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Alzheimer's Flashcards

1
Q

How is dementia classified?

A

major neurocognitive disorder (major NCD), based on DSM 5

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2
Q

What percentage of dementia diagnoses Alzheimer’s?

A

60-80%

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3
Q

How is one diagnosed with dementia?

A

Decline in memory and learning and at least one other cognitive domain:
complex attention, executive function, language, motor, social cognition. Must have no evidence of mixed etiology (side effects from a drug), or other medical problems, decline must interfere with daily life

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4
Q

How are you diagnosed with MILD NCD?

A

modest decline in cognitive performance in one or more of the categories, but not a sever enough decline to affect everyday life

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5
Q

Early symptoms of AD

A

difficulties w/ name recall and event recall

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6
Q

later symptoms of major NCD

A

1) confusion, impaired judgment
2) disorientation
3) general behavior changes
4) difficulty swallowing and speaking

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7
Q

brain abnormalities found

A

1) plaques- beta fragments that become sticky and clump
2) tangles- strands of tau that accumulate in neurons and kills neuron

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8
Q

Death expectancy once diagnosed

A

live an average of 8 years after diagnosis

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9
Q

What is Amnestic Mild Cognitive Impairment (MCI)?

A

occurs in very early stages of AD, display of more memory problems than the “typical” for that age group: occasional short term memory failure, some decline in word finding, impaired reasoning skills, daily activity not significantly impacted

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10
Q

What makes up the diencephalon?

A

thalamus and hypothalamus

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11
Q

what makes up the brainstem?

A

midbrain, pons (rounded), medulla (leads to spinal cord)

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12
Q

gyrus

A

a ridge of the cortex

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13
Q

suclus

A

depression in the surface of the cortex

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14
Q

what are the 5 lobes?

A

frontal, parietal, occipital, temporal, limbic (know location)

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15
Q

4 sulci?

A

central, lateral, parietooccipital, cingulate (know location)

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16
Q

What are the areas of the cerebral cortex and what are their functions/location?

A

primary motor cortex- pre central gyrus
premotor cortex- anterior to primary motor, movement planning, sensory guidance of movement
supplementary motor cortex- medial surface anterior to primary motor cortex, postural stabilization, coordinates movement between body sides

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17
Q

what is the corticospinal tract?

A

descending pathway, voluntary motor control of limbs/trunk, look at slide

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18
Q

what are the primary sensory areas and their location?

A

somatosensory- postcentral gyrus in parietal lobe, receives sensory info from periphery (temp, touch, pain)
vision- banks of calcarine sulcus in occipital lobe
auditory- transverse temporal gyrus

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19
Q

Broca’s area

A

language production, inferior frontal gyrus in dominant hemisphere

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20
Q

wernickes area

A

language comprehension, posterior part of the superior temporal gyrus and inferior parietal lobule in dominant hemisphere

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21
Q

what is arcuate fasciculus?

A

connects brooks and wernickes, axons leave one area and terminates in the other area

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22
Q

the prefrontal cortex (PFC)

A

large area, works with amygdala and hypo campus, regulates emotions and executive functions, connects to sensory areas (vision, hearing and somatosensory)

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23
Q

what does the PFC divide into?

A

dorsolateral cortex- connections with vision, hearing and somatosensory, works memory, motor planning, and organization
ventrolateral cortex- interacts w/ brain regions involved in regulating emotion, impulsitvity and self-control

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24
Q

what are the structures of the limbic system?

A

1) cingulate gryus
2) pariahippocampal gyrus
3) hippocampus
4) amygdala
5) septal nuclei

