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Korsakoff Syndrome — MRCPsych Paper B MCQ

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ModerateSubstance MisuseKorsakoff SyndromeMRCPsych Paper B

A 48-year-old man with a 30-year history of alcohol dependence has remained abstinent for 8 weeks following medically supervised withdrawal. Throughout this period, he has been unable to retain new information, remains disorientated to the date, and fills gaps in his memory with accounts that he believes are true. He is alert and attentive, with no fluctuation in consciousness. Other cognitive abilities are relatively preserved, and examination shows no tremor, autonomic hyperactivity, ophthalmoplegia, nystagmus or gait ataxia. Which is the most likely diagnosis?

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Correct answer: C — Korsakoff syndrome

The correct answer is C, Korsakoff syndrome. The key pattern is a persistent and disproportionate impairment of new learning and episodic memory in an otherwise alert, attentive patient. Confabulation—unwittingly filling memory gaps with incorrect material—is supportive, although it is not essential or pathognomonic. Delirium tremens causes an acute, fluctuating disturbance of attention with autonomic overactivity, usually shortly after alcohol cessation. Wernicke encephalopathy is an acute thiamine-deficiency syndrome characterised by confusion, ocular abnormalities and ataxia, although the full triad is often absent. Alcohol-related dementia generally produces broader impairment across several cognitive domains rather than a predominantly amnestic syndrome. Hepatic encephalopathy typically causes altered attention or consciousness in the context of significant liver dysfunction.

Reference: National Clinical Guideline Centre. Alcohol-use disorders: diagnosis and management of physical complications, NICE CG100, section 2.7.1, 2010; updated 2017. https://www.nice.org.uk/guidance/cg100/evidence/full-guideline-pdf-134509213