Alzheimers

Question 1

most epileptic part of the human brain

Answer 1

hippocampus

Question 2

HM characteristics, conclusion?

Answer 2

LT memory was impaired, but other cognitive functions were intact; function of LT memory is separate from other cognitive functions

Question 3

bundle of white matter fibers leaving the hippocampus twd the thalamus/BG/forebrain

lesion in this structure causes?

Answer 3

fornix

lesion –> anterograde amnesia (cannot provide ACh to hippocampus)

Question 4

another structure crucial to memory formation?

Answer 4

medial temporal lobes

Question 5

associative memory: hearing a sound and assoc w a person and his life story

tying shoes

Answer 5

hippocampus

not assoc w/hippocampus - don’t need to remember contextual features

Question 6

declarative (explicit) memory

nondeclarative (implicit) memory

Answer 6

medial temporal dependent (event learning; recall/recognition)

independent

Question 7

common complication of dural atrophy

Answer 7

subdural hematoma (easily torn)

Question 8

Senile plaques

Answer 8

EC deposition of fibrillar amyloid-B (inflammation, cytokines, complement etc)

Question 9

degeneration of neurons via?

Answer 9

phosphorylation of tau protein leads to aggregation and degeneration

Question 10

amyloid angiopathy

Answer 10

found in vessels and leads to breakage

Question 11

role of microglia

Answer 11

activated and phagocytose debris

Question 12

amyloid hypothesis

Answer 12

AB generation leads to adverse effects; defect in the gamma secretase –> breaks down precursor amyloid in abnormal way generating B-Amyloid –> oxidation, aggregation, inflammation, tau hyperphosphrylation (and microtubules) –> plaques and tangles –> cell death, NT deficit –> cognitive and behavioral changes

Question 13

definition of dementia (MND): multiple realms

Answer 13

impaired memory
disturbed language
visuospatial abnormalities
decreased problem-solving, abstraction and other exec fxns
reduced attention
apraxia
agnosia

end-stage includes deficits in them all

Question 14

most common cause of dementia?

Answer 14

alzheimers

the older you are, the more common the cause of dementia is alzheimers

Question 15

core issue of alzheimers

Answer 15

memory loss

as progresses, further into disease further back memory recall problems become

Question 16

visuospatial problems due to

Answer 16

parietal damage

Question 17

can’t groom, take meds, feed oneself

Answer 17

severe alzheimers

Question 18

common mut in alzheimers
rare
downs

Answer 18

apo-e4 (double risk)

rare: secretases
downs: have an extra copy of the amyloid precursor protein gene so deposit more amyloid since birth

Question 19

increase in which enzyme in alzheimers?

Answer 19

butyrocholinesterase

Question 20

sudden onset of problems w/attention and arousal

Answer 20

delirium

irreversible

Question 21

central symptom of alzheimers

Answer 21

amnesia

Question 22

5 A’s of alzheimers

Answer 22

Aphasia, apraxia, agnosia, executive fxn (abstract reasoning, activities of daily living)

Question 23

conscious, recollective memory

past experiences influence present performance in absence of specific memory

Answer 23

explicit/declarative

implicit/nondeclarative

Question 24

declarative (not non declarative) memory impaired in what kind of amnesia?

Answer 24

anterograde

Question 25

type of declarative LTM that includes where/who with/what time etc --> context/source type of declLTM that contains factual info but not assoc w specific event

Answer 25

episodic memory semantic memory

Question 26

HM lobectomy?

Answer 26

bilateral medial temporal lobe (hippocampus) | language remained normal, IQ increased

Question 27

role of hippocampus

Answer 27

encoding as well as retrieval

Question 28

brain atrophy most severe where?

Answer 28

frontal/temporal lobes

Question 29

accumulations of paired helical filaments in neuronal cytoplasm; birefringent under polarized light and visualized using silver stain

Answer 29

neurofibrillary tangles

Question 30

genetics of alzheimers which two chromosomes? which two genes? which two NT's are decreased?

Answer 30

``` dominant! chromosome 14: presenilin-1 chromosome 1: presenilin-2 apoE-e4 --> higher risk and earlier onset apoE-e2 is protective ACh and somatostatin ```

Question 31

single most powerful risk factor for dementia? | other risk factors?

Answer 31

age --> 45% over 95y have it | genetics (apoE4, family hx of alz, hx of TBI, dearth of education, late-life depression, CV risk fx

Question 32

most common cause of dementia? | core sx of dementia?

Answer 32

alzheimer's amnesia (2-3y prior to dementia dx) STM first, then LTM aphasia, visuospatial, exec dysfxn

Question 33

criteria for MND due to alzheimers

Answer 33

A. Criteria met for major/mild NCD B. Insidious onset/gradual progression of impairment in 1+ cognitive domains C. Criteria met for alzheimers (probable if either of the following, otherwise "possible"): 1. causative genetic mutation 2. all 3 of the following: a) decline in memory/learning and 1+ other domain; b) steadily prog/gradual decline in cognition w/o extended plateaus; c) no evidence of mixed etiology

Question 34

prognosis

Answer 34

most pts btwn 75-85y | 6-12y from dx to death

Question 35

donepezil, galantamine, rivastigmine, memantine not effective for?

Answer 35

frontotemporal dementia

Question 36

meds used in dementia | which med assoc w incr mortality in elders w/dementia?

Answer 36

SSRI's and atypical antipsychotics | atypical antipsychotics

Question 37

strokes here lead to problems with attention strokes here lead to apathy, disinhibition

Answer 37

parietal lobe | frontal

Question 38

sudden change in cognitive fxn indicates?

Answer 38

cerebrovascular incident

Question 39

the onset of cognitive sx at least 1y after onset of motor sx, impairment due to Lewy bodies 1) fluctuating sx, 2) visual hallucinations, 3) cognitive impairment, 4) less severe parkinsonian sx than in parkinsons levy bodies found where?

Answer 39

parkinson's disease dementia DLB cerebral cortex

Question 40

presence of tau inclusion bodies on histo lobar degeneration of frontal/temporal lobe behavioral disturbance/aphasia

Answer 40

FTD onset 50-65y

Question 41

when do you know dx of FTD? | course of FTD? death when?

Answer 41

when tx (antidepr/mood stabz) not effective more rapid than other dementias death w/in 5y of dx

Question 42

other causes of dementia

Answer 42

``` huntington's CJD neurosyphilis wernicke-korsakoff syndrowm (alcohol dementia) CTE CNS tumors HIV/AIDS ```

Question 43

reversible causes of dementia

Answer 43

depression, hypothyroid, B12 def, pressure hydrocephalus, subdural hematoma