Treatment delay within the patient journey of people with Korsakoff's syndrome: A retrospective qualitative multiple-case study in the Netherlands.

Treatment delay is the best explanation for the development of Korsakoff's syndrome. This study aimed to improve the patient pathway to reduce treatment delay and/or increase proper care on time for people with Korsakoff's syndrome by generating knowledge about the patient journey from the first moment that professional care was deemed necessary until the time of admission into a specialised residential facility for long-term care and treatment. This retrospective exploratory multiple-case study used an individual semi-structured interview approach in 14 cases, with a total of 56 respondents. Process mapping was used to understand the chronological patient journey and the multiple-case description was analysed by using the same question as used by the individual case studies: 'What risk factors do the respondents discuss that can explain treatment delay?'. The exploration of the data revealed three reoccurring cross-case risk factors to explain treatment delay or delay in receiving proper care on time. Our respondents discussed: the lack of knowledge of KS, the fragmentation of care/waiting lists and the lack of specialistic home care. We recommend the development of knowledge programmes about Korsakoff's syndrome for family carers, GP's, healthcare professionals in general hospitals and home care workers, which could play an essential role in reducing treatment delays for patients with KS. There is also a need to find ways to organise coordinated care for patients with KS. Further research into the role of Korsakoff case managers is recommended.

Behavioural effects of light intervention in people with Korsakoff Syndrome: A pilot study.

Korsakoff Syndrome (KS) is commonly associated with behavioural symptoms such as agitation, apathy, and disinhibition. People with KS often reside in long-term care facilities, which reduces their exposure to natural light. Little is known regarding positive effects of light intervention in KS. Our objective was to evaluate the influence of a dawn simulation therapy on behavioural symptoms in KS. 38 patients residing in a 24-hour care facility were exposed for 6 weeks to a dawn simulation system in their bedrooms, which gradually increased from 0 lux to 290 lux. Behavioural symptoms were measured over 9 weeks. Weeks 1-3 consisted of the baseline phase and weeks 3-9 consisted of the light intervention phase. Our study showed that total severity of neuropsychiatric symptoms was less prominent during light intervention. More specifically, a decrease on the apathy, disinhibition, behaviour at night and appetite and eating behaviour subscales was found during the light intervention phase compared to the baseline phase. Additionally, a significant effect was found on decreasing emotional distress for caregivers. Results suggest that light intervention therapy has a positive effect on reducing behavioural symptoms in KS as well as the levels of stress experienced by the patients' caregivers.

Identifying, Assessing, and Treating Korsakoff Syndrome Patients: Updated Perspectives.

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.

[The knowledge of resident doctors on diagnostics, etiology and treatment of Wernicke encephalopathy]. / De kennis van a(n)iossen over diagnostiek, etiologie en behandeling van wernicke-encefalopathie.

BACKGROUND: Wernicke encephalopathy (we) is a severe, acute neuropsychiatric disorder caused by a deficiency in thiamine. There have been indications that we is undertreated, which can lead to the Korsakoff syndrome, delirium or death. Treatment according to protocol is simple and effective. The knowledge of physicians about we has not been researched before.
AIM: To test the knowledge of resident doctors on diagnosis, etiology and treatment of we.
METHOD: The knowledge of 70 resident doctors in different medical specialties was examined through two clinical cases: the first with we due to hyperemesis gravidarum and the second due to alcohol abuse. Both open and multiple-choice questions were asked. Cues of the classical triad of we (cognitive disorder, eye movement disorder and gait disorder) were given accumulatively.
RESULTS: The classical triad of we was not recognized by 73% of the resident doctors in the case of hyperemesis gravidarum and they missed we in the case of alcohol abuse. Many of the resident doctors were not able to name the thiamin deficiency, the triad of we, more than three causes of we or the correct treatment with thiamine sufficiently. 67% of resident doctors indicated that their knowledge of we was insufficient and 76% expressed a need for more information about we.
CONCLUSION: The knowledge of resident doctors about the diagnostics, etiology and management of we is insufficient. Moreover, the resident doctors evaluate their knowledge about we to be insufficient. Medical school and postgraduate specialization have to focus more on this common and severe syndrome, which can appear in different medical areas.

Health problems and care needs in patients with Korsakoff's syndrome: A systematic review.

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.

Tell about yourself to improve your autobiographical memory: A study of Korsakoff's syndrome.

