Diagnosis
The greatest importance in the diagnosis of Korsakov’s syndrome is attached to the clinical picture of the disease. Thus, an experienced physician can suspect the presence of Korsakov’s syndrome after a detailed medical history, guided by the typical memory disorder. This is particularly likely to occur if the patient or relatives report excessive alcohol consumption.
However, a past stroke or trauma can also be groundbreaking evidence. In addition to the clinical interview, patients suspected of having this disease always undergo an imaging procedure such as MRI or CT to detect the underlying damage to the brain substance at the expected location. In addition, laboratory tests, such as vitamin determination, as well as an EEG and an examination of the cerebrospinal fluid (liquor puncture) are performed.
The latter examination is mainly used to distinguish it from other memory disorders, such as Alzheimer’s disease. Since the clinical presentation of patients with Korsakow syndrome is significantly characterized by a severe memory disorder, several different tests are used to identify possible functional limitations of memory. These tests are usually specific to certain functional areas of our memory.
For example, the tests must be able to differentiate between long-term and short-term memory and whether the memory disorder merely interferes with the storage of new content or also makes past memory content no longer retrievable. The various tests are combined in so-called test batteries. The best-known representative of these test groups is the minimal-minimum test, which is very often used in cases of suspected dementia or anamnestic syndromes.
- The short-term memory is tested, for example, by simply memorizing words. For example, at the beginning of a conversation, affected persons are given three terms which they have to repeat after 15 minutes. Patients with a Korsakow syndrome would be clearly conspicuous in this test and would probably invent three terms of their own.
The MMST was developed to provide a simple screening procedure for the assessment of cognitive deficits in everyday clinical practice.
Since its introduction in 1975, the MMST has proven to be a very reliable test procedure. It is the most widely used diagnostic tool in the diagnosis of Alzheimer’s disease and dementia. The MMST is ideally suited for measuring the severity of the disease and for monitoring the progress of existing therapies.
Cognitive deficits are assessed over a large area using a 30-point system and the following skills are examined: orientation, memory, concentration and arithmetic, speech, understanding hearing and following instructions, and tracing. Procedure of MMST The Mini Mental Status Test takes about 15 minutes and should be administered by a medical assistant or specialist. The subject is first asked about his or her temporal orientation.
The date and day of the week, as well as the year, month, day and season should be stated. If it appears that the respondent is time oriented and knows the correct date directly, a more precise questioning can be omitted. The respondent receives one point for each individual fact.
The examination of the spatial orientation is similar. Here, reference is made to the current localization of the respondent by asking him/her about the country and state, the city, the institution and the floor on which he/she is located. Afterwards the respondent is given three simple words (e.g. car, flower, candle).
He should repeat these directly and keep them in his short-term memory for a moment. A simple arithmetical exercise follows, in which the respondent is to subtract 7 from 100. From the result 7 must be subtracted again and so on.
The calculation is evaluated until 65. If the respondent does not give the correct result, this is given to him/her so that he/she can continue with the task. If the respondent is not able to complete the calculation successfully, the word “radio” can alternatively be spelled backwards.
In both cases the concentration of the test person is checked. After The Intermediate Task, the memory test is completed. For this purpose, the respondent is asked to repeat the words he has just memorized (e.g. car, flower, candle).
For each term that is remembered, the test person receives one point. Subsequently, the linguistic skills are tested by naming a wristwatch and a pencil, and by repeating any sentence. Some oral instructions follow, which are formulated by the tester.
For example, the patient should take a sheet of paper in his hand and fold it up. UnderstandingIn the MRI of patients with Korsakov’s syndrome, damage to the brain substance in certain areas can usually be detected. In addition to abnormalities in the front part of the brain, degenerations in the so-called limbic system can often be detected.
The term limbic system describes a network of different structures of our brain, whose functions lie primarily in the generation and control of emotions and certain memory functions. This system includes the so-called mammary bodies. These show significant degeneration in almost all Korsakow patients, which may explain the severe memory disorders in these patients. If the development of the disease is due to less frequent causes, such as a stroke or trauma, these can also be depicted in the MRI. You can find detailed information on the topic of “MRI” at MRI of the brain