What happens in the brain
Thiamine is needed by brain cells to obtain energy from glucose. With its deficiency, the structures responsible for transferring information from short-term memory to long-term memory are primarily affected - the mammillary bodies, the thalamus and the pathways associated with them. Alcohol attacks this mechanism from several sides at once: it disrupts the absorption of thiamine in the intestines, its storage in the liver and its transformation into the active form. Additionally, a person with an addiction usually has a poor diet. As a result, the supply of vitamin, which lasts only a few weeks, is quickly depleted.
- Thiamine is needed for neuronal energy metabolism
- The mammillary bodies and thalamus are affected
- Alcohol interferes with the absorption and activation of the vitamin
- Thiamine stores last for weeks, not months.
- Damage with late treatment becomes irreversible
Symptoms
The key symptom is the inability to remember new things with relatively intact memory for old events. A person says hello several times in a row, forgets that he has already eaten, and does not remember the doctor’s visit. Time orientation is often lost: the wrong year, season, or age is given. The gaps are filled with confabulations - detailed stories about events that did not happen; This is not a lie, but an attempt by the brain to complete the picture. The mood is usually even or complacent, criticism of one’s condition is reduced, so relatives bring them for help.
- Inability to remember new events
- Repeating the same questions
- Confabulations - fictitious memories
- Disorientation in time
- Preserved speech and outwardly ordered behavior
- No criticism of memory impairments
Causes and risk factors
The main reason in our region is long-term alcohol abuse combined with malnutrition. However, thiamine deficiency is possible even without alcohol: with repeated vomiting, including severe toxicosis of pregnancy, after operations on the stomach and intestines, with prolonged fasting, dialysis, severe infections and cancer. A dangerous situation is the administration of glucose solutions to an exhausted person without thiamine: this sharply increases the need for the vitamin and can provoke acute encephalopathy.
- Chronic alcohol use
- Poor nutrition, fasting
- Repeated vomiting, severe toxicosis of pregnant women
- Stomach and intestinal surgeries
- Malabsorption, chronic diarrhea
- Oncological diseases and chemotherapy
Survey
The diagnosis is mainly clinical: the doctor evaluates memory with neuropsychological tests, checks orientation, coordination, and eye movements. MRI of the brain helps to see characteristic changes and rule out stroke, tumor and the consequences of injury. Blood tests show liver health, metabolism and associated deficiencies - it is important to check vitamin B12 and folic acid, as their deficiency gives a similar picture. If this syndrome is suspected, treatment with thiamine is started without waiting for research results.
- Neurological examination and memory tests
- MRI of the brain
- General and biochemical blood test
- Liver enzymes
- Vitamin B12 and folic acid
- Assess thyroid function if necessary
Treatment and care
Treatment begins in the hospital with the administration of thiamine in high doses, then proceeds to long-term use. The most important condition is complete abstinence from alcohol; Without it, any therapy is useless. At the same time, they restore nutrition, correct the deficiency of magnesium and other vitamins, and treat concomitant liver diseases. When the acute condition passes, cognitive rehabilitation is included: memory training, daily routine, notebooks, signatures on objects, reminders. Relatives are explained that reproaches and attempts to catch a person for inconsistencies are useless and only increase anxiety.
- Thiamine in high doses, then maintenance
- Complete cessation of alcohol and addiction treatment
- Good nutrition, correction of deficiencies
- Cognitive rehabilitation and memory training
- Organization of safe living, reminders and signatures
- Support and training for relatives