Which mental status changes are characteristic of Wernicke-Korsakoff syndrome (WKS)?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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Alterations in consciousness can present simultaneously with ophthalmoplegia and ataxia but more commonly follow these signs and symptoms by days to weeks. These changes develop in 90% of patients and present in various forms.

Patients with long-term alcoholism are likely to present disheveled and unkempt, but appearance on presentation can range to a well-kept individual. No characteristic perceptual disturbances exist, but those of delirium tremens are present if it coexists.

The patient’s mood can range from calm and blunted or apathetic affect to stupor; agitation can occur in acute delirium and tremens can be found in a patient with alcohol withdrawal. The rare patient presenting in the Korsakoff amnestic state is alert and oriented but lacks the ability to provide adequate history.

No characteristic speech pattern exists. Vocal tremor may be present in a patient undergoing alcohol withdrawal. Reduced verbal content may occur in those with apathy.

Form and content of thought vary depending on patient presentation. Themes may include a lack of concern about the patient’s own current health status or state of affairs.

Sensorium and cognition vary with the level of consciousness. The patient may be in a state of altered sensorium, with decreased attention and concentration (inability to perform "serial 7's" or spell "WORLD" backwards); disorientation is present in the acute state, consistent with other delirium (or encephalopathy). For a patient who is not in delirium, impaired recall or orientation to date or location may occur. Knowledge of historical facts (eg, naming of presidents) is often impaired in persons with Korsakoff syndrome. A patient may cover up the memory deficit by confabulating information.

Suicidal or homicidal ideation is generally not associated with this disorder, although any person in the midst of delirium can become self-injurious or violent.

A global confusional state is the most common early manifestation and is characterized by apathy, inattentiveness, and indifference to surroundings. Spontaneous speech is minimal, and provoked speech indicates general disorientation with regard to time, place, and purpose. Prompt administration of thiamine often results in increased attentiveness and orientation.

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