Exam #02 - Alzheimer's Disease

Question 1

Which of the following statements is false?

A. Early onset AD progresses over a 5-15 yr period
B. AD is a result of polyproteinopathy
C. Behavioral changes increase with AD progression
D. AD results in progressively severe brain atrophy and loss of brain mass
E. Prevalence of AD increases exponentially with age

Answer 1

(A)

Early onset AD (age 40-64) progresses RAPIDLY leading to death in only 2-3 YEARS while LATE onset AD progresses over a 5-15 year period

Question 2

What (2) proteins implicated in AD pathology form potentially pathogenic conformations and accumulate in the brain?

Answer 2

1. A-beta

2. Tau

Question 3

True or False - early onset AD is hereditary and its onset may be caused by mutations in (3) genes?

Answer 3

True

Question 4

What is the strongest genetic risk factor for late onset AD?

Answer 4

Epsilon-4 allele of Apolipoprotein E (which is involved in the transport of cholesterol)

Question 5

Which of the following statements is correct?

A. risk of developing AD decreases with atherosclerosis, peripheral vascular disease, and type II DM
B. Epsilon allele of APOE (apolipoprotein E) impairs amyloid clearance and increases aggregation and deposition
C. Amyloid plaques are twisted fibers, composed of tau protein
D. Neurofibrillary Tangles (NFTs) are dense deposits of protein around nerve cells

Answer 5

(B) is the only correct statement:
Epsilon allele of APOE (apolipoprotein E) impairs amyloid clearance and increases aggregation and deposition

A. Risk INCREASES with atherosclerosis, peripheral vascular disease, and type II DM

C. Amyloid plaques form when dense deposits of beta amyloid protein (A-beta) and cellular material accumulate outside and around nerve cells

D. NFTs are twisted fibers, composed of tau protein build up inside the nerve cell

Question 6

What (2) regions of the brain involved in memory and learning are most affected in early stages of AD?

Answer 6

1. Hippocampus

2. Cortex

Question 7

True of False - there is a correlation between progressive loss of cholinergic neurons and symptom severity?

Answer 7

True

Question 8

True or False - a patient with mild AD would require assistance with daily activities?

Answer 8

False - a patient with moderate AD would require assistance with daily activities

Question 9

All the following are symptoms of severe AD except?

A. Motor disturbance
B. Wandering
C. Dysphagia
D. Incontinence
E. Unstable gait

Answer 9

(B) wandering is NOT a symptom of severe AD. In severe AD the patient is bedridden. Wandering is a symptom of moderate AD.

Dysphagia is difficulty in swallowing
Incontinence is the inability to control urination and defecation

Question 10

True or False - beta-amyloids are short polypeptides that accumulate and form plaque?

Answer 10

True - Amyloid Precursor Protein (APP) is cleaved by Beta-secretase forming beta amyloids

Question 11

Under normal conditions Tau proteins stabilize microtubules. What causes the tau proteins to tangle into neurofibrillary tangles?

Answer 11

Hyperphosphorylation and truncation of tau causes tangle

Question 12

True or False - under normal circumstances, amyloid precursor protein (APP) is cleaved by secretases to from soluble proteins?

Answer 12

True

However, beta-secretase cleaves a little higher than other secretases producing insoluble proteins (A-beta proteins) that accumulate and form a plaque

Question 13

Which PET ligand used in diagnostic/biomarker of AD progression binds to amyloid plaque but not to regions of the brain devoid of plaque?

Answer 13

Florbetapir

Question 14

Name the (5) drugs used to treat AD?

Answer 14

1. Donepezil (Aricept ®)
2. Galantimine (Razadyne ®)
3. Memantine (Nemanda ®)
4. Rivastigmine (Excelon ®)
5. Tacrine (Cognex ®)

Question 15

Which of the following drugs used to treat AD is NOT an AChE inhibitor?

A. Galantimine
B. Memantine
C. Donepezil
D. Tacrine
E. Rivastigmine

Answer 15

(B) Memantine is an NMDA ANTAGONIST, not an AChE inhibitor

Question 16

Which drug used to treat AD comes as a transdermal patch?

Answer 16

Rivastigmine (Excelon ®)

Question 17

All of the following drugs would be appropriate to treat mild to moderate AD except?

A. Galantimine
B. Memantine
C. Donepezil
D. Tacrine
E. Rivastigmine

Answer 17

(B) Memantine is an NMDA antagonist used to treat moderate - severe AD

All the AChE inhibitors are used to treat mild to moderate AD

Question 18

What (4) AE are associated with AChE inhibitors for Tx of AD?

Answer 18

1. N
2. V
3. D
4. anorexia

less AE with titration dosing

Question 19

True or False - anticholinergic drugs decrease the effectiveness of AChE inhibitors?

Answer 19

True - they block ACh receptors

Anticholinergics that would decrease AChE inhibitor effectiveness: benadryl, oxybutynin, imipramine (TCA)

Question 20

What type of AD is Nemanda used to treat?

Answer 20

moderate to severe AD

Question 21

What (4) AE are associated with Memantine for Tx of AD?

Answer 21

1. constipation
2. confusion
3. dizziness
4. hallucinations

Memantine (Nemanda ®) is an NMDA antagonist

Question 22

True or False - elderly patients with dementia related psychosis treated with atypical antipsychotic drugs are at an increased risk of death?

Answer 22

True - Antipsychotic black box warning