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When levels fall too low, brain cells cannot generate enough energy to function properly. As a result, Korsakoff syndrome may develop. Korsakoff syndrome is most commonly caused by alcohol misuse, but can also be associated with AIDS, chronic infections, poor nutrition and certain other conditions.
A person in a coma cannot make any decisions, whereas a person with a severe language problem may be able to make decisions but may be unable to communicate them. People with mild dementia may think clearly enough to understand discussions with their doctors and make some medical decisions.