Dementias and Stroke

Question 1

a descriptive term for a collection of
symptoms that can be caused by a number of
disorders that affect the brain

Answer 1

Dementias

Question 2

how is dementia diagnosed

Answer 2

Dementia is diagnosed only if two or more brain
functions - memory, language skills, perception, or
cognitive skills (reasoning and judgment) - are
significantly impaired without loss of consciousness.

Question 3

Memory loss is a common symptom, but memory

loss by itself does not indicate dementia (T/F)

Answer 3

True

Question 4

a progressive neurodegenerative
disorder in which decline of general cognitive
function occurs, usually accompanied by
affective and behavioral disturbances.

Answer 4

AD

Question 5

cause for dementia

Answer 5

Some cases have a familial (genetic) basis,
but the great majority (90%) appear to be
sporadic

Question 6

patients with AD live for ______
years after they are diagnosed. Patients with
AD often die of _____ _____ because
they lose the ability to swallow late in the
course of the disease.

Answer 6

8 to 10

aspiration pneumonia

Question 7

The key neuropathological elements of AD (macroscopic)

Answer 7

gross atrophy of the

brain

Question 8

The key neuropathological elements of AD (microscopic)

Answer 8

amyloid plaques,
neurofibrillary tangles
extensive neuronal loss in the neocortex,
hippocampus, and other subcortical
regions of the brain.

Question 9

accumulations of aggregated molecules in the extracellular

space of the brain

Answer 9

Amyloid plaques

Question 10

The principal proteinaceous component of plaques is the

Answer 10

amyliod-beta peptide

A-beta

Question 11

amyliod-beta peptide

A beta

Answer 11

a 38– to 43–amino acid peptide derived from a much larger protein, the
amyloid precursor protein, APP

Question 12

tends to spontaneously self-aggregate into multiple coexisting physical forms

Answer 12

alpha beta

Question 13

A-beta peptide is produced from much larger transmembrane protein, the amyloid precursor
protein, ____. The exact physiological function of
APP is unknown.

Answer 13

APP

Question 14

The toxic A peptide is produced from the transmembrane protein APP via cleavage by two enzymes:

Answer 14

beta-secretase and gamma-secretase

Question 15

Excess production of A is a key initiator of cellular damage in ___

Answer 15

AD

Question 16

______ tangles are found in the cytoplasm of neurons

Answer 16

Neurofibrillary tangles (NFTs)

Question 17

The NFTs (Neurofibrillary tangles) are composed of highly stable polymers of cytoplasmic proteins
called

Answer 17

TAU

Question 18

proteins possess microtubule-binding domains and help to stabilize
microtubules.

Answer 18

TAU

Question 19

•In AD, tau proteins become highly phosphorylated and as a result, dissociate
from ________ and polymerize into filaments forming NFTs.
•The microtubules disintegrate in the process, leading to disruption of
______- transport and subsequent neuronal death.

Answer 19

microtubules

axoplasmic

Question 20

Genetics of AD occur in mutations of chromosomes :

Answer 20

mutations on

chromosomes 21, 14, and 1.

Question 21

Mutations on chromosome 21
cause the formation of abnormal
____ ____ _______

Answer 21

amyloid precursor protein (APP).

Question 22

Mutations on chromosome \_\_\_  and
\_\_ cause formation of abnormal
presenilin proteins (prenesilin
proteins are structural subunits of
gamma-secretase complex)

Answer 22

14

1

Question 23

In about 50% of late-onset AD (60 and older) patients, __ isoform of ____
has been identified as a risk factor

Answer 23

E4

apoE4

Question 24

there three major isoforms ___, ___, ___, which arise from

different alleles __, ___, ___ of a single gene on chromosome 19.

Answer 24

(apoE2, apoE3, and apoE4)

E2, E3, and E4

Question 25

The ___ allele is associated with increased risk and earlier onset of late-onset AD, inheritance of __ allele is associated with decreased risk and later onset

Answer 25

E4 | E2

Question 26

Treatment of AD (what 2 drugs)

Answer 26

-Cholinesterase inhibitors -Memantine-NMDA receptors modulator

Question 27

The second most common type of dementia May appear soon after a single major stroke that disrupts the blood supply to a significant portion of the brain (“post-stroke dementia”)

Answer 27

vascular dementia

Question 28

symptoms of vascular dementia

Answer 28

vary depending on the affected brain areas: -with sudden decline function, rather than the slow, steady decline

Question 29

underlying causes of vascular dementia

Answer 29

hypertension, diabetes, smoking, or | lack of exercise

Question 30

characterized by the sudden onset of a focal neurologic deficit due to an abnormality of the cerebral circulation, such as blockage or rupture of the blood vessel, supplying the brain. -third leading cause of death in the United States

Answer 30

Stroke

Question 31

•Significant risk factors of stroke (6)

Answer 31

``` hypertension hypercholesterolemia diabetes smoking heavy alcohol consumption oral contraceptive use ```

Question 32

Strokes may be classified into two major categories based on | pathogenesis:

Answer 32

ischemic stroke and hemorrhagic stroke

Question 33

•In ______ stroke, vascular occlusion interrupts blood flow to a specific brain region, producing a fairly characteristic pattern of neurologic deficits

Answer 33

ischemic

Question 34

Thrombus may form in an artery that is already very narrow. If it completely blocks the artery, it is called

Answer 34

thrombotic stroke

Question 35

Thrombus may break off from another place in the blood vessels of the brain, or some other part of the body, and travel up to the brain to block a smaller artery. It causes

Answer 35

embolic stroke

Question 36

______ stoke occurs upon rapture of a weakened blood vessel in the brain. pattern of deficit depends on the location of the bleeding

Answer 36

•Hemorrhagic strokes

Question 37

Drugs use to treat ischemic strokes (3)

Answer 37

- Thrombolytic agents - Anticoagulants - Aspirin

Question 38

these agent must be administered in the hyperacute phase of stroke (<4.5 hours after onset).

Answer 38

Thrombolytic agents

Question 39

_____ reduces the risk of serious vascular events in high-risk patients (e.g., those with previous myocardial infarction) by 20-25%.

Answer 39

Aspirin

Question 40

•Low-dose (<100 mg/day) aspirin, is relatively (but not exclusively) selective for _____, and is associated with a lower risk for GI adverse events

Answer 40

COX-1

Question 41

aspirin approximately doubles the mean bleeding time in healthy person for 4-7 days. This effect is due to irreversible acetylation of platelet ____

Answer 41

COX

Question 42

Hemorrhagic stroke treatment

Answer 42

Treatment usually involves attempting to control high blood pressure, bleeding, and brain swelling.

Question 43

``` Thrombolytics are not given to someone who is having a _____ stroke. They could worsen the stroke by causing increased bleeding. ```

Answer 43

hemorrhagic

Question 44

these drugs were withdrawn from the | market to cardiovascular toxicity

Answer 44

•COX-2 selective inhibitors

Question 45

currently is the only COX-2 inhibitor | licensed for use in the U.S.

Answer 45

Celecoxib | CELEBREX

Question 46

_____ ____related to drug use promotes damage of cerebral arterioles, which may eventually rupture, resulting in stroke

Answer 46

•Acute hypertension

Question 47

amphetamines, over the counter sympathomimetics (acute hypertension drugs) increase ______ release

Answer 47

catecholamine

Question 48

may cause spontaneous subclinical hemorrhages that eventually become clinically significant through their anti-platelet effects (4)

Answer 48

Thrombolytic agents aspirin anticoagulants SSRI

Question 49

can induce acute hypertension and increase the risk of stroke (3)

Answer 49

Caffeine cigarette smoking alcohol abuse