I agree with Rensen et al. (Reference Rensen, Egger, Westhoff, Walvoort and Kessels2018) on that the introduction of errorless skill learning in long-term Korsakoff care can result in massive reductions of behavioral problems (i.e. aggression and apathy), increased quality of life, and increased autonomy. In response to their article, I would also advocate that the underlying mechanism of behavioral change in severely affected patients is also the result of seeing the patient as a cooperative individual able to make choices despite his or her severe cognitive disorders.
Korsakoff’s syndrome is a severe neuropsychiatric syndrome following vitamin B1 deficiency resulting from alcoholism (Arts et al., Reference Arts, Walvoort and Kessels2017). A large majority of patients with Korsakoff’s syndrome lack insight into their situation (Egger et al., Reference Egger, Wester, De Mey and Derksen2002), and are judge-ordered to stay in long-term care (Van den Hooff and Goossensen, Reference van den Hooff and Goossensen2015). Here, they report to not to feeling well at home (Oudman and Zwart, Reference Oudman and Zwart2012). As Van den Hooff and Goossensen (Reference van den Hooff and Goossensen2015) put forward in their qualitative study of Korsakoff’s syndrome patients in long-term care: “Respondents are imprisoned, although they are not classified as criminals. Their autonomy is affected, and they are seen as incompetent individuals. In some institutions, respondents have to wear digital bracelets giving signals when crossing certain lines on the nursing home grounds.” Essentially, patients report not being listened to, and the patient’s perspective is neglected by professionals in long-term care for Korsakoff’s syndrome patients (Van den Hooff and Goossensen, Reference van den Hooff and Goossensen2014).
One of the essential interventions used by Rensen et al. (Reference Rensen, Egger, Westhoff, Walvoort and Kessels2018) was to ask the patients what skill they wanted to learn, hereby giving full support to the goals and values of the Korsakoff’s syndrome patients themselves. The best results regarding learning, quality of life, and behavioral symptom reduction were seen in patients were the actual goals of the patient were accomplished. In coercive admissions of Korsakoff’s syndrome patients to (specialized) long-term care facilities, there is an urgent need to look at the patient’s perspective instead of merely focusing on the healthcare professional perspective.
Conflict of interest
None.
