Korsakoff Syndrome and Other Cognitive Problems Caused by Substance Use Disorders

1 Jun, 2022
korsakoff syndrome and other cognitive problems caused by substance use disorders

Korsakoff syndrome is a chronic neuropsychiatric syndrome caused by thiamine deficiency, also known as vitamin B1. Korsakoff syndrome is thought to be on the spectrum with Wernicke encephalopathy, another neurological disease induced by thiamine deficiency. These conditions are most often seen in people who chronically use alcohol, as substance use reduces vitamin B1. Therefore, regularly using substances can perpetuate symptoms of Korsakoff syndrome and Wernicke encephalopathy.

Korsakoff Syndrome vs. Wernicke Encephalopathy

Although Korsakoff syndrome and Wernicke encephalopathy both develop from thiamine deficiency, there are differences between the two conditions. Korsakoff syndrome is chronic and can be irreversible while Wernicke’s encephalopathy is acute and can be reversed. However, there is an overlap between the two illnesses, and the two conditions can occur simultaneously. When they occur together, it is referred to as Wernicke-Korsakoff syndrome.

Symptom Similarities

The symptoms of Wernicke-Korsakoff syndrome are:

  • Altered mental status (AMS): AMS can include disordered perceptions of sensory stimuli, confusion, disorientation, and emotional dysregulation.
  • Ataxia: Poor muscle control can cause clumsy voluntary movements and difficulty with balance and walking.
  • Oculomotor findings: For example, repetitive, rapid movement of the eyes and altered pupil reactivity.

Symptom Variances

Symptoms found in Korsakoff syndrome that are not found in Wernicke-Korsakoff syndrome include:

  • Anterograde amnesia: The inability to form new memories after the amnesia-causing event.
  • Retrograde amnesia: The inability to remember events that occurred before the amnesia-causing event. This usually affects more recent memories rather than older memories.
  • Executive difficulties: Some examples are problems with planning and organizing, starting and finishing tasks, and self-regulation.

Substance Use and Dementia

Dementia is a general term that describes a loss of cognitive functioning that specifically impairs an individual’s ability to think, remember, and make decisions. Dementia is a serious global concern. Since there is no cure, prevention efforts and risk reduction are of utmost importance.

It is a well-known fact that chronic substance use can lead to both short-term and long-term cognitive and mental changes in the brain. Specifically, there is evidence that long-term, chronic use of chemical substances may lead to cognitive impairment and dementia in later life.

Can Alcohol Consumption Increase Dementia Risk?

Alcohol is known to have long-lasting harmful effects on the brain and body. However, the severity of harmful effects, including the risk of developing dementia, is dependent on how frequently or intensely a person is consuming alcohol.

Mild or moderate drinking habits have been found to lack any obvious link to an increase in dementia risk. However, when it comes to high-level alcohol consumption, there is an undeniable link to an increase in dementia risk.

Can Methamphetamine Use Increase Dementia Risk?

Methamphetamines are neurotoxic. Methamphetamine use causes structural and functional changes in parts of the brain associated with memory. Specifically, they can cause cognitive impairment, neuropsychological issues, and tissue damage that mimic similar problems that result from Alzheimer’s Disease. These changes may explain why people who use methamphetamines tend to experience long-term cognitive issues. Although some of these changes are at least partially reversible, others seem to be more permanent.

Can Benzodiazepines and Opiates Increase Dementia Risk?

Although the chronic use of Benzodiazepines has been associated with an increased risk of cognitive impairment, information regarding the increased risk of dementia is inconclusive.

A study in 2016 showed that there was a slightly higher dementia risk among people in the study with the heaviest opioid use. However, the same result was also seen with heavier use of non-steroidal anti-inflammatory drugs (NSAIDS).

Anticholinergic Medications and Dementia Risk

Alcohol, benzodiazepines, and methamphetamine are not the only substances that are associated with an increased risk of dementia or cognitive impairment. Another class of prescription and over-the-counter (OTC) medications can lead to an increased risk of dementia. In the brain, acetylcholine is involved in learning and memory.  Anticholinergic medications block the action of acetylcholine. This group of medications can include:

  • Tricyclic antidepressants
  • Antihistamines
  • Decongestants
  • Antihypertensives
  • Medications for overactive bladder

Some antihistamines, tricyclic antidepressants, and medications for overactive bladder are the strongest anticholinergic medications. It is extremely important to take these medications exactly as prescribed. The risk for dementia increases with increased dose and duration of consumption so do not take OTC medications longer than recommended on the label.

When taking prescription anticholinergic medications, it is important to consult with the prescriber before stopping the medications. Any medications’ risks and benefits must be carefully weighed, and alternative medications and treatment options can be explored.

Even if a medication has weak anticholinergic effects, these effects can add up when multiple medications are taken at once. It can be helpful for patients to take an updated list of their medications to appointments with their doctor to avoid possible adverse side effects and decrease medication-related dementia risks. Pharmacists can also be an excellent resource for asking questions about medications, identifying possible risks, and understanding side effects including the risk of dementia and other cognitive impairment.

The brain is a complex organ that controls all other body functions. It is extremely important to take care of it and keep it healthy. Unfortunately, chronic substance use can damage the brain, and sometimes that damage can be permanent. Seeking treatment and beginning your journey in recovery as soon as possible can often help minimize the damage done to the brain. If you are ready to begin your recovery or have completed a detox or residential program and need continuing care, Sober Life can help. We offer a variety of flexible outpatient treatment options that allow you to stay engaged in your everyday life while getting treatment. Even if you cannot make it to our San Diego facility, we offer a virtual Intensive Outpatient Program (IOP) option. Call Sober Life at (619) 542-9542 to learn more about our flexible and accessible outpatient treatment programs.

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