Pharmacological treatment of Korsakoff's psychosis:: A review of the literature and experience in two cases

Introduction. Korsakoff's psychosis (KP) is a relatively frequent pathological condition in our community that has been infradiagnosed. The most common cause is chronic alcohol consumption, although it can be brought about by other aetiologies accompanied by vitamin deficiencies. The lack of thiamine entails an alteration in the synthesis of neurotransmitters, which provides the neurochemical foundation for the specific cognitive impairment that defines the syndrome. Aims. To evaluate the application of pharmacological treatments, in accordance with the neurochemical disorders described in the literature, and report our experience in two cases treated with anticholinesterases. Case reports. 1) Female aged 47, with a history of addiction to alcohol. Following Wernicke's encephalopathy, which improved with parenteral thiamine, she presented a memory disorder compatible with KP. After two months 'treatment with donepezil, a cognitive improvement was observed in the neuropsychological tests. 2) Male aged 77, who presented KP a month after being diagnosed and treated for a postencephalitic vasculitis caused be varicella zoster virus. His cognitive and functional condition improved after 3 months' treatment with donepezil. Discussion and conclusions. There are not enough studies in the literature with representative samples that consider the effects of thiamine or of other forms of treatment on cognitive impairment in KP. Noradrenaline, serotonin, glutamate and acetylcholine have been proposed in the pathogeny of the syndrome. Based on experiences gained in cholinergic disorders, two cases responded to treatment with donepezil. Effective treatment must be based on a combination of aetiological and pharmacological treatment, and cognitive rehabilitation.