Korsakoff's syndrome (KS) has been associated with a difficulty to retrieve specific autobiographical memories. We investigated whether this difficulty can be alleviated after the retrieval of statements describing self-images. KS patients and control participants were recruited and asked to retrieve autobiographical memories after providing statements to the question "Who am I?" and after a control condition consisting of verbal fluency. Analysis showed higher autobiographical specificity in the "Who am I?" than in verbal fluency condition in both patients with KS and control participants. At a theoretical level, our findings demonstrate how retrieval of information related to conceptual self may influence autobiographical memory in KS. At a clinical level, our procedures are important as they demonstrate how a simple task (i.e., "Who am I?" statements) may serve as a tool to cue specific autobiographical memories in patients with KS.

Beyond Thiamine: Treatment for Cognitive Impairment in Korsakoff's Syndrome.

BACKGROUND: Wernicke's encephalopathy is a condition whose treatment many consultation-liaison psychiatrists know quite well. Less clear, however, is the treatment of its dementia disorder descendent, the Korsakoff's syndrome (KS). OBJECTIVE: This article seeks to review treatment options and provide recommendations for consultation-liaison psychiatrists treating cognitive impairment in KS. METHODS: In this nonsystematic review, we reviewed PubMed, CINAHL Plus, and Google Scholar for published reports and studies regarding treatment of KS. RESULTS: The literature revealed case reports and placebo-controlled trials of various medications for treatment of KS, though the samples sizes were small and were mostly case reports. There is more attention devoted toward medications used in other dementia disorders, such as donepezil and memantine. The literature revealed more studies around behavioral interventions recommended for treatment of memory impairment in KS and they focused on cognitive remediation and environmental adaptation, such as the use of PDAs or alarms. CONCLUSIONS: There is no single, well-studied intervention proven effective as a primary treatment for cognitive impairment in KS. An approach of using environmental modifications in a well-structured living environment, combined with various cognitive interventions, such as pictorial associations, and perhaps a trial of donepezil or memantine, likely represents the best strategy for treating long-term cognitive impairment in KS.

[The prevention of Korsakoff's syndrome by offering involuntary care?] / Voorkómen van het syndroom van Korsakov door aanbieden onvrijwillige zorg?

BACKGROUND: The new draft Law on care and coercion focuses on the care of people with a psychogeriatric disorder or intellectual disability. Perhaps this law can be applied to people suffering from chronic alcoholism, associated with an increased risk of Korsakoff's syndrome. AIM: To explore whether the new draft law on care and coercion can be applied to people suffering from chronic alcoholism who still live at home. METHOD: A description of possibilities of involuntary homecare to people suffering from chronic alcoholism based on literature, current legislation and two new draft laws. RESULTS: It seems possible to apply the law care and coercion to people suffering from chronic alcoholism. CONCLUSION: The application of the draft law care and coercion offers the possibility of providing involuntary homecare to people suffering from chronic alcoholism, enabling the administration of thiamine. This reduces the chances of developing Korsakoff's syndrome. Further research is necessary to explore the practical possibilities in offering involuntary care.

[The possibilities of neurostimulation (sympathetic correction) in the treatment of amnestic (Korsakoff's) psychosis]. / Vozmozhnosti neirostimuliatsii (simpatokorrektsii) v terapii amnesticheskogo (korsakovskogo) psikhoza.

AIM: To evaluate the efficacy of non-invasive multichannel electrical stimulation (sympathetic correction) in patients with alcohol amnesic (Korsakoff's) psychosis. MATERIAL AND METHODS: Thirty-seven men, aged 33-48 years, with Korsakoff's (amnestic) psychosis were studied. The duration of disease varied from 12 to 24 month. The device of electrical stimulation of neck nerve structures was used for neuroelectrostimulation. Treatment included 15 sessions within 3 weeks. During this period, patients did not receive pharmacological therapy. The Frontal Assessment Battery (FAB), the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) were used to determine changes in cognitive state of patients. Electroencephalography with qEEG analysis and spectral analysis of heart rate variability (HRV) were carried out as well. RESULTS AND CONCLUSION: Positive effects of treatment were observed in all patients that suggested the high therapeutic potential of the neuroelectrostimulation method.

Modification of Automatic Alcohol-Approach Tendencies in Alcohol-Dependent Patients with Mild or Major Neurocognitive Disorder.

BACKGROUND: To examine the applicability of an alcohol-avoidance training procedure in patients with alcohol dependence and alcohol-induced neurocognitive disorders (NDs), we trained 2 groups that differed in the degree of cognitive impairment: One group fulfilled the DSM-5 criteria for alcohol-induced mild ND, and 1 group was diagnosed with Korsakoff's syndrome (KS) (alcohol-induced major ND, confabulatory/amnesic subtype; DSM-5). The intervention is assumed to match the preserved cognitive capacity for implicit learning in both groups. METHODS: Fifty-one inpatients with a mild ND and 54 inpatients with KS were trained. Six training sessions (including pre- and posttests) of a computerized implicit alcohol approach-avoidance task were applied. Neurocognitive variables were available from the standard assessment procedure of the clinic. RESULTS: Training of alcohol-avoidance tendencies is feasible in a population with alcohol-related NDs. The alcohol-approach bias decreased for both groups in each session. Better learning results over time were obtained in participants with a larger baseline alcohol-approach tendency. Learning effects were positively related to age and implicit (nondeclarative) memory functioning. No relation between training effects and executive or explicit memory functions was found. CONCLUSIONS: Training of an alcohol-avoidance tendency can be successfully applied in patients with alcohol dependence including those with alcohol-induced NDs.

