Amnestic Korsakov syndrome is a pathopsychological disorder caused by a deficiency of vitamin B1, provoked by prolonged alcohol abuse. The disease is expressed by the loss of short-term memory while retaining the ability to remember long-standing events, preserved by long-term memory.
Amnestic syndrome with alcoholism
The disease is named after the Russian professor of psychiatry Korsakov SS, who studied memory disorders in alcoholic polyneuritis. The name of the syndrome comes from Greek words - the particles of the negation "a" and mneme, meaning "memory".
The term syndrome refers to a set of clinical signs that characterize a particular disease. Korsakov's syndrome with alcoholism is a combination of symptoms caused by damage to the structures of the limbic system of the brain.
Vitamin B1 primarily causes changes in the hypothalamus, thalamus, mastoid bodies, leading to severe memory impairment.
The amnesic Korsakov syndrome is characterized by amnesia:
- retrograde - memories associated with the onset of the disease disappear from memory, but the most remote memories, for example, children's, are preserved;
- fixing - the inability to hold current events in memory.
In the Korsakov syndrome, caused by alcoholism, the limbic system is always affected by a two-sided process, in which memory impairments are not restored.
Causes of
Alcohol intake leads to changes in the digestive system, impaired absorption of vitamins, microelements, including vitamin B1.
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- is necessary for normal operation of nerve cells;
- is involved in the synthesis of acetylcholine - a mediator necessary for the transmission of a nerve impulse, creating stable connections between neurons.
The lack of acetylcholine leads to impaired transmission of impulses between neurons, new connections are unstable, unable to persist, leading to a lack of memory for recent events. But memories of long-term memory, especially the most distant childhood memories and skills, are preserved.
So, the patient forgets how his new friend's name is, but without difficulty he plays chess with him. The rules of the game are in long-term memory. However, he can not think through the game for several moves forward, he plays the situation, solving a narrowly posed problem. If he is asked to repeat the moves made, he can not do it.
Clinical picture of
For patients with Korsakov's syndrome, anosognosia is characteristic - the negation of its disease. And the patient not only does not realize the loss of memory, does not agree with his illness, but also forgets that he forgets everything.
Patients with alcoholism in the amnestic syndrome:
- are always disoriented in time;
- can not replicate new information with delayed playback.
Patients are hard to remember the date, they can not reproduce the text just read, unable to remember in the evening what they ate for breakfast.
The closest events that have just happened, the patient saves in memory. He is able to perform a test consisting of memorizing successively named 5 words. But after a few minutes the patient forgets about this sequence, and that the test passed.
The Korsakov syndrome is characterized by a deterioration in visual memory. In patients with alcoholic amnestic syndrome, intellectual abilities are reduced, judgments are stereotyped, there is no ability to think logically, to notice contradictions in one's own statements.
Memory Failures
Symptoms of the syndrome combine symptoms of paramnesia and amnestic disorders. Leading symptoms of Korsakov's syndrome with fixative amnesia:
- paramnesia;
- affective disorders.
Parameters
Paramedesis refers to memory disorders, manifested in substituting genuine memories with fantastic ones, in which their role is exaggerated. Patients with paramnesia assure that they saved the world from stellar aliens, and yet they do not lie, as they sincerely believe so.
Typical paramnesia in alcoholism are:
- confabulation;
- pseudo reminiscences;
- of the cryptomnesia.
On video lecture about paramnesia:
Confabulation of
With this disorder, the spaces in the patient's memory are filled with fictitious plots that can be of a fantastic or domestic character, when some real events are replaced by others.
So, when replacing confabulation in the story of a patient with alcoholism, this event - a meeting with a friend and a sit-round with beer at the TV, is replaced by a visit to a football match.
Fantastic confabulations are manifested by a broader flight of thought. The patient is sure that he communicated on the reverse surface of the Moon with green men, and they opened to him the mystery of the universe, which he is about to remember and will tell everyone.
