Figure 1.

Acetylcholine in Wernicke-Korsakoff syndrome. ^a Acetylcholine synthesis: Choline is acetylated to the neurotransmitter acetylcholine by choline acetyltransferase (CAT) and by use of acetyl-CoA. In the metabolism of glucose, the enzymatic step that is catalyzed by pyruvate dehydrogenase requires thiamine pyrophosphate, the active form of thiamine. Reduced activity of pyruvate dehydrogenase may result in deficiency of acetyl-CoA and reduced synthesis of acetylcholine [45]. ^b Wang and Hazell (2011) observed induction of microglia activity in their thiamine deficient rodent model [39]. ^c Based on an hypothesis of van Gool and colleagues (2011) microglia hyperactivity may lead to a delirium [16]. Delirium due to thiamine deficiency = Wernicke encephalopathy [15]. ^d For instance, alcohol withdrawal, brain injury, hepatic failure, renal failure, brain injury, infections, and electrolyte disorders. ^e Neurocognitive disorder due to thiamine deficiency = Korsakoff syndrome.