Preventing and diagnosing dementia.

While dementia is an umbrella term for a range of degenerative brain disorders, many share similar presentations. Nurses are ideally placed to identify those at risk and empower them to access treatment and plan and prepare for their future needs--as such, they need up-to-date knowledge of the signs and symptoms of the different types of dementia to identify risk factors and make an informed diagnosis. This article, the third in a four-part series on dementia, examines the risk factors, signs, symptoms and diagnosis of dementia, as well as outlining lifestyle factors such as diet and exercise that may help to prevent the development of the condition.

Increasing incidence of Korsakoff's psychosis in the east end of Glasgow.

A retrospective analysis of all admissions between 1990 and 1995 in a population of 160,000 identified 47 new cases of Korsakoff's psychosis only seven of which were preceded by Wernicke's encephalopathy. There was a higher ratio of females to males, relative to admissions for severe alcohol dependence. It postulated that the increasing incidence may be related to the warning of anaphylaxis and subsequent withdrawal of high-potency parenteral multivitamins with thiamine.

Preventing the Wernicke-Korsakoff syndrome in Australia: cost-effectiveness of thiamin-supplementation alternatives.

Alcoholic Wernicke's encephalopathy has been commonplace in Australia for many years and, as this syndrome is attributed to a deficiency in the diet, it should be preventable. This study employs conventional cost-effectiveness methodology to compare the economic efficiency of several thiamin-supplementation alternatives that have been proposed for the prevention of Wernicke's encephalopathy. A series of rankings of these measures is derived from an estimated cost per case averted for each of the alternatives studied. These rankings identify the least cost-effective thiamin-supplementation alternative as that of enriching bread-making flour with thiamin.

Wernicke's encephalopathy and Korsakoff's psychosis: to fortify or not to fortify?

The conventional wisdom suggests that Korsakoff's psychosis, an amnesic disorder associated with prolonged alcohol consumption, is the chronic outcome of a thiamin deficiency first exhibited as Wernicke's encephalopathy. The present paper describes the debate in Australia over whether flour and alcoholic beverages should be fortified with thiamin, in an attempt to prevent Wernicke's encephalopathy and thus Korsakoff's psychosis. We conclude that the scientific evidence linking Wernicke's encephalopathy and Korsakoff's psychosis is tenuous. Certainly, it is not sufficient to support what would amount to mass medication.

The Wernicke-Korsakoff syndrome: a reappraisal in Queensland with special reference to prevention.

The Wernicke-Korsakoff syndrome occurs most frequently in alcoholic patients when they become thiamin deficient. First admissions to psychiatric units with the chronic component of this syndrome, Korsakoff's psychosis, peaked in Queensland in 1975-1976. The fall in hospital admission rates since this time could relate to a decline in per-capita alcohol consumption in Australia, or to more awareness of the thiamin needs of drinkers. Alternatively, the improvement may be illusory: although many cases of Wernicke's encephalopathy are being diagnosed, many of these patients are not receiving psychiatric assessment and treatment, perhaps because admission to psychiatric hospital beds is more difficult than it was formerly. Patients who are diagnosed as having Korsakoff's psychosis fare badly in the community, and have a greatly increased mortality rate than do such patients in hospital. Optimal care for such patients is necessarily costly of medical resources. Of available preventive measures, evidence is presented to support the fortification of beer with thiamin and the provision of community educational programmes. The fortification of flour with thiamin may have little impact on the thiamin-deficiency syndromes that arise in problem drinkers in Queensland.

Thiamin deficiency and prevention of the Wernicke-Korsakoff syndrome. A major public health problem.

There has been long-standing debate in Australia about the role of thiamin deficiency in the aetiology of the Wernicke-Korsakoff syndrome, the prevalence of the syndrome itself and the preventive measures that might be undertaken to reduce the prevalence rates. A literature review, and the results of a study of the follow-up arrangements of patients who were admitted with Korsakoff's syndrome to the two major South Australian psychiatric hospitals indicate that the syndrome is a major public health problem which requires immediate political intervention. Recommendations are made that a national policy of the fortification of flour and bread with thiamin, as well as of alcoholic beverages, should be implemented.

