This study is investigating on a specific patient (Mr C) who’s suffering from Korsakoff syndrome. In this report, the case study indicates mainly to memory deficiency. The sequence of events in this case study is used to show the possibilities of side effects of ‘chronic alcohol abuse’ which is also known as Korsakoff syndrome. The literature review introduces the medical model of Korsakoff syndrome that is presented with particular attention that has a link to anterograde and retrograde amnesia. A variety of memory tests were set for the patient in order to provide more reliable diagnosis. The results from different studies were compared to the normative brain and Korsakoff patients to see the similarity. Furthermore, after the results were undertaken the results shown a variety of scores which indicated that the patient needed further treatments. Lastly, suggestions for prevention and treatments damages that the patient may have will be presented.
Introduction
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Indicating to Mr C’s case study, the patient may have developed Korsakoff syndrome. Korsakoff syndrome is associated with ‘Diencephalic Amnesia’ which is seen as ‘neurological disease’. Patients that are experiencing this condition are highly related to ‘heavy alcohol’ consumptions over a very long period (Butterworth, 1989). Heavy alcohol is a public health problem with almost one in four people in the UK reporting having had this problem at some point in their lives (Kessler, 1994). This study is based on Korsakoff syndrome that’s caused by alcohol related issue which Mr C has clearly been taking nearly half of his life due to going downhill during some time (Appendix 1). This is the reason patients may lead to obtaining the syndrome.
This is based on biological evidence that heavy alcohol consumption may lead to ‘thiamine deficiency’ which affects the brain and the nervous systems. People who drink excessive amount of alcohol may damage important area part within the brain, resulting serve short term memory loss where the patient constantly asks the same questions and repeats the same stories (Sergei Korsakoff, 1879). Many heavy drinkers have poor dieting problems which their body doesn’t contain much vitamins, due to the fact that alcoholics spend time trying to replace high calories food with alcohol. This can cause a lot of complications in the patient’s body as the intestinal mucosa could be damaged by the alcohol which can lead to make it difficult for the liver to store vitamins. Alcohol plays a role that interferes with the change of thiamine into the active form of vitamin which is known as ‘thiamine pyrophosphate.’ Korsakoff syndrome inflames the stomach lining in your body that causes frequent vomiting, and make it harder for the body to absorb the main vitamins. Thiamine deficiency is a clear sign of the development of Korsakoff syndrome. (Moselhy, Georgiou, & Kahn, 2001).
However, due to the biological evidence there are many symptoms that may appear suddenly within few days. The patients that have normal IQs are alert and attentive, appear motivated, and generally lack other neurological signs of cerebral deficits such as abnormal EEGs. Most patients with Korsakoff syndrome have a deficit in visual-perception. Mr C has the same symptoms that occur in Wernicke-Korsakoff Syndrome (1881). Although Sergei Korsakoff (1879) didn’t take any notice to Wernicke’s work, he mentioned the existence of several of the same type of symptoms in his patients (Gudden, 1896). Wernicke suggested that mental confusion and eye movement disturbances were the primary symptoms and the first stage of Korsakoff Syndrome.
As there is a strong indication of Korsakoff syndrome, the patient’s behaviour and symptoms has a big impact in the patient’s lifestyle. Change in personality (become unconcerned, lacking of emotional reactions, talkative etc), confabulation (makeup information they can’t remember), loss of muscle co-ordination when the patients balance is weak, memory loss (unable to recall information), and difficulty in obtaining new information or learning new skills (amnesia). (Spear, 2002).
In addition, there are two types of well known form of amnesia (anterograde and retrograde) that play a role in Korsakoff syndrome which encounter ‘chronic alcohol’. Alcohol has shown various affective memory levels including semantic, prospective, explicit, episodic and implicit (Fama, 2006, d’Ydewalle & Van Damme, 2007). Problems with the patient’s short term memory are a strong sign of support to the patients having Korsakoff syndrome due to the characteristic of the syndrome being severe and having memory loss which is a type of amnesia. The episodic and semantic memory of a patient with Korsakoff syndrome is the most affected characteristic, episodic refers to events from the persons past (going back in time) and semantic memories deal with knowledge of facts, language and concepts.
In the terms of the retrograde memory, there are many tests that can measure the aspects of memory used by significant events which had happened during the past year of the patient’s life. Remote Memory Impairment calculates the patient’s past history; it’s a multiple choice questions test that’s applied. This test measures if the patient can remember the past events that have occurred in their life. The questions are given to recall there memory and testing there memory stage of their life for example about time and place of their birth, age, names of schools they attended, etc. (Cohen & Sqauire, 1981).
As for anterograde memory, is a different memory aspect to the retrograde test. There is a different Remote Memory Impairment test that would be given to patients which measures there memory on recalling famous faces and words. Patients will be assessed on; famous face recognition, identification and naming, and famous name recognition and identification. Overall the results will show an indication to a minimal outline of preserved remote memory with evidence of an association between remote memory performance and decision making functioning in the patient’s brain. (Albert, 1981).
Furthermore assessments can be also applied for the patients who are suffering from Korsakoff syndrome. Wechsler Adult Intelligence Scale (WAIS) can be applied which is quiet common, to assess the patient’s intelligence; it measures the verbal and nonverbal abilities of adults. The assessment has been revised over the recent years the person scoring it would look to see if there are any differences between the verbal and non verbal sections. If there is any big difference between the two sections will indicate to learning problem. (David Wechsler, 1955).
The aim of this study that is going to be carried out by several tests, the patient is experiencing through mental deficits from Korsakoff syndrome. A small amount of tests will be given to the patient to see if the symptoms displayed by the patient are the same as the symptoms of someone who is suffering from Korsakoff syndrome. Overall, if the patient is found with any complications regarding any condition, further action and preventions measures will be recommended to improve the patient’s lifestyle.
