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Alcohol-Related Brain Damage Profile — MRCPsych Paper B MCQ

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HardSubstance MisuseAlcohol-Related Brain Damage ProfileMRCPsych Paper B

A 55-year-old man with a 25-year history of harmful alcohol use was treated eight months ago for confusion, ataxia and ophthalmoplegia. He has remained abstinent for six months, but repeatedly asks the same questions, confidently recounts recent events that did not occur, requires prompting for everyday tasks and has become socially tactless. Neuropsychological testing shows severely impaired acquisition of new episodic information, relatively preserved vocabulary and remote autobiographical knowledge, and poor set-shifting and response inhibition. MRI shows bilateral mammillary body atrophy and frontal volume loss, without strategic infarction or ventriculomegaly. Which cognitive profile best accounts for these findings?

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Correct answer: C — Disproportionate anterograde amnesia and confabulation with additional frontal dysexecutive features

The correct answer is C. Korsakoff syndrome produces disproportionate anterograde episodic-memory impairment, often with temporally graded retrograde loss and confabulation, reflecting damage within diencephalic memory circuits that include the mammillary bodies and thalamus. Executive dysfunction, apathy, disinhibition and poor social judgement can coexist because alcohol-related brain damage commonly also affects frontal systems. Alzheimer’s disease usually has a progressive course with broader episodic and later semantic deficits. Behavioural-variant frontotemporal dementia can cause early disinhibition and executive dysfunction, but early episodic memory is often relatively preserved and mammillary body injury is not characteristic. Vascular cognitive impairment requires a compatible vascular pattern, while normal-pressure hydrocephalus would suggest ventriculomegaly with gait and urinary symptoms.

Reference: Royal College of Psychiatrists. Alcohol and Brain Damage in Adults: With Reference to High-Risk Groups, College Report CR185, sections on alcoholic Korsakoff syndrome and diagnosis of ARBD, 2014. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr185.pdf?sfvrsn=66534d91_2