Description, Causes and Risk Factors:
An alcohol amnestic syndrome characterized by confusion and severe impairment of memory, especially for recent events, for which the patient compensates by confabulation; typically encountered in chronic alcoholics; delirium tremens may precede the syndrome, and Wernicke syndrome often coexists; the precise pathogenesis is uncertain, but direct toxic effects of alcohol are probably less important than severe nutritional deficiencies often associated with chronic alcoholism.
Dysmnesic syndrome is a syndrome of impaired memory and other symptoms caused by chronic alcoholism. Dysmnesic syndrome is characterized by confusion, severely impaired memory of recent events (also known as anterograde amnesia), and an inability to learn new skills. It can also cause retrograde amnesia, which is a loss of memory for information from the past. A person with dysmnesic syndrome copes with gaps in memory by confabulating (unintentionally making up incorrect information). Before someone develops Dysmnesic syndrome, he/she may first experience delirium tremens, which is an acute (sudden) confusional state, often caused by severe alcohol withdrawal.
Dysmnesic syndrome is more likely due to severe nutritional deficiencies (particularly in B complex vitamins such as thiamine [B1] and B12) caused by excessive alcohol intake, than to the direct harmful effects of alcohol consumption. The problem is that some people who consume excessive amounts of alcohol replace important parts of their diets with the alcohol, preventing them form getting the proper amounts of vitamins and minerals.
Dysmnesic syndrome often coexists with Wernicke's syndrome. In Wernicke's syndrome, there is a deficiency in the vitamin, thiamine, due to poor nutrition. The thiamine deficiency in Wernicke's syndrome leads to brain damage. Specifically, the brain becomes inflamed, bleeds, and deteriorates over time. It is known that the nutritional deficiencies in Korsakoff's syndrome cause degeneration of the thalamus, which is an area of the brain that sends out messages regarding sensation.
There are six major symptoms of dysmnesic syndrome:
Apathy - the patients lose interest in things quickly and generally appear indifferent to change.
Retrograde amnesia, severe memory loss.
Confabulation, that is, invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts.
Meager content in conversation.
Lack of insight.
Dysmnesic syndrome cannot be diagnosed until the person has abstained from alcohol for at least four-to-five weeks, to enable the acute symptoms of alcohol withdrawal to subside.
Psychological tests of the person's memory and other abilities will then be carried out to see whether they may have Dysmnesic syndrome or some other condition. They will also be observed to see whether their condition progresses without alcohol. If their condition does not change, they may be diagnosed with a form of dementia, such as Alzheimer's disease. It is possible to have both dysmnesic syndrome and a dementia.
Tests may include:
U&Es (to exclude hypernatremia, hypercalcaemia, and uraemia).
Liver function tests.
Blood arterial gases (to rule out hypercarbia and hypoxia).
Serum thiamine levels (Vitamin B1) levels may be low.
Pyruvate is elevated.
Red cell transketolase activity is decreased in thiamine deficiency, but not usually necessary to diagnose the condition.
Lumbar puncture may be needed to exclude nonfocal CNS infections.
FBC, particularly looking at the MCV.
Imaging: CT head scan may be useful in the acute phase, but is likely to be less sensitive than MRI.Diffusion-weighted imaging (an enhanced view based on local water diffusion properties) can improve MRI sensitivity.
Once the syndrome is diagnosed, hospital admission is required to control symptoms. Thiamine replacement may improve symptoms of confusion, difficulties with vision and eye movement, and lack of coordination. It doesn't generally improve loss of memory and intellect.
Further treatment aims to control symptoms and prevent the disorder progressing. An important part of this is total abstinence from alcohol and eating a healthy diet.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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