Method
Design- This experiment is a case study base (Appendix 1).
Participants-Mr C, as an only one patient that is being assessed in this study, the participant is one perceived to be suffering from Korsakoff syndrome, which displays many symptoms related to his case study (Appendix 1).
Materials- the tests that are going to be taking place are;
Remote memory assessments-
Famous faces test- have to indentify 150 photographs of famous people (anterograde amnesia)
Past event test- multiple choice test, 88 events questions (retrograde amnesia).
Weschler Adult intelligence scale (WAIS) – Working memory index; Arithmetic, Digit span and Letter-Number Sequencing.
California Verbal Learning (CVLT)
Wechsler Memory Scale (WMS)
The Mini-Mental State Examination (MMSE)- assessment of memory function, supplementary memory questions should be asked, e.g. about recent news, family or personal events.
Implementation- These tests are being used on the patient due to find out if the patient has any mental deficits issues and any complications he might have in his everyday life. Before taking the tests, the patient will be required to be sober from alcohol for a period of time, to ensure that there were no effects which might cause cognitive issues on the results. Results from all the tests as described in the material section are compared to similar case studies that have been diagnosed with Korsakoff syndrome as well as a healthy normative control group. It will be compared between both group controls to provide rationale of the patient’s conditions.
Results
Source (tests)
Normative
Korsakoff patient
Control
Indentify famous faces (anterograde amnesia)
41
15
38.1
88 multiple choice questions on past events (retrograde amnesia)
70
46
41.1
Working memory index (WAIS)
108
56.7
55
California Verbal Learning (CVLT)
13
2
12
Memory Scale (WMS)
32
12
26
The Mini-Mental State Examination (MMSE)
24
2.6
3.1
Findings; the patients with Korsakoff syndrome have diencephalic lesions indentified.
Remote memory assessment
Indentify famous faces (anterograde amnesia)- The famous faces identification assessment clearly shows the patients performance appeared to be weak which the patient scored 15, compared to the normative scoring 41. This may be due to primarily to loss of semantic knowledge regarding famous persons.
Multiple choice questions on past events (retrograde amnesia)- patient has shown similar remote memory impairment in Korsakoff syndrome might reflect to anterograde amnesia. Mr C may be going through nerve breakdown.
Working memory index (WAIS)
the results show the Korsakoff patient impairment within the episodic and working memory. the control and Korsakoff scoring has displayed similar scorings of episodic and working memory deficits. this shows similar patterns of brain damage compared to the normative score. the technique was overall was found not to be significant.
California Verbal Learning (CVLT)
the recalling tests showed the patients
Memory Scale (WMS)
the patient scoring was not significant which shows in the results of 12, the results shows the control scoring were higher than the patients score.
Mini mental state examination
The test that was undertaken by the patients was used to screen for cognitive impairment to help to screen for global confusion which Mr C has. the scores show he defiantly has memory disorder if you see the comparison to the normative scoring of 24 and the patients scoring shows 2.6 which is really low. it has shows that he failed the MMSE recall item. the results has clearly displayed impairments of episodic memory, recollection, contextual memory and retrieval.
Discussion
Based on the overall results, there is a strong indication that Mr C has Korsakoff syndrome. The patients test performances show that there are impairments in memory in Mr C compared to the normative results. The results showed a clear evidence for the typical mental deficits associated with Korsakoff syndrome. Furthermore, to help the patient to overcome the symptoms there should be a variety of techniques which could be used to try to reduce the symptoms that the patient is experiencing, which may be based on therapies which have shown positive beneficial to the condition.
To minimise the symptoms there are types of medical drugs that could be given to the patient in order to help them reduce the side effects of mental deficits that the patient may be going through due to Korsakoff syndrome. Due to Mr C vomiting he will need to take IV Thiamine drinking plenty water right away, even though the improvement is a slow process he will need to change his diet along with it. This is found to give improvements in the memory deficits that may have caused by the condition particularly if the patient who have memory deficits due to alcohol.
Likewise, if the patient wouldn’t like to take any medication they will have to change their diet. This might be the prevention that caused nerve damage to the patient which has stated above it’s due to ‘thiamine deficiency’. Healthy lifestyle includes drinking alcohol only within a safe recommendation amount (up to 3-4 units a day for men, and 2-3 units a day for women). Eating a balance will help the patient by eating, whole grain, vegetables and wheat which may lead to preventing further memory loss (Hillbom, 2006); it could improve memory, cognitive impairment and confusion in Korsakoff patients.
In addition, the most effective method of preventing Korsakoff syndrome is to avoid vitamin/thiamine B deficiency. In the western countries, the most common causes of mental deficits are due to extreme alcohol and weight disorders. Thus, requiring preventing this companies that sell alcoholic beverages to supplement them with B vitamin/thiamine would avoid many cases of Korsakoff.
In conclusion, the patient has shown to have Korsakoff syndrome which he had a sufficient amount of memory deficits within himself that show adequate evidence of Korsakoff syndrome. This report shows describes the most effective and practical way of controlling the condition at the present time and providing improvements to the patient’s lifestyle, it leads to variety of assessments. Further
Still, there are several criticism associated with memory assessments which have been used in this study, it may not be utterly reliable to diagnose the patient, therefore it may be wise to administer further testing on the patient throughout their life to make sure the he is accurately diagnosed of the conditions. It is very often falls to the psychiatrist to coordinate care for the patients, a psychiatrist is highly recommended for Mr C to follow-up, arrange placement, and assess further tests when necessary. GP will be there supporting the patients and families. Long-term outcomes have been studied previous patients are reported to have a normal life expectancy if they remain sober from alcohol (Leenane, 1986).