Current progress toward the prevention of the Wernicke-Korsakoff syndrome.

The Wernicke-Korsakoff syndrome is a rare neurological disorder which strikes primarily alcoholics and is caused, at least in part, by insufficient bioavailability of thiamin. Because of the low cost of preventing this disease by adding thiamin to alcoholic beverages relative to the cost of the long-term care of patients with the chronic phase of the disease, there has been a need to determine the feasibility of this particular preventive strategy. Recent data demonstrating normal levels of erythrocyte transketolase in patients presenting with Wernicke's encephalopathy has led some to question the link between thiamin deficiency, and the development of the syndrome, despite the fact that virtually all patients with Wernicke's encephalopathy will respond favorably to parenteral thiamin, and the evidence that rats deprived of thiamin develop lesions that are characteristic of the disease. Thiamin is nontoxic, is stable in alcoholic beverages, and is undetectable in beer to professional taste-testers at levels theoretically sufficient to guarantee adequate absorption. Although there is much inter-subject variability it appears that thiamin at therapeutic concentrations can be absorbed by the jejunum in the presence of alcohol. Evidence that patients with the Wernicke-Korsakoff syndrome have an altered thiamin-requiring isoenzyme and evidence that six patients with Wernicke's encephalopathy failed to respond to oral thiamin has caused some doubt as to whether the target population would be able to benefit from the measure. Other determinants of thiamin utilization, such as folate and magnesium status, also may figure in the etiology of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The Wernicke-Korsakoff syndrome in Queensland, Australia: antecedents and prevention.

The Wernicke-Korsakoff (W-K) syndrome is commonplace in Queensland, Australia. In a population of mental hospital inpatients with the W-K syndrome, males, particularly single males and widowers, and subjects who had undergone partial gastrectomy were over-represented. Some possible antecedents of the W-K syndrome are examined by focusing, not on W-K patients, but on problem drinkers. The results of a cross-national comparison of drinkers from Queensland, Australia and Merseyside, in the United Kingdom, are presented. The data support the hypothesis that Queensland drinkers are comparatively less involved with their families than Merseyside drinkers. This parallels a social perspective which regards allegiance to a male drinking group as very important in confirming social solidarity and 'mateship' in Australia. Such groups attach no importance to eating, setting the stage for dietary neglect and thiamine deficiency of which the W-K syndrome may be the end result. The fortification of alcoholic beverages with thiamine in Queensland has been previously proposed and attracted much local publicity. It seems possible that this publicity may have contributed to an increased awareness by heavy drinkers in Queensland of the need for supplementary B vitamins. However, this awareness is not so complete as to rule out the need for further measures aimed at reducing the incidence of the W-K syndrome in that state.

The attempted enrichment of beer with thiamine alkyl disulphides.

The Wernicke-Korsakoff syndrome, commonplace in Australia, might be prevented by the enrichment of alcoholic beverages with thiamine. The use of the well absorbed thiamine alkyl disulphides for the enrichment of the most relevant Australian beverage, namely beer, is examined. A liquid chromatographic method is described whereby thiamine tetrahydrofurfuryl disulphide and thiamine propyl disulphide can be detected in beer in concentrations down to 125 ng/ml. It is concluded that the thiamine alkyl disulphides offer no special advantage because their disulphide bonds are reduced by substances in beer, yielding free thiamine.

The supplementation of alcoholic beverages with thiamine--a necessary preventive measure in Queensland?

The large and increasing number of cases of Korsakoff's psychosis in a Queensland mental hospital prompts an examination of the theoretical and practical issues concerning the supplementation of alcoholic beverages with thiamine. It is concluded that supplementation of alcoholic beverages in Queensland with thiamine (and in particular with one of the allithiamines) warrants urgent and unprejudiced consideration.