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Korsakoff's syndrome (KS) is a neuropsychiatric disorder, caused by vitamin B1 insufficiency. KS is characterized by severe declarative amnesia. Often, also executive disorders are present. Emotion recognition and theory of mind are gold-standard measures of social cognition. Moral decision making is often assessed by means of moral dilemmas. Surprisingly social cognition and moral decision making has received hardly any attention in research on KS, although the severity of behavioural problems in KS suggest possible problems in both domains. The aim of this study was therefore to broadly assess social cognition and moral decision-making capacities in patients with KS.
Participants and Methods:
20 KS patients and 20 age-, education-, and gender-matched healthy controls were assessed on standardized tests for social cognition, namely the mini-Social Cognition and Emotional Assessment battery (mini-SEA), and a specialized version of the Sally-Anne Test. Moral decision making was assessed by means of the Moral Behaviour Inventory (MBI) for everyday moral dilemmas, and ten cartoons of abstract moral dilemmas. For moral decision making, “yes” and “no” responses were scored, together with a scoring for moral reasoning according to the Kohlberg stages of moral maturity.
Results:
KS patients have large impairments in both cognitive and affective aspects of social cognition. Their ability to recognize emotions, take the perspective of others, and understand socially awkward situations is vastly compromised. While KS patients were able to replicate the Sally Anne storyline, their task performance was on chance level. Regarding moral decision making, there was a tendency to more frequently carry out the moral dilemma. Moral maturity, as indexed by means of their reasoning behind the decision was of a lower level. Of interest, moral immaturity could find its origin already before the onset of the KS diagnosis, as suggested by elevated premorbid levels of delinquent behavior.
Conclusions:
Both social cognition and moral decision making are compromised in KS patients. Specifically social cognitive disorders are the direct result of KS, and are likely to strongly relate to social and neuropsychiatric issues in KS. Moral decision making was more likely to be already of a lower level of maturity, based on a strong relationship between premorbid delinquency and moral immaturity in KS patients. This study highlights the importance to properly index social cognition in neuropsychological assessments for individuals with a possible KS diagnosis
Korsakoff’s syndrome (KS) is a neuropsychiatric disorder, caused by malnutrition. Central to KS are severe amnesia and executive dysfunctions. KS patients often fail to remember future intentions (prospective memory),and rely heavily on external support by caregivers. Recently, specialized smartwatches have been developed to support prospective memory verbally and by displaying pictures of future events. We investigated the benefit of a smartwatch and smartphone compared to no aid in supporting time accuracy and the ability to carry out future intentions in one case study. In three subsequent case studies, we investigated the possible benefits of a smartwatch aid for prospective memory (PM) compared to verbal in-person reminders.
Participants and Methods:
In the first case study, one high-functioning KS patient with a WAIS IQ of 127 points, performed a total of 36 novel prospective memory tasks in three conditions (smartwatch, smartphone and no-aid).
In the second case series, three KS patients with average IQ performed 30 everyday PM tasks in two conditions (smartwatch, in-person).
Two dependent variables were indexed in both studies: PM time accuracy (in minutes), this was calculated as minutes difference from the assigned time, and precision of the PM task (correct or incorrect).
Results:
In the first study, time accuracy was improved with a smartwatch compared to a smartphone and no-aid condition. Furthermore, the smartwatch and smartphone conditions were more effective than no aid in assisting memory for task content. In the second study, both the smartwatch and in-person instructions were equally effective in supporting prospective memory tasks.
Conclusions:
Since prospective memory is compromised in KS, patients require assistance throughout the day in performing everyday and non-everyday tasks. The results of our case studies suggest that a smartwatch that gives specific verbal and visual reminders can be particularly helpful in supporting prospective memory for KS patients. Giving in-person instructions was equally effective as the use of this smartwatch, highlighting the possibility to support KS patients with less intensive everyday coaching. Together, these results are promising in applying smartwatches clinically to support prospective memory.
People with Korsakoff syndrome (KS) experience severe neuropsychological and neuropsychiatric complications following vitamin B1 deficiency predominantly due to alcoholism. KS often presents itself with neuropsychological symptoms such as problems in episodic memory, executive functioning, and social cognition. Common neuropsychiatric symptoms in KS are disorders of affect, confabulations, anosognosia, and apathy. Apathy can be defined by a pathological lack of goal-directed behaviors, goal-directed cognitions, and goal-directed emotions. Patients with KS have an increased risk of cerebrovascular comorbidity. Cerebrovascular accidents are known to increase the risk for developing apathy. Apathy in KS patients can negatively influence the ability to live an autonomous life, often making 24-hour care a necessity. Limited research on apathy in KS patients has been published to this day. Our aim was to assess apathy in Korsakoff patients with and without neurovascular comorbidity.
Participants and Methods:
General apathy and related subconstructs, such as judgment and decision-making skills, emotional blunting, and the intentions to perform pleasurable activities, were studied in fifteen KS patients, fifteen KS patients with additional cerebrovascular comorbidity, and fifteen healthy controls. The first responsible caregiver of each patient filled in the Apathy Evaluation Scale and Scale for Emotional Blunting. An examiner administered the interview-based Judgement scale of the Neuropsychology Assessment Battery with the KS patients and each KS patient filled in the self-report section of the Pleasurable Activities List. Both KS patient groups receive 24-hour care in a specialized facility for Korsakoff Syndrome.
