Thiamin treatment and working memory function of alcohol-dependent people:Preliminary findings

Background: Wernicke-Korsakoff syndrome (WKS) is most often seen in people who are alcohol dependent. Treatment with thiamin may rapidly resolve acute symptoms. However, much evidence suggests that identification of WKS on cl inical examination is relatively insensitive when compared with diagnosis a t postmortem. No study has investigated the therapeutic effect of thiamin i n a sample of alcohol-dependent people without the clinical triad of acute WKS. Methods: We conducted a randomized, double-blind, multidose study of thiami n treatment in 107 subjects who were detoxifying from alcohol. Five groups of subjects were assessed with the Mini-Mental State Examination and were e xamined for the presence of neurological signs. Subjects were given differe nt doses of intramuscular thiamin for two consecutive days. The posttreatme nt performance of these groups then was examined on a test of working memor y derived from comparative neuropsychology, namely, the delayed alternation task. This test has been established as sensitive to the neuropathology of WKS. Results: Pretreatment measures of mental status and neurological signs were equivalent across groups. Groups were equated with respect to the backgrou nd variables of age, education, typical daily alcohol consumption, and year s of drinking. On the posttreatment measure, a superior performance was fou nd in the group that received the highest dose of thiamin, compared with th e other four treatment groups. Conclusions: A therapeutic relationship between dose and working memory per formance was indicated. These results have important implications for the m anagement and prevention of WKS, but further investigations are needed to s ubstantiate the nature of the therapeutic relationship.