A 72-year-old woman with a longstanding history of alcohol use disorder is admitted to the geriatric behavioral unit. She has retrograde and anterograde amnesia, and she displays confabulation during her psychiatric evaluation. What diagnosis is most appropriate?

Choice A reason: Korsakoff’s syndrome is a chronic neuropsychiatric condition resulting from thiamine deficiency, most commonly associated with prolonged alcohol use. It is characterized by severe memory impairment, including both retrograde and anterograde amnesia, and confabulation—where the patient fills in memory gaps with fabricated stories. This clinical presentation matches the description provided. Choice B reason: Lewy body dementia involves fluctuating cognition, visual hallucinations, and parkinsonian features. It does not typically present with confabulation or the specific memory deficits seen in Korsakoff’s syndrome. Choice C reason: Delirium is an acute, fluctuating disturbance in attention and awareness, often reversible. It does not cause persistent amnesia or confabulation and is not consistent with the chronic nature of this patient’s symptoms. Choice D reason: Kuru is a rare prion disease historically found in Papua New Guinea, associated with cannibalistic rituals. It presents with tremors and neurodegeneration but is not relevant to this case and does not involve confabulation or alcohol-related pathology.