Living with Korsakov
This information concerning the specific behavioural characteristics of Korsakov patients is intended as guidance for those close to Korsakov patients. Where possible, guidelines are given for the best way to cope with the specific behaviour. Although all patients are different, and therefore no general rules can be given, Korsakov patients demonstrate a large number of similarities in their behaviour. Some of these are given in random order. It is possible however that care providers prefer a different approach to that given here. These care providers will always be willing to explain why they choose a particular treatment. In addition you can help the care providers with information concerning your family member.
The Korsakov syndrome is an affliction caused by excessive alcohol consumption. Through misuse of alcohol (often in combination with poor nutrition), certain parts of the brain are damaged, leading to loss of memory, judgment impairment and information retention problems. In these respects, the affliction seems similar to dementia. Unfortunately, brain cell damage is irreversible. This means that healing is not possible. The consequence of this can be that the patient is no longer able to lead an independent life. The seriousness of the affliction depends on the extent and/or quantity of alcohol consumption. In addition, some people are more susceptible than others to the results of alcohol misuse.
It is established that everyone who consumes too much alcohol over long periods can become a sufferer of the Korsakov syndrome. In the last few years there has been a disturbing increase in the number of relatively young persons suffering from the Korsakov syndrome.
The most readily apparent consequence of brain damage in Korsakov patients is loss of memory. The patient can no longer recall specifically recent events. Retention is better for things which were longer ago. The patient is aware of the loss of memory and tries to hide or compensate for the loss. The way in which this often happens will be explained in a later part of this brochure.
Healthy people can orient themselves in time, location and person.
Even without a clock or agenda, everyone has an idea about how late and which day of the week it is.
If the understanding of time is disturbed, the Korsakov patient does not know which day of the week it is, or what happened on a particular day. Sometimes the understanding of time is so disturbed that the patient no longer knows whether he is dressing or undressing. He then has no idea whether it is morning or evening. The result is that the patient feels unhappy.
People are able to recognise a location e.g. "I've been here before!"
People are able to recall others by recognition of name, face, voice etc. With Korsakov patients this orientation is disturbed.
The social life becomes disorganised because the patient has difficulty in making and keeping appointments. Especially when the patient is removed from the most familiar surroundings, he can only adapt to the new situation with great difficulty.
The people orientation (recognising people) usually remains intact the longest, but it can eventually become disturbed. The Korsakov patient profits most from orientation help. Pointing out mistakes almost never helps and only makes the patient more uncertain. Simple aids usually help the patient. For example, a diary to write down appointments in, or the use of photos to aid recognition of people. Another aid is a shopping list or a step by step guide for activities such as getting up, washing and dressing. It is necessary however to realise that these aids can only be employed after intensive training.
Korsakov patients often fabricate stories (confabulation). In this context, confabulation is filling memory gaps by fantasy stories or lies. This phenomenon occurs in almost everyone who suffers loss of memory. It is not possible to predict where memory gaps occur. This is often difficult to understand for those in contact with the patient. Unimportant details are remembered, important information seems to be forgotten. There is no point in telling the patient about the memory gaps. This even has the opposite effect in most cases. The patient feels caught out and reacts defensively. The usual result is conflict. But what can we do?
Try to complete the story with the correct information to guide the patient in the right direction.
Fear of failure
The memory loss faces the Korsakov patient with new problems each day. The patient can often not solve these problems himself. This causes fear of failure, fear of making mistakes.
Every day is full of uncertainties because the patient is no longer able to learn. Where is the exit? What time do we dine?
Where is the toilet? Who can I ask a question or who are all these people around me?
These are questions to which healthy people can find an answer, but for the Korsakov patient they recur each day because the answers are almost immediately forgotten. The patient often realises that he should know the answer, but finds it impossible to recall it. This frequently results in fear of failure. To prevent failure, the patient avoids new and unfamiliar situations as much as possible. For some patients this results in apathy (avoidance behaviour), whilst others become aggressive (fighting back); as such understandable reactions. They are ways of preventing or covering up continual failure. The Korsakov patient needs a fixed daily routine. If the patient can follow a fixed regime he feels safe. Fear of failure will occur less frequently. If there is no such fixed routine, then it should be established. Making such a fixed daily routine is very time consuming.
Loss of decorum
Many Korsakov patients suffer from loss of decorum. That means that they neglect themselves and show no interest in their personal appearance or hygiene. This is caused by the way in which they live, but also by brain damage. If there is a loss of decorum, outside help is always essential. Regular change of clothing, washing of clothing that has been worn and a daily shower or wash will always need the attention of helpers. As the patient can only occasionally be motivated, a more forceful approach may be required. The lack of interest in the personal hygiene also manifests itself in the care for personal belongings. A result is the frequent loss of personal items. Many Korsakov patients demonstrate this problem. There is no real solution. In many cases it will be necessary to take control of important matters on behalf of the patient. Many Korsakov patients collect and hide all sorts of items which they find. This leads to conflict and lack of understanding if it occurs during admittance to a hospital.
Almost all Korsakov patients will sooner or later be admitted to a care institute. Many are admitted initially to general- and psychiatric hospitals and others, in a latter phase, to psycho-geriatric homes. All of these institutions have one thing in common. The treatment is based on the provision of a fixed daily routine and structure.
There are other ways to assist the patient, for example use of name boards, information posters, route directions, photos of personnel and other inhabitants.
It will be apparent from the foregoing that the Korsakov patient cannot live without the help of others. The behaviour of the alcoholic/Korsakov patient is usually unbearable for his surroundings. On top of this, the patient as alcoholic has often lost credit with family and friends. Eventually they give up being with the patient. The drinking behaviour continues unless action is taken. The result is that the loss of brain function continues.
Family members are not usually able to persuade the patient to stop drinking. In addition, feelings of shame play a role with respect to the surroundings. The alcoholism of the patient will often have been concealed. Determined pressure will be needed to get the patient to stop drinking, and long term control will be necessary. The patient will start drinking again given the chance.
In other words: admittance for the Korsakov patient is unavoidable. Family members often feel guilty after admittance of the patient, because they are no longer able to care for the patient themselves, or because admittance to a hospital or care home seems like rejection of their own responsibility. Feelings of guilt because there were often pleasant times before the drinking started. Helpers are usually trained to deal with Korsakov patients and treat them accordingly. If the behaviour of the patient becomes too disturbed, the helpers can seek strength from each other. Family members usually have to cope on their own for 24 hours a day. Feelings of guilt over what went wrong or over the admittance itself will always remain in the background. Helpers know how life with a Korsakov patient is and will only show understanding. They can help the family to understand and accept the Korsakov syndrome and its consequences.
Your general practitioner is the first person with whom to discuss the problems. He is also familiar with the care providers. He can refer you for example to the Regional Mental Health Institute (RIAGG), Consultation Bureau for Alcohol and Drugs (CAD) or to social workers.
For more information refer to English language websites via http://www.google.co.uk/