Non-alcoholic Korsakoff syndrome in psychiatric patients with a history of undiagnosed Wernicke's encephalopathy.

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.

Experiences of home and institution in a secured nursing home ward in The Netherlands: A participatory intervention study.

Nursing homes have been criticised for not providing a home for their residents. This article aims to provide insight into (1) the features of home and institution as experienced by residents and caregivers of a secured ward in a nursing home, and (2) how interventions implemented on the ward can contribute to a more home-like environment. For this purpose, a participatory intervention study, involving both caregivers and residents, was carried out. We collected data through qualitative research methods: observations, in-depth interviews and diaries to evaluate the interventions over time. We adopted an informed grounded theory approach, and used conceptualisations of total institutions and home as a theoretical lens. We found that the studied ward had strong characteristics of a total institution, such as batch living, block treatment and limited privacy. To increase the sense of home, interventions were formulated and implemented by the caregivers to increase the residents' autonomy, control and privacy. In this process, caregivers' perceptions and attitudes towards the provision of care shifted from task-oriented to person-centred care. We conclude that it is possible to increase the home-like character of a secured ward by introducing core values of home by means of interventions involving both caregivers and residents.

Healthcare professionals under pressure in involuntary admission processes.

The main objective of this paper is to describe how quality of care may be improved during an involuntary admission process of patients suffering from Korsakoff's syndrome. It presents an empirically grounded analysis with different perspectives on 'doing good' during this process. Family carers', healthcare professionals' and legal professionals' ways of understanding and ordering this problematic situation appear very different. This could prevent patients from getting the proper care they need, with risk of more suffering and quality of life below the minimum acceptable. All this possibly lead to immoral dehumanizing situations. Firstly, the background of our empirical study is sketched. Secondly, the different perspectives on 'doing good' are summarized and compared. Thirdly, the tensions arising from the different conceptualizations of autonomy and different types of responsibilities of the actors are clarified. A common 'doing good' during involuntary admission necessitates removal of any tensions within the relational network by weighing and balancing the different perspectives on autonomy and the resulting responsibilities. With this in mind, we propose a renewed time/action table for involuntary admission, which tends to address all patients' needs at the right time. The solution presented might help healthcare professionals, who are squeezed in between patients, family carers, legal professionals and overall rules, to create practices in which patients suffering from Korsakoff's syndrome can maintain their dignity and receive the care they need. Earlier interventions, timely and adequate diagnosis, and diminishment of tensions between the different actors by fine-tuning their paradigmatic frameworks are suggested to be part of a solution.

Evolution of quality of life in patients with Korsakoff's syndrome in a long-term care facility.

BACKGROUND: Korsakoff's syndrome (KS) is a neuropsychiatric disorder characterized by severe amnesia. Quality of life (QoL) is becoming an increasingly used outcome measure in clinical practice but little is known about QoL in KS and how it may change over time. The purpose of this study was therefore to assess the QoL in patients with KS at baseline and with a 20-month follow-up. METHODS: The current study is a longitudinal study on the QoL in patients with KS living in two long-term care facilities for KS patients in the Netherlands. QoL was scored with the proxy-based QUALIDEM scale with a 20-month follow-up. RESULTS: Of the 72 KS patients included at baseline, 57 KS patients had a follow-up QoL score (79.2%). On the subscales "Feeling at home," "Positive affect," and "Care relationship" of the QUALIDEM, there was a better QoL in the follow-up, although effects were relatively small. Other subscales indicated a stable QoL over time. There were inter-relations between changes in subscales. CONCLUSIONS: The main finding of this study is that patients with KS on average do show a relatively stable moderate to good QoL despite the severity of the syndrome. On specific subscales, there is a small increase in QoL over time. Results do suggest that prolonged stay in a long-term care facility for KS patients does have a neutral to a positive effect on QoL in KS.

Healthcare professionals' dilemmas: judging patient's decision making competence in day-to-day care of patients suffering from Korsakoff's syndrome.

Patient's decision making competence (PDMC) is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff's syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals' duty to take care of their patient's best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas.

[Treatments for otorhinolaryngological patients with psychiatric disorders].

There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families.