title: Wernicke-Korsakoff syndrome not related to alcohol use: a systematic review.
abstract: OBJECTIVE
  Although Wernicke-Korsakoff syndrome (WKS) is a common condition, diagnosis remains difficult. WKS not associated with alcohol is rare and thought to present differently to alcohol-related WKS. We conducted a systematic review of WKS not related to alcohol to enhance understanding of WKS not related to alcohol and WKS in general.
  
  
  METHODS
  A systematic review was conducted of case reports, published in English, of Wernicke's encephalopathy and WKS in patients without a history of alcohol-use disorder. Main data sources: MEDLINE, Index Medicus. Eligible cases totaled 623. Publication dates ranged from 1867 to 2014. Comparisons of clinical presentation were made with published data on samples comprising, almost exclusively, alcohol-related WKS.
  
  
  RESULTS
  A wide array of illnesses precipitated WKS. When diagnosis of WKS was performed postmortem, non-alcohol-related cases presented a similar number of signs of the classic triad as alcohol-related cases (p=0.662, Cohen's w=0.12) but more signs when diagnosed antemortem (p<0.001, Cohen's w=0.46). The most common sign was altered mental state. Korsakoff syndrome or ongoing memory impairment was reported in 25% of non-alcohol-related WKS, although cognitive status was not explicitly reported in many cases. When duration of memory impairment was reported, 56% had clinically obvious memory impairment lasting beyond the period of acute presentation. Non-alcohol-related WKS was more often associated with female gender, younger age, shorter duration of precipitating illness and better survival rate compared to alcohol-related WKS.
  
  
  CONCLUSIONS
  Thiamine deficiency in the absence of an alcohol-use disorder can cause the full clinical spectrum of WKS, including chronic cognitive impairment and Korsakoff syndrome.
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Scalzo
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Bowden
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Ambrose
authors.affiliation: Addiction Services, The Melbourne Clinic, Richmond, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Whelan
authors.affiliation: Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000150:complications*; D005260:Female; D006801:Humans; D020915:Korsakoff Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors
keywords: ALCOHOL-RELATED PROBLEMS; CLINICAL NEUROLOGY; EVIDENCE-BASED NEUROLOGY; MEMORY; NEUROPSYCHIATRY