Jan W Wijnia1, Erik Oudman2, Willem A van Gool3, André I Wierdsma4, Esmay L Bresser5, Jan Bakker6, Albert van de Wiel7, Cornelis L Mulder8. 1. Lelie Care Group, Slingedael Korsakoff Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus MC: University Medical Center, Rotterdam, The Netherlands. Electronic address: j.wijnia@leliezorggroep.nl. 2. Lelie Care Group, Slingedael Korsakoff Center, Rotterdam, The Netherlands; Helmholtz Institute, Utrecht University, Utrecht, The Netherlands. 3. Department of Neurology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC: University Medical Center, Rotterdam, The Netherlands. 5. Lelie Care Group, Pniël Nursing Home, Rotterdam, The Netherlands. 6. Intensive Care Adults, Erasmus MC: University Medical Center, Rotterdam, The Netherlands. 7. Delft University of Technology, Delft, The Netherlands; Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands. 8. Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC: University Medical Center, Rotterdam, The Netherlands; Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Wernicke encephalopathy can have different clinical outcomes. Although infections may precipitate the encephalopathy itself, it is unknown whether infections also modify the long-term outcome in patients developing Korsakoff syndrome. OBJECTIVE: To determine whether markers of infection, such as white blood cell (WBC) counts and absolute neutrophil counts in the Wernicke phase, are associated with cognitive outcomes in the end-stage Korsakoff syndrome. METHOD: Retrospective, descriptive study of patients admitted to Slingedael Korsakoff Center, Rotterdam, The Netherlands. Hospital discharge letters of patients with Wernicke encephalopathy were searched for relevant data on infections present upon hospital admission. Patients were selected for further analysis if data were available on WBC counts in the Wernicke phase and at least 1 of 6 predefined neuropsychological tests on follow-up. RESULTS: Infections were reported in 35 of 68 patients during the acute phase of Wernicke-Korsakoff syndrome-meningitis (1), pneumonia (14), urinary tract infections (9), acute abdominal infections (4), sepsis (5) empyema, (1) and infection "of unknown origin" (4). The neuropsychological test results showed significant lower scores on the Cambridge Cognitive Examination nonmemory section with increasing white blood cell counts (Spearman rank correlation, ρ = -0.34; 95% CI: -0.57 to -0.06; 44 patients) and on the "key search test" of the behavioral assessment of the dysexecutive syndrome with increasing absolute neutrophil counts (ρ= -0.85; 95% CI: -0.97 to -0.42; 9 patients). CONCLUSIONS: Infections may be the presenting manifestation of thiamine deficiency. Patients with Wernicke-Korsakoff syndrome who suffered from an infection during the acute phase are at risk of worse neuropsychological outcomes on follow-up.
BACKGROUND:Wernicke encephalopathy can have different clinical outcomes. Although infections may precipitate the encephalopathy itself, it is unknown whether infections also modify the long-term outcome in patients developing Korsakoff syndrome. OBJECTIVE: To determine whether markers of infection, such as white blood cell (WBC) counts and absolute neutrophil counts in the Wernicke phase, are associated with cognitive outcomes in the end-stage Korsakoff syndrome. METHOD: Retrospective, descriptive study of patients admitted to Slingedael Korsakoff Center, Rotterdam, The Netherlands. Hospital discharge letters of patients with Wernicke encephalopathy were searched for relevant data on infections present upon hospital admission. Patients were selected for further analysis if data were available on WBC counts in the Wernicke phase and at least 1 of 6 predefined neuropsychological tests on follow-up. RESULTS:Infections were reported in 35 of 68 patients during the acute phase of Wernicke-Korsakoff syndrome-meningitis (1), pneumonia (14), urinary tract infections (9), acute abdominal infections (4), sepsis (5) empyema, (1) and infection "of unknown origin" (4). The neuropsychological test results showed significant lower scores on the Cambridge Cognitive Examination nonmemory section with increasing white blood cell counts (Spearman rank correlation, ρ = -0.34; 95% CI: -0.57 to -0.06; 44 patients) and on the "key search test" of the behavioral assessment of the dysexecutive syndrome with increasing absolute neutrophil counts (ρ= -0.85; 95% CI: -0.97 to -0.42; 9 patients). CONCLUSIONS:Infections may be the presenting manifestation of thiaminedeficiency. Patients with Wernicke-Korsakoff syndrome who suffered from an infection during the acute phase are at risk of worse neuropsychological outcomes on follow-up.
Authors: Sharea Ijaz; Helen Thorley; Katie Porter; Clare Fleming; Tim Jones; Joanna Kesten; Loubaba Mamluk; Alison Richards; Elsa M R Marques; Jelena Savović Journal: Int J Equity Health Date: 2018-01-16