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25
where Is the hippocampus and what is the function
location- temporal lobe function- formation of new memories, emotion, spatial orientation
26
location and function of amygdala
location- medical temporal lobe, anterior to hippocampus function- processing and memory of emotional reactions, especially fear
27
why do we vividly remember emotional experiences?
amygdala is closely related to hippocampus which help form memories that are connected to emotion
28
entorhinal cortex
part of pariahippocampal gyrus (main input region), inputs directly to amygdala, filters what makes it to the hippo.
29
what is white matter?
myelinated axons
30
APP
concentrated in synapses, aids in neuron growth and development
31
sAPPa(alpha)
neuroprotective properties, promotes neurotic expansion, synapse production and cell adhesion
32
AICD
regulates cell death, maintaining cellular actin
33
P3
no known function but doesn't appear toxic
34
what are plaques surrounded by?
microglia and astrocytes
35
what does tau do?
binds and stabilizes microtubules
36
tau in AD
abnormal hyperphosphorylation
37
what does kinase do?
adds phosphate group during phosphorylation
38
what does phosphatases do?
remove phosphates
39
where are tangles first observed?
in the entorhinal cortex
40
early onset familial AD (EOAD)
diagnosed at <65 years old
41
late onset AD (LOAD)
diagnosed at >65 years old, linked to genes and environment
42
what's autosomal dominance?
only 1 copy needed of a mutated gene to cause disease
43
what is Presenilin?
a subunit of gamma secretase (enzyme that cuts the bottom of the amyloid protein)
44
what does apolipoprotein E do?
transports lipids and regulates neurite outgrowth
45
types of cholinesterase inhibitors?
1) donepezil (aricept)- for all stages 2) rivastigmine (exelon)- for mild to moderate stages 3) galantamine (razadyne)- for mild to moderate
46
what does mematine (Namenda) do?
regulates glutamate activity
47
what is ACH?
a neurotransmitter, widely located in the brain, stimulates learning and memory (hippocampus/cortex) and attention (cortex), also found in nucleus of meynert, septal nucleus
48
what is the main input region of ACH?
entorhinal cortex
49
what ACH enzyme is involved in synthesis?
cholineacteyltransferase
50
What ACH enzyme is involved in metabolism?
acetylcholinesterase
51
What does neuron degeneration result in?
60-80% loss of choline acetlytransferase
52
what does a decrease in ACH lead to?
a reduction in mental capacity and learning
53
what is glutamate?
predominant excitatory neurotransmitter, central to hippocampal learning and memory processes
54
types of glutamate receptors?
AMPA, Kainate, NMDA, mGluR
55
what is excitotoxicity?
triggers neuron cell death
56
what do cholinesterase inhibitors do patients?
6-12 month duration, significant benefits for cognition usually in earlier stages
57
what does NMDA receptor antagonist-memantine do for patients?
significant benefits in cognition and neuropsychiatric symptoms for later stages
58
what does vitamin E do for patients?
can interact w/ cholesterol and clotting drugs
59
what does gingko biloba do for patients?
moderate benefits but doesn't really slow memory decline
60
what does Aducanumab do?
recently FDA approved, appears effective in reducing amyloid plagues in mild to moderate AD, has an antibody that targets beta amyloid
61
what does Lacanemab do for patients?
approved in 2023, works like Aducanumab but binds more tightly and stays attached to the plaques longer which reduces the plagues in MCI and mild AD
62
what does Tau aggregation inhibitors do for a patient?
accumulates in the brain so It crosses the BBB, proteosomal degredation of tau (breaks down proteins that aren't functioning properly), prevention of disulfide bridges from forming between tau proteins
63
when do brain changes begin?
about 10 years before symptoms begin
64
what could blood biomarkers do?
detect AD before cognitive symptoms appear
65
what does an AD medical evaluation require?
medical history mental status testing physical and neuroscience exam tests to rule out other dementia like symptoms
66
commonly used neuropsychological testing for AD?
mini-mental state exam (MMSE) mini-cog test
67
what is SV-MMSE?
most common, for cognitive decline, 30pt test that lasts 25 min.
68
what is BV-MMSE?
16pt test, for screening large populations/individuals, usually for a survey/study, not for cognitive complaints
69
what is EV-MMSE?
90pt test, increased sensitivity for individuals w'/ less severe cognitive impairment, 20 min, very difficult
70
what is the mini-cog test?
3 min test, 85-99% accuracy in predicting dementia, less influenced by education name 3 unrelated words, patient repeats words, then draws a clock, then recalls words
71
what is GPCOG?
General Practitioner Assessment of Cognition, similar accuracy as the MMSE 1) cognitive test 2) informant interview
72
other health related problems that cause dementia-like symptoms?
drug interactions iron deficiency excessive alcohol consumption thyroid and kidney problems
73
what does an MRI show with AD?
brain structure, tissue loss in hippocampus and entorhinal cortex, best biomarker for AD, episodic memory loss is well correlated w/ hippocampal volumes
74
what does an fMRI show for AD?
reveals decreased task-associated activation of parahippocampla and hippocampal regions, abnormal prefrontal activation patterns
75
Pet scanning
shows levels of amyloid beta binding
76
what compounds are used in PET scanning?
11C PIB, 18F florbetapir (Amyvid), 18F flutemetamol (vizamyl)
77
causes of vascular dementia
10% of dementia cases, blood vessel blockage/damage leading to strokes or bleeding in brain
78
Vasulcar dementia symptoms
impaired judgment or ability to make decisions, plan/ organize, symptoms appear instantly
79
cause of dementia w/ levy bodies
build up of lower bodies in motor and cognitive areas, mainly found in Parkinson's
80
how do levy bodies form?
alpha synuclein sticks and bundles which forms the Lewy body in a neuron
81
symptoms of lewy body dementia
memory loss and thinking problems, sleep disturbances, hallucinations, gait imbalance
82
how to diagnose DLB?
dementia first, then , motor symptoms
83
cause of FTD?
progressive nerve cell loss in frontal and temporal lobe, some have a genetic link, asymmetrical tissue loss
84
3 subtypes of FTD?
behavior variant FTD primary progressive aphasia distrubances of motor function
85
symptoms of behavior variant dementia
changes in personality, interpersonal relationships and conduct, around age 50-60, most common
86
primary progressive aphasia
affects language skills, speaking, writing, and comprehension, diagnosed before age 65
87
diagnoses of FTD
neurological exam, MRI/PET scans
88
differences between FTD and AD
age of diagnosis, memory loss is an early symptom of AD, behavioral changes in bvFTD, speech problems common in PPA

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