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Abstract
Objective To investigate cognitive and brain changes in patients with Korsakoff syndrome (KS) over months and up to 10 years after the diagnosis.
Methods Two groups of 8 patients with KS underwent neuropsychological, motor, and neuroimaging investigations, including structural MRI and 18F-fluorodeoxyglucose-PET. The KSC group, recruited at Caen University Hospital, was examined early after the KS diagnosis (KSC-T1) and 1 year later (KSC-T2). The KSR group, recruited at nursing home at Roubaix, was evaluated 10 years after the diagnosis. Longitudinal comparisons in KSC explored short-term changes, while cross-sectional comparisons between KSC-T1 and KSR informed about long-term changes.
Results No cognitive, motor, or brain deterioration occurred over time in patients with KS. There was no clear improvement either, with only modest recovery in the frontocerebellar circuit. Compared to the norms, KSC-T1 had severe episodic memory impairments, ataxia, and some executive dysfunctions. They also presented widespread atrophy and hypometabolism as well as cerebellar hypermetabolism compared to 44 healthy matched controls. Episodic memory remained significantly impaired in KSC-T2 and KSR. Contrary to KSC at T1 and T2, KSR had preserved inhibition abilities. Atrophy was similar but less extended in KSC-T2 and even more limited in KSR. At all times, the thalamus, hypothalamus, and fornix remained severely atrophied. Hypometabolism was still widespread in KSC-T2 and KSR, notably affecting the diencephalon. Cerebellar metabolism decreased over time and normalized in KSR, whereas motor dysfunction persisted.
Conclusion In KS, structural and metabolic alterations of the Papez circuit persisted over time, in accordance with the irreversible nature of amnesia. There was neither significant recovery as observed in patients with alcohol use disorder nor progressive decline as in neurodegenerative diseases.
Glossary
- AUD=
- alcohol use disorder;
- CVLT=
- California Verbal Learning Test;
- DSM-5=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- FCC=
- frontocerebellar circuit;
- FCSRT=
- Free and Cued Selective Reminding Test;
- FDG=
- 18F-fluorodeoxyglucose;
- FWE=
- family-wise error;
- HC=
- healthy controls;
- IMAP=
- Imagerie Multimodale de la Maladie d’Alzheimer à un stade Précoce;
- KS=
- Korsakoff syndrome;
- KSC=
- patients with KS recruited at Caen University Hospital;
- KSR=
- patients with KS recruited in a nursing home at Roubaix;
- MNI=
- Montreal Neurologic Institute;
- PC=
- Papez circuit
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received August 6, 2020.
- Accepted in final form January 13, 2021.
- © 2021 American Academy of Neurology
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