Pseudo reminiscences
A random event from your own past is placed in place of the event that has fallen out of memory. Such mistaken memories of the patient's mind are considered real, to challenge them is meaningless. Relatives need to understand that this is not just stubbornness, but a disease.
Kryptomnesia
The compensation for lost memories during cryptomnesia is due to information taken from the read seen on TV.It's hard for a person to separate a dream from reality, to remember if he heard music in reality or she dreamed of it.
Affective disorders
When alcohol dependence is clearly expressed emotional instability of the patient. Change of mood occurs several times a day. The mood changes easily at the slightest excuse, goes from friendliness to aggression, from complacency to anxiety, anxiety.
Affective disorders in the Korsakov syndrome are manifested asthenic depression, which is characterized by lethargy, inability to concentrate, fatigue, melancholy, motor retardation.
Symptoms of
Asthenic disorders in Korsakov's syndrome are manifested by increasing weakness, fatigue, not disappearing after rest.
Somatic disorders
In addition to disorders in the psychoemotional sphere, somatic disorders are noted in patients:
- changes in the autonomic nervous system - palpitation, dizziness;
- metabolic disorders - decreased appetite, weight loss;
- pains of different origin - in the heart, muscles, back, head;
- sleep disorders;
- amyotrophy is a disease in which loss of muscle strength and mass develops;
- intolerance of bright light, sounds.
Gradually, changes lead to a decrease in activity, a complete loss of interest in the environment. The patient's mood is apathetic, depressed.
Changes in the nervous system
The Korsakov syndrome is a consequence of toxic damage to the brain for a long time. Pathological brain disorders affect the functioning of the nervous system as a whole.
Peripheral nerves, innervating limbs, internal organs, skin, also suffer from a deficiency of vitamin B1 and work in a tense mode.
In Korsakov's syndrome there are:
- neurogenic dermatoses;
- itching;
- decreased tactile sensitivity;
- cramps of limbs;
- sensation of "goosebumps" creeping over the skin;
- changes gait.
Increased symptoms lead to a loss of ability to move independently.
The course of
Korsakov's syndrome begins, as a rule, suddenly. The disease is chronic, progressing with time.
The verbal memory and memory for current events suffer the most. To a lesser extent, the imaginative and emotional types of memory are violated. The ability of patients to orient themselves in the environment and in time varies in different degrees.
Korsakov syndrome with alcoholism occurs in old age, characterized by increasing dementia. The process intensifies with time, lasts up to 15 years, leads to intellectual insufficiency.
Forecast
Amnestic syndrome is replaced by alcoholic dementia - progressive dementia. To prevent this, it is necessary to overcome alcohol dependence as soon as possible.
In the amnestic Korsakov syndrome, caused by alcoholism, the forecast is unfavorable.
Treatment of
Treatment scheme includes detoxification of the body, coding from alcoholism, restoration of brain functions, social rehabilitation.
The restoration of the brain in its entirety is impossible because during the years of drunkenness a large volume of nerve cells is lost.
Partial brain rehabilitation is sought:
- by improving microcirculation - appoint trental, agapurin, reopolyglucin, nicotinic acid;
- stimulating metabolism of neurons - use piracetam, glutamic acid, vitamin B1.
The effectiveness of vitamin B1 in the treatment of alcoholism in adolescents and adults has been proven. Cocarboxylase is used - the active form of vitamin B1.In addition to vitamin B1, the synthesis of acetylcholine requires vitamin B5, manganese and a number of other trace elements.
The effectiveness of vitamin B1 absorption increases with simultaneous intake with vitamins PP, C, and vitamins B2 and B6.
The possibility of social adaptation in patients with Korsakov syndrome in alcoholism is reduced. Cure such a patient is impossible because of the destruction of the most important brain structures responsible for memory and intelligence.
With alcohol dependence, a person suffering from the amnestic syndrome requires constant supervision, compliance with the regime of the day, a diet rich in protein and vitamins, moderate physical activity. It is useful to practice memory, memorize verses, solve arithmetic problems, crossword puzzles.