Wernicke-Korsakoff Syndrome: Signs, Effects, and Treatment

What Is Wernicke-Korsakoff Syndrome (“Wet Brain”)?

Wernicke-Korsakoff syndrome (WKS) is sometimes colloquially referred to as “wet brain.” This term, however, used to talk about WKS is stigmatizing and stems from the inaccurate belief that individuals willfully contracted WKS due to prolonged alcohol misuse. Using phrases like “wet brain” can create a negative bias, perpetuate the idea that addiction is a moral failing—and not a medical condition—and prevent individuals from seeking the help they need for WKS, which is a severe, life-threatening brain disorder that is actually comprised of two conditions.¹

The first part of WKS, Wernicke’s encephalopathy, is a severe and temporary condition characterized by confusion, loss of muscular coordination, and abnormal eye movements and vision changes.¹

The second aspect of WKS, Korsakoff’s psychosis, often follows or accompanies Wernicke’s encephalopathy. Korsakoff’s psychosis is a persistent, chronic condition that can cause significant impairment in learning and memory and interfere with a person’s ability to function normally.^2,3

The symptoms of WKS begin from a deficiency in thiamine that is typically associated with extended heavy alcohol use but may also be caused by malnutrition and other diseases.^2,3 Up to 80% of people with severe alcohol use disorder become thiamine deficient.²

Although it is estimated that only 1%-2% of the general population develop WKS, those who chronically misuse alcohol are at a higher risk with prevalence rates estimated around 12%-14%.¹

How is Alcohol Misuse Connected to Wernicke-Korsakoff Syndrome?

Thiamine (vitamin B1) is an essential nutrient utilized by all parts of the body which can only be obtained through diet.^2,3 Thiamine deficiency can cause damage to the brain, nerves, and heart.³

In the United States, alcohol misuse is the leading cause of thiamine deficiency, and consequently the development of WKS.³

Chronic alcohol misuse can lead to thiamine deficiency through poor nutrition and malabsorption.^1,4 For example, people who drink heavily often do not eat a balanced diet and do not take in sufficient levels of thiamine to meet their nutritional needs.³ Indeed, studies show that chronic drinkers consume lower levels of thiamine.³

For the body to absorb thiamine, it must pass through the gastrointestinal tract to be transported to the tissues of the body, and absorption is decreased in people who chronically misuse alcohol.³ Alcohol use can create inflammation in the digestive tract, which makes it far more difficult for the body to absorb thiamine.⁴ Heavy drinking can also make it difficult for the body to effectively process and utilize thiamine in the cells of the body.^3,4 Thiamine is essential for building enzymes that play important roles in processing and converting sugar into energy and creating chemical messengers in the brain and genetic material in the cells.^3,5

Who is at Risk for Developing Wernicke-Korsakoff Syndrome?

As previously mentioned, a thiamine deficiency is a common cause of Wernicke’s encephalopathy. This lack of vitamin B1 may result from chronic alcohol misuse, dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy.⁶

For individuals who repeatedly misuse alcohol or suffer from an alcohol use disorder, alcohol can impair the absorption of thiamine from the intestine, decrease the levels of stored thiamine in the liver, and other nutritional deficiencies.^3,7

Thiamine helps brain cells produce energy from sugar. When levels fall too low, brain cells can’t generate enough energy to function properly.⁸ 

Additionally, a thiamine deficiency impacts the cerebellum, mammillary bodies, thalamus, hypothalamus, and brainstem—areas of the brain responsible for balance, coordination, reflexes, cognition, memory, body temperature, appetite, emotions, blood pressure, and sleep.⁸

A thiamine deficiency from heavy alcohol consumption may contribute to the cognitive deficits associated with alcohol misuse, such as memory, attention, and problem solving impairments.³

Wernicke-Korsakoff Syndrome Symptoms

The typical symptoms of WKS can seem similar to those of intoxication. However, the symptoms of WKS persist in the absence of drinking.³ 

In addition to the long-term physical and mental deterioration, WKS can also lead to reduced consciousness, coma, or even death in some cases.^3,5,9

