Executive dysfunction in Korsakoff's syndrome: Time to revise the DSM criteria for alcohol-induced persisting amnestic disorder?

Objective. This study examines the profile of executive dysfunction in Korsakoff's syndrome. There is accumulating evidence of executive deficits in Korsakoff patients that may greatly affect activities of daily living. However, the DSM-IV criteria for "alcohol-induced persisting amnestic disorder" do not take this into account. In addition, existing studies have failed to determine the type of executive deficits in this syndrome. Methods. Executive functioning was assessed in 20 Korsakoff patients using the Behavioural Assessment of the Dysexecutive Syndrome (BADS), an ecologically valid neuropsychological assessment battery consisting of various subtests that assess planning, organisation, inhibition, shifting, cognitive estimation and monitoring. Results. Sixteen patients (80%) had executive deficits, i.e. impairments on at least one BADS subtest compared to a normative control group. Overall, the profile is characterized by planning deficits on unstructured tasks. Conclusions. Next to amnesia, executive deficits are a prominent characteristic of cognitive impairment in Korsakoff patients. It is argued that the new DSM criteria should consider incorporating executive dysfunction as an important feature of alcohol-induced persistent cognitive disorder.