A 38-year-old with chronic alcoholism develops short-term memory loss, invents stories, and seems confused and disoriented. The most likely diagnosis is:

A 38-year-old with chronic alcoholism develops short-term memory loss, invents stories, and seems confused and disoriented. The most likely diagnosis is:

• A. Korsakoff's syndrome
• B. Wernicke's encephalopathy
• C. Alzheimer's disease
• D. Huntington's disease

Answer: (A)

Korsakoff's syndrome is the pattern most suggested by this presentation. Chronic alcohol use leads to thiamine (vitamin B1) deficiency, which can damage memory systems. Korsakoff's is a persistent memory disorder characterized by severe problems with forming new memories (anterograde amnesia) and extensive memory gaps, often accompanied by confabulation—the patient invents stories to fill in missing memories. The confusion and disorientation accompany the memory deficits, and the history of long-term alcohol use fits. Wernicke's encephalopathy is the acute phase that can precede Korsakoff's, with a triad of confusion, eye movement problems, and ataxia, but the hallmark feature here is the chronic memory impairment with confabulation rather than the acute neurologic signs. Alzheimer's disease tends to show a broader, progressive cognitive decline and is less tied to heavy alcohol use in a younger individual. Huntington's disease would typically present with motor symptoms such as chorea and behavioral changes earlier on. Treatment focuses on thiamine replacement, nutrition, abstinence from alcohol, and cognitive rehabilitation as needed.

Korsakoff's syndrome is the pattern most suggested by this presentation. Chronic alcohol use leads to thiamine (vitamin B1) deficiency, which can damage memory systems. Korsakoff's is a persistent memory disorder characterized by severe problems with forming new memories (anterograde amnesia) and extensive memory gaps, often accompanied by confabulation—the patient invents stories to fill in missing memories. The confusion and disorientation accompany the memory deficits, and the history of long-term alcohol use fits.

Wernicke's encephalopathy is the acute phase that can precede Korsakoff's, with a triad of confusion, eye movement problems, and ataxia, but the hallmark feature here is the chronic memory impairment with confabulation rather than the acute neurologic signs. Alzheimer's disease tends to show a broader, progressive cognitive decline and is less tied to heavy alcohol use in a younger individual. Huntington's disease would typically present with motor symptoms such as chorea and behavioral changes earlier on.

Treatment focuses on thiamine replacement, nutrition, abstinence from alcohol, and cognitive rehabilitation as needed.