39: Neurodegenerative Disorders Flashcards Preview

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Flashcards in 39: Neurodegenerative Disorders Deck (31):
1

main characteristics of neurodegenerative disorders

- progressive and irreversible loss of neurons
- due to both genetic and environmental factors
- pathology including cellular aggregation of misfolded prtns

2

loss of hippoampal and cortical neurons results in impaired memory formation and cognitive deficits =

alzheimers disease

3

loss of dopaminergic neurons in basal ganglia leads to altered movement control

parkinson's disease and huntington's disease

4

degeneration of cortical and spinal motor neurons results in muscular weakness

amyotrophic lateral sclerosis ALS

5

what prtns accumulate in alzheimers?

b-amyloid plaques and neurofibrillary tangles

6

what prtns accumulate in ALS? parkinson's disease?

intracytoplasmic aggregrates
parkinsons: alpha-synuclein

7

what prtns accumulate in huntington's disease?

intranuclear inclusions of huntingin prtn

8

extracellular prion amyloid plaques located in different brain regions =

prion disease (transmissible spongiform encephalopathy TSE)

9

what are the cognitive symptoms of AD?

-loss of short term memory
- aphasia
- apraxia
- agnosia
- disorienation

10

what are the noncognitive symptoms of AD?

-depressioin
-psychotic symptoms

11

initial manifestation of a progressive degenerative dementia

mild cognitive impairment MCI

MCI can progress to AD ata rate of 10-15% per year

not yet dementia

12

language impairment, decreased comprehension, disorientation, and sleep disorders indicate what stage of AD

moderate (2-10 yrs)

13

dependence, delusion, agitation and incapacitation indicate what stage of alzheimers disease?

severe (8-12 yrs)

14

3 pathological signs of AD

1. neuronal degeneration and cortical atrophy
2. neuritic plaques (amyloid or senile)
3. neurofibrillary tangles

these changes eventually lead to clinical symptoms, but they begin years before the onset of symptoms

15

5 brain areas typically affected by AD

hippocampus
nucleus of meynert
temporal lobe
frontal lobe
parietal lobe

16

cholinergic hypothesis

deficiency of Ach causes AD

17

amyloid hypothesis

extracellular accumulations of b-amyloid peptides that are toxic to neurons

but deposition of b-a plaques does not correlate well with neuronal loss

18

why do people with down syndrome experience AD at an early age?

APP gene is on chromosome 21, people with trisomy 21 (down syndrome) have extra copies of APP and commonly exhibit AD by age of 40

19

early onset AD is associated with ___ late onset AD is associated with _____

APP, PSEN1 and PSEN2

E4 allele of APOE (ApoE enhances proteolytic breakdown and clearance of a- within and between cells)

20

50% of all AD patients have this allele

ApoE-E4 isoform for ApoE

21

Tau hypothesis

hyperphosphorylation of Tau aggregates and forms neurofibrilary tangles

tau provides support to microtubules and neuronal cytoskelton

22

first line therapy for symptomatic treatment of cognitive impairments in mild to moderate AD

cholinesterase inhibitors

reduce the breakdown of endogenously released ACh resulting in greater activation of postsynaptic ACh receptors

23

MOA donepezil

inhibits Acetylcholinesterase

24

MOA rivastigmine

inhibits both acetylcholinesterase and butyrylcholinesterase

25

side effects of AchEinibitors

nausea
vomiting
diarrhea
SLUDGE

26

what does SLUDGE stand for?

cholinergic side effects

salivation
lacrimation
urinary incontinence
diarrhea
gastrointestinal cramps
emesis

27

MOA memantine

non-competitive antagonist of the NMDA glutamate receptors with long half-life

provides neuroprotection by reducing intracellular Ca2+ influx and glutamate induced excitotoxicity

28

leading cause of nursing home admission

behavioral and psychiatric symptoms in dementia BPSD

29

treatment for AD associated psychosis/agitated behavior

atypical antipsychotics

(risperidone, olanzapine and quetiapine)

30

what would you use to treat depression and anxiety in AD? what would you not use?

use SSRI (setraline, citalopram)

do not use TCA (because anticholinergic effects and orthostatic hypotension)

31

what treatments do you avoid for sundowning and wandering?

benzodiazepines
Antihistamines