{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:57:21Z","timestamp":1789685841378,"version":"4.0.1"},"reference-count":49,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2013,6,21]],"date-time":"2013-06-21T00:00:00Z","timestamp":1371772800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>ernicke's encephalopathy (<jats:styled-content style=\"fixed-case\">WE<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>orsakoff's syndrome are considered to be different stages of the same disorder due to thiamine deficiency, which is called <jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>ernicke\u2212<jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>orsakoff syndrome (<jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>). The earliest biochemical change is the decrease of \u03b1\u2010ketoglutarate\u2010dehydrogenase activity in astrocytes. According to autopsy\u2010based series, mental status changes are present in 82% of <jats:styled-content style=\"fixed-case\">WE<\/jats:styled-content> cases. The objective of the present review is to identify possible underlying mechanisms relating the occurrence of delirium to <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Studies involving delirium in <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>, however, are rare. Therefore, first, a search was done for candidate biomarkers of delirium irrespective of the clinical setting. Secondly, the results were focused on identification of these biomarkers in reports on <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In various settings, 10 biochemical and\/or genetic biomarkers showed strong associations with the occurrence of delirium. For <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content> three of these candidate biomarkers were identified, namely brain tissue cell counts of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>68 positive cells as a marker of microglial activation, high cerebrospinal fluid lactate levels, and <jats:styled-content style=\"fixed-case\">MHPG<\/jats:styled-content>, a metabolite of norepinephrine. Based on current literature, markers of microglial activation may present an interesting patho\u2010etiological relationship between thiamine deficiency and delirium in <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content> cases, changes in astroglia and microglial proliferation were reported. The possible loss\u2010of\u2010function mechanisms following thiamine deficiency in <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content> are proposed to come from microglial activation, resulting in a delirium in the initial phase of <jats:styled-content style=\"fixed-case\">WKS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12217","type":"journal-article","created":{"date-parts":[[2013,6,21]],"date-time":"2013-06-21T16:20:50Z","timestamp":1371831650000},"page":"1531-1538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Biomarkers of delirium as a clue to diagnosis and pathogenesis of <scp>W<\/scp>ernicke\u2212<scp>K<\/scp>orsakoff syndrome"],"prefix":"10.1111","volume":"20","author":[{"given":"J. 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