiovascular disease, COPD and diabetes mellitus. The commonest psychiatric comorbid conditions were mood disorder, personality disorder and psychotic disorder. Anxiety, aggressive/agitated behaviour, depressive symptoms and care needs in social functioning and (instrumental) activities of daily living were also very commonly reported. Discussion In patients with Korsakoff's syndrome, somatic and psychiatric comorbid conditions co-occur with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. Adequate responses to their care needs require high-quality integrated care. Implications for practice Patients with Korsakoff's syndrome should receive integrated care based on accurate multidimensional and multidisciplinary diagnostics in which nurses have a prominent role.
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Affiliation(s)
- Mirjam Johanna van Dam
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Parnassia Psychiatric Institute, The Hague, the Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, the Netherlands
| | - Albert Postma
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Erik Oudman
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
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18
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Vitamin D supplementation after malnutrition associated with time-related increase of cancer diagnoses: A cohort study of 389 patients with Wernicke-Korsakoff syndrome. Nutrition 2019; 66:166-172. [DOI: 10.1016/j.nut.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/20/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022]
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19
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Atypical presentation of a forgotten disease: refractory hypotension in beriberi. Eur J Clin Nutr 2019; 73:1598-1600. [PMID: 31285553 DOI: 10.1038/s41430-019-0469-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Thiamine deficiency is a treatable disease with an excellent prognosis. However, it is often unrecognized because of the diversity of its clinical presentations. SUBJECTS/METHODS Herein, we report two atypical cases of nonalcoholic thiamine deficiency that presented with refractory hypotension in the absence of lactic acidosis. RESULTS Case 1 developed recurrent hypotension, right-sided heart failure, and a classic triad of Wernicke's encephalopathy (WE) after gastrointestinal surgery. Case 2 had decreased dietary intake and diuretic abuse, and had multiple episodes of syncope prior to present admission with refractory hypotension and mental status changes. The diagnosis of both cases was confirmed by undetectable pretreatment serum thiamine and dramatic improvement with thiamine replacement. CONCLUSIONS In this report, we highlight refractory hypotension as a complication of, not only cardiovascular, but also neurologic beriberi. Moreover, thiamine replacement should be considered without delay in hypotensive patients with signs of WE and/or risk factors for beriberi.
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20
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Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, Minicucci MF. Role of Thiamin in Health and Disease. Nutr Clin Pract 2019; 34:558-564. [DOI: 10.1002/ncp.10234] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Bertha F. Polegato
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Amanda G. Pereira
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Paula S. Azevedo
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Nara A. Costa
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Marcos F. Minicucci
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
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21
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Mellentin AI, Ellermann AE, Nielsen B, Mejldal A, Möller S, Nielsen AS. The prognosis of out-patient alcohol treatment among parents with childcare responsibility. BJPsych Open 2018; 4:471-477. [PMID: 30450227 PMCID: PMC6235993 DOI: 10.1192/bjo.2018.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite expansive knowledge on the detrimental effects of growing up with parents with alcohol use disorders (AUDs), little is known about the prognosis of alcohol treatment among parents with childcare responsibility. AIMS This observational cohort study aimed to examine the prognosis of patients with and without childcare responsibility, in a conventional out-patient alcohol treatment clinic. METHOD A consecutive AUD sample (N = 2201), based on ICD-10 Diagnostic Criteria for Research, was assessed with the European Addiction Severity Index during the clinical routine, at treatment entry and conclusion. Data on addiction severity, treatment course and drinking outcomes were derived, and adjusted odds ratios (AORs) were calculated with logistic-regression models. Drinking outcomes were compared in an intention-to-treat analysis, including all patients in a logistic regression with inverse probability weighting. RESULTS Patients with childcare responsibility (aged <18 years) had a less severe addiction profile and lower drop-out rate compared with patients without children or with children living out-of-home. They were also more likely to improve on all drinking-related outcomes, including abstinence (AOR 2.68, 95% CI 1.82-3.95), number of drinking days (AOR 2.45, 95% CI 1.50-4.03) and excessive drinking days (AOR 4.66, 95% CI 2.36-9.17); and those with children living out-of-home had better outcomes on abstinence (AOR 1.59, 95% CI 1.08-2.34) than patients without children. CONCLUSIONS Childcare responsibility among out-patients was associated with better treatment course and outcomes than those without or not living with their children. This knowledge can help guide clinical practice, effectuate interventions and inform social authorities.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark and Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark and Clinical Psychologist, Psychiatric Hospital, Odense University Hospital, Denmark
| | | | - Bent Nielsen
- Professor, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark and Psychiatrist, Psychiatric Hospital, Odense University Hospital, Denmark
| | - Anna Mejldal
- Statistician, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Sören Möller
- Statistician, Professor, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Anette Søgaard Nielsen
- Associate Professor, Research Director, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Denmark
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Davis BC, Bajaj JS. Effects of Alcohol on the Brain in Cirrhosis: Beyond Hepatic Encephalopathy. Alcohol Clin Exp Res 2018; 42:660-667. [PMID: 29417604 DOI: 10.1111/acer.13605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/30/2018] [Indexed: 02/07/2023]
Abstract
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy (HE). Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as HE. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of HE associated with alcohol use. Acute management of the alcoholic cirrhosis patient with altered mental status should focus on ruling out other causes, best intensive care, and use of gut-based therapies such as lactulose and rifaximin. Long-term management centers on optimizing treatment of concurrent mood disorders, nutritional support, and medical management of complications associated with cirrhosis. Future studies are needed to clarify mechanisms of brain injury in concomitant alcohol misuse and HE in addition to designing treatment interventions in order to improve outcomes in these patients.
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Affiliation(s)
- Brian C Davis
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center (BCD, JSB), Richmond, Virginia
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center (BCD, JSB), Richmond, Virginia
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