title: Severe Infections are Common in Thiamine Deficiency and May be Related to Cognitive Outcomes: A Cohort Study of 68 Patients With Wernicke-Korsakoff Syndrome.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors: 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.
authors: Jan W
authors: JW
authors: Wijnia
authors: Lelie Care Group, Slingedael Korsakoff Center, Rotterdam, The Netherlands; Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
authors: Erik
authors: E
authors: Oudman
authors: Department of Neurology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors: Willem A
authors: WA
authors: van Gool
authors: Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC: University Medical Center, Rotterdam, The Netherlands.
authors: André I
authors: AI
authors: Wierdsma
authors: Lelie Care Group, Pniël Nursing Home, Rotterdam, The Netherlands.
authors: Esmay L
authors: EL
authors: Bresser
authors: Intensive Care Adults, Erasmus MC: University Medical Center, Rotterdam, The Netherlands.
authors: Jan
authors: J
authors: Bakker
authors: Delft University of Technology, Delft, The Netherlands; Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands.
authors: Albert
authors: A
authors: van de Wiel
authors: Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC: University Medical Center, Rotterdam, The Netherlands; Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
authors: Cornelis L
authors: CL
authors: Mulder
mesh_terms: D015415:Biomarkers / Q000097:blood; D003072:Cognition Disorders / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000150:complications*; D020915:Korsakoff Syndrome / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D013832:Thiamine Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D015415:Biomarkers
keywords: Wernicke-Korsakoff syndrome; critical illness.; executive function; infection; memory disorders; thiamine deficiency