Neurodegenerative Diseases Pt. 3 Flashcards Preview

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Flashcards in Neurodegenerative Diseases Pt. 3 Deck (17):
1

What type of inheritance pattern is associated with Huntington Disease?

Autosomal dominant

2

Describe the onset of motor, cognitive, and behavioral symptoms in Huntington Disease

  • Motor symptoms are predominant at the onset of HD in 60% of cases (chorea)
  • Cognitive symptoms may occur at or before the onset of motor symptoms (patients become demented as disease progresses)
  • Neuropsychiatric symptoms in 98% of patients (10% have attempted suicide)

3

How long does it take for Huntington Disease to reach complete motor disability and dementia?

aproximately 20 years

4

What mutation is associated with Huntington Disease (HD)?

What is the hypothesized mechanism of this gene in contributing to HD?

  • Mutation on huntingtin gene on chromosome 4
    • Expanded trinucleotide repeat in gene (CAG) causes structural abnormalities in huntingtin protein
  • Hypothesized that gene expansion causes a toxic gain of function in huntingtin protein

5

What is Anticipation in terms of HD?

Earlier age of onset in subsequent generations, found when mutated gene passed to offspring from father

6

What microscopic changes to the brain are seen in HD?

  • Loss of medium striatal neurons in the caudate and putamen (increased motor output)
  • Neuronal loss in cerebral cotex - cognitive changes

7

What gross changes are seen in HD?

  • Atrophy of caudate and putamen
  • Ventricular enlargement
  • Mild to moderate atrophy of gyri

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8

How are the following symptoms of Huntington Disease treated?

  • Depression
  • Delusions and paranoia
  • Uncontrolled Movement

  • Depression: Fluoxetine
  • Delusions and paranoia: Low dose antipsychotics
  • Uncontrolled Movement: Tetrabenzine (inhibits Vesicular monoamine transporter)

9

What is the typical age of onset of ALS?

60 years old

10

Is ALS more likely to be sporadic or familial?

Sporadic; only 5-10% of cases are believed to be familial

11

What features of ALS are associated with...

Lower motor neuron degeneration:

Upper motor neuron degeneration :

  •  Lower motor neuron degeneration:
    • Muscular atrophy, weakness, fasciculations (amytrophy) –
    • Degeneration of anterior horn cells/axons
  • Upper motor neuron degeneration
    • Spastic tone, hyperreflexia, Babinski signs
    • Degeneration of the corticospinal tracts in lateral column of spinal cord (lateral sclerosis)

12

What does bulbar dysfunction cause in ALS?

Dysarthria and dysphagia (involvement of the brainstem motor cranial nerves)

13

What is the mean survival of ALS and cause of death?

Mean survival is 3-5 years and death is from respiratory failure

14

How many geness have been associated with familial ALS?

What type of inheritance pattern does ALS follow?

What is the most common mutation?

14 different genes have been described

Most often - autosomal dominant inheritance

Superoxide dismutase 1 gene (SOD1)

15

What are some potential outcomes of the SOD1 mutation associated with ALS?

  • SOD1 mutations:
    • Decreased ability to detoxify free radicals
    • Misfolded proteins

16

What changes in the brain are associated with ALS?

  • Anterior motor roots of spinal cord are atrophic
  • Primary motor cortex (cerebrum) may show atrophy
  • Reduced numbers of anterior horn cells
  • Loss of corticospinal tract axons and myelin (brainstem motor cranial nerves may be affected)

17

What is the role of Riluzole in treating ALS?

Inhibitor of NMDA channels, inhibits glutamate release; increases uptake

Modest but genuine effects on ALS

Increases lifespan 2-3 months