Introduction: Alcohol-induced persisting amnestic disorder (Korsakoff’s syndrome) is generally defined as an irreversible and important clinical condition. There is not enough information about its treatment. In this report, a case has been reported about effect of donepezil in Korsakoff syndrome is presented.
Case report: A 51-year-old male patient was admitted to psychiatry outpatient clinic of Necmettin Erbakan University Meram Medical Faculty with insomnia, disable to eat, a strange speech, forgetfulness, difficulty in recognize his relatives for a month. The patient had a history of alcohol use since nearly 30 years, separated from her wife six years ago. On his mental examination there was decreased self-care, corrupted orientation, impaired close memory, confabulation, retrograde and anterograde amnesia, labile affect, psychomotor restlessness, insufficient insight. Physical examination was normal. It was found, nystagmus, hypoesthesia on right lower extremity, ataxia in neurological examination. After examination and clinical interview, the patient was diagnosed Alcohol-induced persisting amnestic syndrome according to DSM-IV(Diagnostic and statically manual of mental disorders IV edition) diagnostic criteria. In magnetic resonance imaging, there was sulcus expansion and atrophy of the mammillary bodies. Serum level of GGT 103 U/L, total protein, 5 g/dl, albumin 2.6 g/dl, fT4 0.59 ng/dl, other biochemistrical and hematological values were normal. The point of the standardized mini-mental test (SMMT) was 18. Treatment of patient was started as thiamine 100 mg/day, quetiapine 100 mg/day and levotiron 50 mg/day. Because of no clinical improvement during first week, donepezil 5 mg/day treatment was started additionally. After 1 weeks donepezil dosage increased 10 mg/day. Minimal improvement in clinical status of the patient was observed within 3 weeks following donapezil initiation. Six weeks later, confabulation, disorientation and memory impairment showed moderate improvement and SMMT was 21. Total time of hospitilitation was 50 days. The patient was followed up 3 months after discharge. His relatives said that there is significant improvement in patient’s symptoms such as orientation, confabulation and memory, at that time, MMSE was 25. No side effects were observed during treatment of donepezil.
Discussion: In the literature, there are several cases and a small study about usage of donepezil in Korsakoff’ssyndrome. Although Şahin et al. Reported that donepezil does not seem to provide marked beneficial effect in patient with Korsakoff’s syndrome, their study had only 7 subjects and relatively short follow up period. Also, they are statically significant improvements some subtypes of neuropsychologic evaluations. On the other hand, there are several case reports in the literature and this reports emphasizes that donepezil usage is beneficial in Korsakoff’ssyndrome. Mayes et al. has suggested cholinergic involvement in Korsakoff’ssyndrome. More do