Describe the key features of Korsakoff syndrome and how it might appear in the mental status examination.

• A. Anterograde and retrograde amnesia with confabulation and severe short-term memory deficits; associated with chronic alcoholism and thiamine deficiency.
• B. Aphasia with preserved memory.
• C. Delirium with fluctuating attention.
• D. Progressive motor and language decline with preserved memory.

Answer: (C)

Korsakoff syndrome is a memory-dominant disorder caused by thiamine deficiency, usually from chronic alcohol use. The hallmark is severe impairment in forming and retrieving new memories (anterograde amnesia) and often some loss of older memories (retrograde amnesia), with persistent confabulations as the person fills memory gaps with plausible but false stories. In the mental status exam you’d typically see a patient unable to learn new information across repeated trials, poor recall for recent events, and intermittent confabulation to explain lapses. Attention and alertness are generally preserved, especially early on, which helps distinguish it from delirium. This pattern contrasts with descriptions of aphasia (language problems with relatively intact memory), degenerative conditions with progressive motor and language decline and preserved memory, or delirium (which features fluctuating attention and consciousness). Thus the memory impairment with confabulation in the context of thiamine deficiency best fits Korsakoff syndrome.