Criminal behavior in alcohol-related dementia and Wernicke-Korsakoff syndrome: a Nationwide Register Study.

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.

Síndrome de Wernicke-Korsakoff y otras patologías asociadas al déficit de tiamina / Wernicke-Korsakoff syndrome and other diseases associated with thyamine deficiency

El síndrome de Wernicke-Korsakoff es la consecuencia más conocida del déficit de tiamina; se asocia frecuentemente a pacientes con un consumo crónico y excesivo de alcohol, pero puede deberse a cualquier causa que produzca déficit de tiamina.La enfermedad está infradiagnosticada, por lo que es fundamental tener una alta sospecha clínica, principalmente en los pacientes que no presentan consumo de alcohol como factor de riesgo. El diagnóstico sigue siendo eminentemente clínico, con la dificultad de una elevada variabilidad clínica. Las pruebas complementarias sirven para apoyar el diagnóstico y descartar otras causas que puedan producir sintomatología similar, siendo la resonancia magnética la prueba de imagen más rentable.El tratamiento se basa en la administración de tiamina, que debe iniciarse precozmente, de forma parenteral y a las dosis adecuadas en todos los pacientes con clínica compatible, sin esperar a confirmar el diagnóstico. (AU)

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. (AU)

[Wernicke-Korsakoff syndrome and other diseases associated with thyamine deficiency]. / Síndrome de Wernicke-Korsakoff y otras patologías asociadas al déficit de tiamina.

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.

"Vascular" Korsakoff Syndrome With Bilaterally Damaged Mammillothalamic Tracts: Insights Into the Pathogenesis of "Acute" Korsakoff Syndrome As Acute-Onset Irreversible Anterograde Amnesia.

The structural pathogenesis of Wernicke-Korsakoff syndrome remains debatable. Wernicke encephalopathy is acute and often reversible whereas Korsakoff syndrome (KS) is chronic and may be irreversible. The cognitive deficits observed in KS are considered to be primarily due to damage to the anterior nucleus of the thalamus, mammillary bodies, and corpus callosum. We present an extremely rare case of non-alcoholic "vascular" KS (vKS) as acute-onset amnesia. A 97-year-old man living alone was brought to our hospital, complaining of sudden-onset behavioral changes with amnesia. Diffusion-weighted images (DWIs) showed fresh cerebral infarction in the right thalamus involving the right mammillothalamic tract (MTT). T2*-weighted images (T2*WIs), in addition, revealed a microbleed scar over the left MTT. This case supports the hypothesis that bilateral MTT dysfunction can lead to KS. Furthermore, in collaboration with a prior report about non-alcoholic "acute" KS due to cerebral infarction, this case supports the existence of vascular KS as an acute-onset amnestic syndrome, as well as insight into the pathogenesis of KS as an irreversible amnestic syndrome.

Confabulations in Alcoholic Korsakoff's Syndrome: A Factor Analysis of the Nijmegen-Venray Confabulation List.

Confabulations generally refer to the emergence of memories of experiences and events that, in reality, never took place, and which are unintentionally produced. They are frequently observed in alcoholic Korsakoff's syndrome. The aim of the current study was to validate the Nijmegen-Venray Confabulation List (NVCL), an observation scale for quantifying both spontaneous and provoked confabulations. The NVCL was completed for 252 patients with alcoholic Korsakoff's syndrome. Exploratory and confirmatory factor analyses were conducted to test three- and four-factor models of the NVCL structure. A four-factor model (provoked confabulations, spontaneous confabulations, severity of spontaneous confabulations, and distorted sense of reality) fitted the data better than the initially proposed three-factor model (provoked confabulations, spontaneous confabulations, memory, and orientation). The new instrument is therefore referred to as the NVCL-R. We encourage clinicians to include the assessment of confabulations in the neuropsychological examination, and to do so with validated instruments such as the NVCL-R.

The relationship between executive dysfunction and neuropsychiatric symptoms in patients with Korsakoff's syndrome.

Objective: Patients with Korsakoff's syndrome (KS) show executive dysfunction and neuropsychiatric symptoms. This study investigates whether specific executive subcomponents (shifting, updating, and inhibition) predict variance in neuropsychiatric symptoms. We hypothesized that shifting deficits, in particular, are associated with neuropsychiatric symptoms.Method: Forty-seven patients participated (mean age 61.5; 11 women). Executive function (EF) was measured using six component-specific tasks. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory - Questionnaire (NPI-Q). General cognitive functioning was assessed with the Montreal Cognitive Assessment (MoCA). First, factor analysis was conducted to examine shared variance across the EF tasks. Subsequently, a regression analysis was performed with the EF factors and the MoCA as predictors and the NPI-Q as the dependent variable. It was also investigated whether an interaction effect between the EF factors and the MoCA was present.Results: The prevalence of neuropsychiatric symptoms was high (85.7% of the KS patients showed at least one symptom). A two-factor model was extracted with a shifting-specific factor and a combined updating/inhibition factor. The overall regression model was not significant, and no interaction was found between the EF factors and general cognitive functioning. However, a significant relationship between general cognitive functioning and neuropsychiatric symptoms (r = -.43; p <.01) was detected.Conclusions: Results point at an association between neuropsychiatric symptoms and general cognitive functioning. Possibly, diminished cognitive differentiation in these patients with severe cognitive dysfunction accounts for the absence of a significant association between EF and neuropsychiatric symptoms. While the results should be interpreted with caution due to a limited sample size, the found association highlights the need to further unravel the underlying cognitive mechanisms of neuropsychiatric symptoms in patients with KS.

Wernicke-Korsakoff syndrome: Focus on low-threshold diagnosis and prompt treatment in the primary care setting.

The authors present the case of an inpatient hospitalized at the Veterans Affairs psychiatric unit diagnosed with Wernicke-Korsakoff syndrome to promote awareness of this prevalent yet often underdiagnosed and undertreated condition. Although Veterans present with a unique predisposition for alcohol abuse, it remains problematic in the general population as well. Analysis from 2000 to 2003 reveals alcohol use in the past month in Veterans at 56.6% and 50.8% in comparable non-Veterans. According to the National Survey on Drug Use and Health, it is estimated that of those who are 18 and older, 86.4% have used alcohol, 26.9% have engaged in binge drinking in the past month, 7% engaged in heavy alcohol use in the past month, and 6.2% (15.1 million) carried the diagnosis of alcohol use disorder., The lifetime prevalence of alcohol abuse in the general population is estimated to be between 4.5% and 13.2%. Primary care providers should maintain a high degree of vigilance in evaluating patients for timely diagnosis and prompt treatment of those suspected to have thiamine deficiency. Indeed, Wernicke's encephalopathy carries a significant level of morbidity and mortality associated with the syndrome, even in cases when it does not present with all of the classic signs. This article aims to raise the primary and ambulatory care provider's ability to recognize the condition, emphasize a low threshold to treat, and highlight current treatment recommendations.