Wernicke’s Encephalopathy Symptoms

As mentioned, WKS is comprised of two characteristic parts. The first component of WKS is Wernicke’s encephalopathy (WE), which is a short-term neurological disorder.^3,5 The three hallmark signs of WE include mental confusion and apathy, loss of muscular coordination while standing or walking,  and eye movement dysfunction and vision disturbances.^2,3,5 The nerves that control the eyes may become paralyzed in people who suffer from WE, leading to involuntary eye movements, drooping eyelids, and difficulty tracking objects properly.^3,5 Coordination issues can cause people with WE to walk with a stagger, and in severe cases, to lose the ability to walk.^3,9

While there are three characteristics of WE, a person does not have to exhibit all three of these symptoms to have the disorder.^2,9 Studies have shown that many cases of WE were undiagnosed because all three symptom types weren’t exhibited, making holistic evaluation of a patient even more critical.³ WE is caused by thiamine deficiency^2,3 and is reversible, but treatment must be provided as quickly as possible to ensure  better treatment outcomes.⁹

Korsakoff Psychosis Symptoms

Around 80% to 90% of people who misuse alcohol and have WE go on to develop Korsakoff’s psychosis, a form of neuropsychiatric dementia.^3,9 Korsakoff’s psychosis is seen as a residual condition that results when WE isn’t treated quickly and effectively, resulting in a range of symptoms that can become detrimental to a person’s ability to function.⁴ This condition may also be referred to as “alcohol amnestic disorder” or “alcoholic dementia.”³

Symptoms of Korsakoff’s psychosis include amnesia, hallucinations, and changes in behavior.^3,4 Memory issues may involve difficulty remembering past information (retrograde amnesia) and trouble forming new memories (anterograde amnesia), which can lead to confabulation, the formation of stories to make up for gaps in one’s memory.^3,5,10

Severe memory loss and other damage associated with Korsakoff’s psychosis could become permanent.¹¹ People with this disorder may not even realize that they have any symptoms and may show certain behavioral changes, such as becoming apathetic, irritable, or displaying less emotion that normal.⁴

How is Wernicke-Korsakoff Syndrome Diagnosed?

Wernicke’s encephalopathy may be hard to diagnose since incoherence of thought and communication are also signs of alcohol intoxication and protracted withdrawal, which may mask the severity of acute Wernicke’s encephalopathy. So besides the above-mentioned symptoms, a diagnosis of WKS may be made after a clinical evaluation, patient history, and an MRI, which studies show works effectively to rule out the disorder.¹²

Is Wernicke-Korsakoff Syndrome Preventable?

Korsakoff psychosis, which typically emerges in the aftermath of Wernicke encephalopathy (though not always) is a life-threatening neuropsychiatric syndrome that is preventable. It requires prompt recognition and treatment of the thiamine deficiency.¹³

WKS is a potentially reversible condition.^1,4,9 The severity of a person’s symptoms, how early a person begins treatment, and the type of treatment that they receive can all have a significant impact on whether a case of WKS can be reversed or alleviated.¹

Some people may make a full recovery, although this is rare. Thiamine therapy offers varying levels of improvement in symptoms after 5-12 days.⁵

How is Wernicke-Korsakoff Syndrome Treated?

The primary way that physicians treat WKS is through potent thiamine supplementation. Abstinence from alcohol is also beneficial while receiving treatment for WKS.^3,4,5 Since WKS is caused by thiamine deficiency, high-dose thiamine supplementation proves to be one of the most effective treatments for the reversal or prevention of symptoms, especially in the early stages of WKS.^2,4,5,9

Thiamine may be taken as an oral supplement or as an intramuscular or intravenous injection to restore normal thiamine levels to the body and reduce symptoms.^4,9Additional vitamins or supplements can be provided as well, which can help the body to process thiamine and increase levels in the body.^5,9 Increased thiamine levels have been shown to reduce confusion, increase coordination, improve eye function, and reduce memory problems in patients with WKS.^3,5

Treatment for Alcohol Use Disorder and Alcohol Addiction

It is recommended that those with WKS abstain from alcohol, which may require treatment for an alcohol use disorder. This may slow the progression of their condition and improve chronic symptoms of WKS.¹¹ American Addiction Centers (AAC) offers a range of programs that treat alcohol addiction and help people get and stay sober across the United States. 

Our treatment programs provide comprehensive care starting with medical detox through treatment, with qualified staff available to assist you. AAC is so confident in their ability to help people stay sober that they offer a 90-day promise. If you relapse after having completed 90 days of consecutive treatment at an AAC facility, you can return for another 30 days of treatment at no additional cost.