Results:
Our study found higher levels of general apathy in both KS patient groups, when rated by their caregiver compared to healthy controls. No difference was found between the KS patient groups and the healthy control group on the self-reported section of the Pleasurable Activities List, which might suggest the presence of intrinsic motivation in KS patients. However, a discrepancy was found between the self-reported activity levels and proxy reported levels of apathy. KS patients with cerebrovascular comorbidity showed increased levels of emotional blunting compared to KS patients without cerebrovascular comorbidity and healthy controls. Decreased judgment and decision-making skills were found in both patient groups compared to healthy controls, with no difference found between KS patients with cerebrovascular comorbidity and KS patients without.
Conclusions:
Our findings suggest that people with Korsakoff syndrome experience more general apathy compared to healthy controls. Both patient groups showed decreased judgement and decision-making skills and increased emotional blunting. Intrinsic motivation was found to be intact in KS patients. Experiencing cerebrovascular comorbidity in KS carries a risk for developing emotional blunting. Our findings show that apathy greatly affects people with KS. Future scientific research is warranted to further benefit the care for this complex patient population.
Eye movement desensitization and reprocessing (EMDR) is an established treatment for post-traumatic stress disorders (PTSD). Some patients diagnosed with amyotrophic lateral sclerosis (ALS) experience PTSD following choking or suffocation in the course of progressive loss of the ability to breathe. Although a loss of breathing functions in ALS is relatively common, there are currently no studies available on treatment for the fear of choking following advanced ALS.
Methods
In this case study, we describe the positive effects of EMDR, an evidence-based form of trauma therapy, in a 48-year-old female, suffering from advanced ALS. As the consequence of ALS, she was not able to speak or breath independently, but could communicate through a speech-generating device. She experienced panic attacks, flashbacks, nightmares, and severe anxiety after her tracheostomy jammed, and she almost suffocated.
Results
Mediative treatment was started by instructing the care staff to respond neutrally with step-by-step instructions following tracheostomy jam, resulting in significantly less panic attacks and flashbacks. EMDR was initiated two weeks later, and resulted in full remittance of the trauma symptomatology.
Significance of the results
The present case study suggests that symptoms of PTSD, namely the strong fear of suffocation, can be successfully treated by means of mediative behavioral therapy combined with EMDR.
Acquired brain injury (ABI) is accompanied by impairments in social, emotional, cognitive and behavioural skills and highly prevalent in the population. Social and emotional skills are crucial for moral cognition, but the extent to which moral cognition contributes to social competence deficits in people with ABI is largely unclear.
Method:
To provide more insight on this topic, we conducted a scoping review according to the PRISMA guidelines. After screening 1269 articles that we obtained via PubMed and Scopus, we found 27 articles on moral cognition in ABI.
Results:
We encountered four important topics across these studies which include traumatic brain injury (TBI) versus non-TBI, the influence of the different approaches used to measure moral cognition in ABI, the role of age of onset and the role of location of the injury. Overall, evidence suggests that the earlier the brain damage occurred, the more this leads to impairments in moral cognitive functioning. The location of the injury furthermore seems to differentially affect the way impairments are manifested. Finally, we found that the use of different measurement approaches can heavily influence the interpretation of the impairment.
Conclusion:
We conclude that impairments in moral cognition in people with ABI are derived from a complex interplay between the age of onset, the location and the approach used to index moral cognition.
Korsakoff’s syndrome (KS) is a chronic neuropsychiatric disorder characterised by severe anterograde amnesia and executive deficits. Theory of Mind (ToM) is the capacity to represent others’ mental states such as their knowledge, thoughts, feelings, beliefs, and intentions in order to explain and predict their behaviour. Surprisingly this topic has received hardly any attention in research on KS, although the severity of behavioural problems in KS suggest possible ToM difficulties. The aim of the present study was therefore to assess whether cognitive and affective ToM are impaired in patients with KS.
Methods
We examined 21 KS patients and 21 age- and gender-matched healthy controls on three standardised tests that assess cognitive and affective ToM, including the subtests of the mini-Social Cognition and Emotional Assessment battery and a specialised version of the Sally–Anne Test.
Results
KS patients showed largely impaired cognitive and affective ToM compared to healthy controls, as reflected in large effect sizes on both cognitive and affective ToM tests. Executive deficits explained problems in emotion recognition, but not other ToM aspects.
Conclusion
KS patients have large impairments in both cognitive and affective aspects of social cognition. Their ability to recognise emotions, take the perspective of others, and understand socially awkward situations is vastly compromised. The impairments in ToM functioning are to a large degree functionally discrepant from executive disorders that are commonly present in KS. This study therefore highlights the importance to properly index ToM functioning in neuropsychological assessments for individuals with a possible KS diagnosis.
Korsakoff's syndrome (KS) is a neuropsychiatric disorder characterized by severe amnesia. Quality of life (QoL) is becoming an increasingly used outcome measure in clinical practice but little is known about QoL in KS and how it may change over time. The purpose of this study was therefore to assess the QoL in patients with KS at baseline and with a 20-month follow-up.
Methods:
The current study is a longitudinal study on the QoL in patients with KS living in two long-term care facilities for KS patients in the Netherlands. QoL was scored with the proxy-based QUALIDEM scale with a 20-month follow-up.
Results:
Of the 72 KS patients included at baseline, 57 KS patients had a follow-up QoL score (79.2%). On the subscales “Feeling at home,” “Positive affect,” and “Care relationship” of the QUALIDEM, there was a better QoL in the follow-up, although effects were relatively small. Other subscales indicated a stable QoL over time. There were inter-relations between changes in subscales.
Conclusions:
The main finding of this study is that patients with KS on average do show a relatively stable moderate to good QoL despite the severity of the syndrome. On specific subscales, there is a small increase in QoL over time. Results do suggest that prolonged stay in a long-term care facility for KS patients does have a neutral to a positive effect on QoL in KS.
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