Alzheimer's Disease

Question 0

Brain growth spurt

Answer 0

Due to increase in…

1. Neuron size
2. Myelination
3. # of glial cells
4. Elaboration of dendritic processes

Question 1

Mitosis after pre-natal life

Answer 1

Occurs only in olfactory, dentate gyrus, and prefrontal cortex neurons

Question 2

Common causes of death in Alzheimer’s

Answer 2

Infection, aspiration pneumonia, cerebral hemorrhage

Question 3

Areas of neuron loss in Alzheimer’s

Answer 3

Limbic Strucutres:
1. Neo-cortex- association and higher-order areas

2. Hippocampus- memory
3. Amygdala

Reticular Structures:
4. Nucleus basalis of Meynert

5. Nucleus locus coeruleus- decreased O2 and glucose retrieved from blood; loss of REM
6. Raphe nuclei- unregulated mood

Question 4

Nissl bodies

Answer 4

Stains RER and RNA; chromatolysis causes decreased staining in Alzheimer’s

Question 5

NFT

Answer 5

Neurofibrillary Tangles

Insoluble tau proteins that build up in neurons of Alzheimer’s pts

*Tau normally stabilizes microtubules

Question 6

Senile plaques

Answer 6

Contain an:
Amyloid core
Swollen neurites
    -lysosomes, ApoE 
Reactive astrocytes
    -Drawn by chronic inflammation

Question 7

Normal changes in dendritic shafts

Answer 7

Will produce growth of other neuronal dendrites

*Not the case in Alzheimer’s

Question 8

Congophilic angiopathy

Answer 8

Deposition of amyloid in cerebral/meningeal arteries

• Leads to cerebrovascular hemorrhage
• Normally cleared by the BBB during sleep

Question 9

Behavioral changes in Alzheimer’s

Answer 9

1. Memory loss
2. Decreased initiative
3. Depression
   * Must give SSRIs to treat
4. Faulty judgment

Later symptoms get more severe w / language deficits and incontinence

Question 10

Sundowning

Answer 10

Presence of severe anxiety/fear in the evening for Alzheimer’s pts.

-Can also induce hypersexuality

Question 11

Donepezil

Answer 11

Cholinesterase inhibitor used to treat Alzheimer’s

• Will delay onset of Alzheimer’s for up to 3yrs
• Should only be used acutely to treat symptoms

Question 12

DBS

Answer 12

Deep Brain Stimulation

• Can stimulate glucose metabolism and the Papez circuit
• Reduced memory loss in Alzheimer’s

Question 13

Mini Mental Status Exam

Answer 13

Most widely used cognitive test for Alzheimer’s

-Decreasing scores track the rate of decline; pts. often fail memory, concentration, and motor sections

Question 14

Early onset Familial Alzheimer’s Disease

Answer 14

Mutations that are inherited in AD fashion

• Genes are on chromosomes 21, 14, and 1
• Gene on 21 codes for B-amyloid precursor; gets irregularly cleaved and accumulates into senile plaques

Question 15

Late onset sporadic Alzheimer’s Disease

Answer 15

Can be due to infectious (prions; encephalitis), toxic (aluminum accumulation) or CV dysregulation (amyloid build-up)

Question 16

Risk factors for Alzheimer’s

Answer 16

-Age

-Inheritance of E4 alleles
(codes for EpoE; normally involved in lipid metabolism and binding amyloid)

• Mild TBIs
• Atherosclerosis
• Untreated depression (kills neurons in hippocampus)
• Low Vitamin D
• MCI
• Possible connection to Hormone Replacement Therapy in women >65

Question 17

MCI

Answer 17

Mild Cognitive Impairment- short-term memory loss w/o other cognitive defects

Question 18

Decreasing risk factors for Alzheimer’s disease

Answer 18

• E2/E2 inheritance => tau stability
• Continuing mental challenge
• Omega-3 fats, low LDL
• Vitamin B12
• Exercise

Question 19

Damage to hippocampus causes…

Answer 19

Short-term memory loss

Loss of spatial coordinate system

Loss of declarative memory