Prevalence and Improvement of Caine-Positive Wernicke-Korsakoff Syndrome in Psychiatric Inpatient Admissions

Psychosomatics. 2020 Jan-Feb;61(1):31-38. doi: 10.1016/j.psym.2019.08.002. Epub 2019 Aug 14.

Abstract

Background: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunction/ataxia, and oculomotor abnormalities.

Objective: We describe Caine-positive WKS prevalence among psychiatric inpatients and compare pretreatment-versus-posttreatment neurocognitive improvement to an unaffected group.

Methods: This 6-month quality-improvement evaluation included two-stage screening for Caine-positive WKS, administering high-dose intravenous thiamine (day 1: 1200 mg; days 2-4: 200 mg) with reexamination on day 5. We used descriptive statistics and fitted random effects models to examine rate-of-change differences in pre-/posttreatment Montreal Cognitive Assessment (MoCA), delayed 5-item recall, and gait/coordination scores between treated Caine-positive patients with WKS and untreated Caine-negative patients.

Results: Of 262 patients, 32 (12%) had Caine-positive WKS; 17 (53%) used alcohol currently. Treated Caine-positive WKS (n = 26) versus Caine-negative comparison (n = 34) before and after treatment observed a mean change (standard deviation) in the MoCA score of 3.6 (2.5) versus 1.8 (2.5) (P < 0.01); 5-item recall: 1.8 (1.4) versus 0.5 (1.4) (P < 0.001); gait/coordination scores: -0.6 (1.2) versus -0.1 (0.6) (P < 0.001). Oculomotor abnormalities were infrequent (n = 4 in Caine-positive WKS, n = 2 in Caine-negative comparison groups).

Conclusions: Caine-positive WKS prevalence among psychiatric inpatients was 12%; only half used alcohol. Patients treated with high-dose thiamine demonstrated clinically significant neurocognitive improvement.

Keywords: Wernicke-Korsakoff Syndrome; alcohol-related brain diseases; memory; nutritional diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcoholic Korsakoff Syndrome / diagnosis
  • Alcoholic Korsakoff Syndrome / drug therapy
  • Alcoholic Korsakoff Syndrome / epidemiology
  • Alcoholic Korsakoff Syndrome / physiopathology
  • Ataxia / physiopathology*
  • Brain Diseases / physiopathology*
  • Cerebellar Diseases / physiopathology
  • Delirium / physiopathology
  • Female
  • Hospitalization
  • Humans
  • Korsakoff Syndrome / diagnosis
  • Korsakoff Syndrome / drug therapy
  • Korsakoff Syndrome / epidemiology*
  • Korsakoff Syndrome / physiopathology
  • Male
  • Malnutrition / epidemiology
  • Mass Screening
  • Memory Disorders / physiopathology
  • Mental Status and Dementia Tests
  • Middle Aged
  • Ocular Motility Disorders / physiopathology
  • Ophthalmoplegia / physiopathology*
  • Prevalence
  • Thiamine / therapeutic use
  • Thiamine Deficiency / drug therapy
  • Thiamine Deficiency / physiopathology
  • Thinness / epidemiology
  • Treatment Outcome
  • Vitamin B Complex / therapeutic use
  • Weight Loss

Substances

  • Vitamin B Complex
  • Thiamine