Korsakoff Syndrome beyond amnesia: A neuropsychiatric hypothesis of affective and autobiographical disintegration

Abstract

Objective: to propose a neuropsychiatric hypothesis in which Korsakoff syndrome is not restricted to an amnestic disorder but involves a disruption of the integration of present experience, affective valuation, and autobiographical narrative. Methodology: a narrative and integrative review was conducted, combining classical European psychiatric descriptions with recent neurobiological evidence on thiamine deficiency, Wernicke encephalopathy, the Papez circuit, confabulation, and autobiographical memory. Results: the synthesis suggests that diencephalic–limbic lesions may impair the assignment of emotional relevance to new experiences, hindering their incorporation into personal history and favoring confabulatory reconstructions based on older autobiographical models. On this basis, a three-level clinical gradation—mild, moderate, and severe—is proposed, together with the heuristic concept of a “hedonistic autonomous” state, which should be regarded as a hypothesis rather than an established diagnosis. Conclusion: Korsakoff syndrome may be understood as a disorder of experience integration, with implications for early psychiatric recognition and the preservation of occupational and social roles. The proposed framework is conceptual and requires prospective, neuropsychological, and neuroanatomical validation.