Neurodegenerative Disorders 2

Question 1

Alzheimer’s Disease is a chronic, progressive, degenerative condition. It is the most common from of dementia. What type of problems are seen generally?

Answer 1

Memory, language, visuospatial skills and personality changes

Question 2

Cause of AD is unknown, but it is genetic and abnormal processing of what normal cellular substance?

Answer 2

Amyloid

Question 3

Decrease risk of AD with…

Answer 3

Higher education, light to moderate alcohol use, daily use of statins, cognitive and physical activities, Mediterranean diet

Question 4

Pathogenesis of AD: what are the affected brain areas

Answer 4

Cerebral cortex, hippocampus, amygdala

Question 5

Pathogenesis of AD: ______ tangles, _____ plaques, and ______

Answer 5

Neurofibrillary tangle
Senile plaques
Atrophy (brain shrinks as neurons die)

Question 6

Plaques and tangles are normal in aging process, but dramatically increase in persons with ___

Answer 6

Alzheimer’s Disease

Question 7

Early symptoms of AD

Answer 7

Visuospatial deficits
Psychological changes (mood)
Subtle personality changes (egocentric, indifference, impulsive, irritability)
First symptom is loss of ability to learn new information
Disorders of higher function are due to cortical lobe dysfunction

Question 8

First symptom of AD is

Answer 8

loss of ability to learn new information

Question 9

Disorders of higher function are due to _____ _____ dysfunction

Answer 9

cortical lobe

Question 10

Early stages of AD

Answer 10

Losses of learning and memory
Both storage (new learning) and retrieval (memory) are impaired

Question 11

____ often do not help with the person with AD to remember

AD causes loss of _____ memories and recall of events from early in life

Answer 11

Clues

older

Question 12

What does it mean that language deadlines in AD? Rank them in when they appear

Answer 12

First: Word finding is difficult
Next: Inability to remember names (anomia)
Later: Diminished comprehension
Eventually all learning is lost

Question 13

Some ways to handle AD in therapy

Answer 13

Stick with same therapist, Same routine, same time, same exercise and same order. Schedule morning or afternoon while sun is still out

Question 14

Loss of ability to solve mathematical problems and handle money is in what stage of AD

Answer 14

Early

Question 15

Other clinical manifestations of AD

Answer 15

Loss of smell, taste leads to decrease in appetite
Incontinence
Decision, agitation, violence
Sundowning syndrome
Disorders of sleep, eating, sexual behavior

Terminal Stages:
Sleep a lot, stare into space when awake, may be impossible to feed, inevitably mortality often results due to dehydration infection or pneumonia

Question 16

In terminal stages of AD, what usually leads to death?

Answer 16

Often results due to dehydration infection or pneumonia

Question 17

Treatment of AD

Answer 17

While theres no cure…

Manipulation of environment
Treating comorbid complications (depression, visual/hearing deficits, CHF, UTI, hypothyroidism)
Diet in midlife shows potential for neuroprotection

Question 18

Whats a good diet for prevention or treatment of AD

Answer 18

Low in fat, high in omega 3 oils, high in dark vegetables and fruits, use of soy (women), vitamin C, coenzyme Q10, folate

Question 19

Parkinson’s Disease typical age of onset

Answer 19

40-70

Question 20

PD is the ___ most Neurodegenerative disease

Answer 20

2nd

Question 21

Rare genetic PD cases. Juvenile age and young onset age

Answer 21

Juvenile: <20 years
Young onset: 20-40

Question 22

In PD, what structure is affected?

Answer 22

Substantial nigra

Question 23

Symptoms will appear after what percentages of nigral neurons and dopamine are lost

Answer 23

70-80%

Question 24

What thing is present in scans in PD?

Answer 24

Lewy Body

Question 25

Substantia nigra is in what part of brain

Answer 25

Midbrain

Question 26

Cardinal signs of PD

Answer 26

TRAP T- Tremor (starts in one UE) R- Rigidity (Affects agonist and antagonist) (identified by passive ROM) A- Akinesia (cant initiate) (or Bradykinesia) P - Postural instabilities (high risk of fall)

Question 27

Initial PD signs

Answer 27

Unilateral tremor Vague hand clumsiness Asymmetric gait Reduced blinking Decrease in or lack of arm swing Olfactory dysfunction Microagraphia Dysphagia Visua; perception dysfunction Masked face (hypomimia) Abnormal eye movements Depression or flat affect Myersons sign (inability to suppress blinking when tapping) Hypophonic Freezing of gait Narrow BOS Stoop posture

Question 28

Later Stage clinical manifestations PD

Answer 28

Cognitive dysfunction: Bradyphrenia (slowness in response to questions), memory dysfunction, dementia

Question 29

The hoehn and Yahr classification grades what disease

Answer 29

PD

Question 30

In the Hoehn and Yahr classification grades go from

Answer 30

1-5

Question 31

In the Hoehn and Yahr classification what stage is balance not impaired

Answer 31

Stage 2

Question 32

What medications does PD take?

Answer 32

Levadopa and Carbidopa (Think dopa = dopamine for Parkinson’s)

Question 33

Positive vs Negative prognostic factor for PD

Answer 33

Positive: Tremor Negative: Older at onset, rigidity/hypokinesia as initial symptom, male, presence of associated comorbidities

Question 34

Typical MS patient

Answer 34

Female, middle age

Question 35

What physiologically happens with MS

Answer 35

Immune system attacks myelin sheath

Question 36

Prognosis for MS is highly variable or not variable?

Answer 36

Highly

Question 37

What is the myelin sheath

Answer 37

Protein and fatty substance that surrounds and insulates nerves, allowing the speed of signals

Question 38

Myelin sheath is produced where (2)

Answer 38

In PNS by Schwann cells In CNS by oligodendrytes

Question 39

MS affects the myelin sheath in the

Answer 39

CNS (only affects oligodendrytes)

Question 40

MS affects which sex more

Answer 40

Females

Question 41

Cause of MS is

Answer 41

Unknown but linked to infection genetics environmental factors and autoimmune And LOW VIT D

Question 42

List the 5 types of MS

Answer 42

Radiologically isolated syndrome (RIS) Clinically isolated syndrome (CIS) Relapsing-remitting MS Primary Progressive MS Secondary Progressive MS

Question 43

Radiologically isolated syndrome

Answer 43

Lacks clinical manifestations but demonstrated abnormal imaging

Question 44

Clinically isolated syndrome

Answer 44

Involves clinical attack but may/may not be diagnosed as MS depending on dissemination

Question 45

Relapsing-remitting MS

Answer 45

Most common type of MS - affects 85% of cases Unpredictable attacks which may or may not leave permanent deficits follows by periods of remission

Question 46

Primary progressive MS

Answer 46

Steady increase in disability without attacks

Question 47

Secondary progressive MS

Answer 47

Initial relapsing remitting MS that suddenly begins to have decline without periods of remission

Question 48

Clinical manifestations of Ms

Answer 48

Progressive disability - varies widely Visual changes (optic n neuritis, visual fields deficits) Fatigue Sleep dysfunction Spasticity Weakness Eye movements abnormalities Balance problems

Question 49

Treat exacerbations in MS via

Answer 49

Corticosteroids

Question 50

Manage the symptoms of MS via

Answer 50

Muscle relaxers like baclofen

Question 51

+ Prognostic Factors for MS

Answer 51

Sensory symptoms Infrequent attacks Full neurological recovery after relapse Low level of disability after 5-7 years

Question 52

- Prognostic Factors for MS

Answer 52

Motor and cerebellar problems Disability after 1st attack Short time interval between attacks Numerous relapses within the 1st year