Altered awareness in patients with Korsakoff syndrome living in long-term care facilities; a network analysis

Korsakoff syndrome (KS) is a neuropsychiatric disorder characterized by cognitive impairments such as episodic memory loss, executive dysfunctioning and confabulations. Problem behavior such as agitation, restlessness and apathy are also highly prevalent in patients with KS. The presence of cognitive impairments and problem behavior often constitute a reason for institutionalization in long-term care facilities (LTCF). Recently, it was demonstrated that altered awareness, an overestimation of one’s own capabilities, was also highly common in KS patients living in Dutch LTCFs (Gerridzen et al. 2019). We believe that altered awareness might be associated with problem behavior and reduced functioning and in turn poses challenges for good care provision.
Therefore, we assessed how altered awareness relates to cognitive, neuropsychiatric, social and physical functioning by applying a network analyses. We used an existing dataset from a retrospective, cross-sectional study of KS patients (N=210) living in Dutch nursing homes (Gerridzen et al. 2019).
Our results demonstrate that altered awareness was a central node in the network. Altered awareness was directly associated with impaired cognition and reduced social participation yet also with increased quality of life. Only apathy was directly related to altered awareness, the other neuropsychiatric symptoms were only indirectly related. Apathy was also a central node and higher apathy scores related directly to impaired cognition, reduced social participation and to more physical dependence.
This study sheds new light on the central role that altered awareness plays in the functioning and behavior of patients with KS living in LTCFs.