Degenerative Diseases part 1 Flashcards
Degenerative diseases are diseases of _____ matter
Gray matter diseases
In general, Degenerative diseases involve the progressive loss of ____ and presence of ______
Progressive loss of neurons
Presence of protein aggregates (inclusions)
In general, Degenerative diseases involve the progressive loss of ______ and the presence of _____
Progressive loss of neurons
Presence of protein aggregates (inclusions)
What is Dementia?
Progressive loss of cognitive function = NOT a normal part of aging
The incidence of Alzheimer Disease increases with?
Increasing age – most cases sporadic
What is the most common type of Dementia?
Alzheimer Disease
A pathologic examination of the brain is needed for a definitive diagnosis of Alzheimer Disease. How does the brain look?
Frontal, Temporal and Parietal lobe have cortical atrophy!
= Widened sulci and hydrocephalus ex vacuo
A pathologic examination of the brain is needed for a definitive diagnosis of Alzheimer Disease. How does the brain look?
Frontal, Temporal and Parietal lobe have cortical atrophy
= widened sulci and hydrocephalus ex vacuo
What is the initiating event for Alzheimer Disease development?
Amyloid beta generation
What correlated to the degree of dementia with Alzheimer Disease?
The # of tangles correlates with the degree of dementia
What are the 2 histo items seen with Alzheimer Disease?
Amyloid Beta plaques in neuropil
Tau Neurofibrillary Tangles intracellularly in the neuron
What are the 2 histo items seen with Alzheimer Disease?
Amyloid Beta plaques in the neuropil
Tau Neurofibrillary Tangles intracellularly in the neuron
What gene has an increased risk of developing Alzheimer Disease?
ApoE
What are the 2 types of plaques seen with Alzheimer Disease?
- Neuritic plaques
- Diffuse plaques
Neuritic plaques are seen with Alzheimer Disease. Describe them.
Neuritic processes around an amyloid core
Diffuse plaques are also seen with Alzheimer Disease. Describe them.
NO Amyloid core!
Neuritic plaques with Alzheimer Disease have an Amyloid Beta core. What stain will show positive and what Amyloid Beta is contained in the core?
Congo red stain +
– Amyloid Beta 40 and 42
This disease has abundant Granulovacuolar degeneration and eosinophilic Hirano bodies made of actin
Alzheimer Disease
What angiopathy usually accompanies Alzheimer Disease?
Cerebral Amyloid Angiopathy
– Amyloid beta in vessel walls
What syndrome has early onset Alzheimer Disease due to the APP (amyloid precursor protein) being on the affected chromosome?
Down Syndrome (trisomy 21)
What are Frontotemporal Lobar Degenerations (FTLDs)?
Diseases that involve dementia and have degeneration of the frontal and temporal lobes
What 2 inclusions are options to be seen with Frontotemporal Lobar Degenerations (FTLDs)?
Tau
TDP-43
What are 2 FTLDs - tau inclusions?
Pick Disease
Progressive Supranuclear Palsy
What are the symptoms of Pick Disease (FTLD-tau)?
Behavioral changes and language disturbances
With Pick Disease, there is atrophy of the frontal and temporal lobes. What is spared?
Posterior 2/3 of superior temporal gyrus
How do the Gyri look with Pick Disease?
KNIFE-edge thin gyri
What is the symptom of Progressive Supranuclear Palsy (FTLD-tau) that classifies it as a type of parkinson syndrome?
Progressive truncal rigidity
This disease involves progressive truncal rigidity with globose (4R-tau) neurofibrillary tangles and neuronal loss
Progressive Supranuclear Palsy (FTLD-tau)
Degenerative Diseases of the Basal Ganglia and Brainstem are associated with what types of disorders?
Movement disorders
Degenerative Diseases of the Basal Ganglia and Brainstem involve what pathway specifically in the Basal Ganglia that is commonly affected?
Nigrostriatal pathway –> movement disorders
What are the 3 main types of Degenerative Diseases of the Basal Ganglia and Brainstem?
- Parkinson Disease
- Atypical Parkinson Syndromes (3)
- Huntington Disease
List some of the symptoms of Parkinson Disease?
- Masked facies
- Stooped posture
- Pill-rolling tremor
- Bradykinesia (slow movements)
- Festinating gait (short and fast steps)
What types of neurons are lost and from where with Parkinson Disease?
Loss of dopaminergic neurons from the Substantia Nigra –> slow movement
If patients are responsive to ____ they likely have what disease?
L-Dopa
= Parkinson Disease
What gene is the most common cause of AD form of Parkinson Disease?
LRRK2
What 3 genes encode mitochondrial dysfunction in the AR form of Parkinson Disease?
DJ-1
PINK1
Parkin
Pallor of the substantia niga and locus ceruleus suggests?
Parkinson Disease
Lewy bodies are seen with Parkinson Disease. How do they look and what are they made of?
Eosinophilic cytoplasmic inclusion with dense core surrounded by a pale halo
– Alpha Synuclein clumps is what they are made of
Lewy bodies are seen with Parkinson Disease. How do they look and what are they made of?
Eosinophilic cytoplasmic inclusion with dense core surrounded by a pale halo
– Alpha Synuclein clumps is what they are made of
Dementia with lewy bodies can occur. What is the common symptom of that?
Hallucinations
What are 3 types of Atypical Parkinsonian Syndromes?
- Progressive Supranuclear Palsy
- Corticobasal Degeneration
- Multisystem Atrophy
What are 3 types of Atypical Parkinsonian Syndromes?
- Progressive Supranuclear Palsy
- Corticobasal Degeneration
- Multisystem Atrophy
What differentiates Atypical Parkinsonian Syndromes from Parkinson Disease?
The syndromes have extra symptoms and are NOT RESPONSIVE to L-dopa!
What inclusion is seen and where with Corticobasal Degeneration?
Tau in gray and white matter
What inclusion is seen with Multisystem Atrophy and what are 3 symptoms?
Alpha-synuclein
- Parkinsonism
- Ataxia
- Autonomic Dysfunction
How is Huntington Disease inherited?
Autosomal Dominant – symptoms do not start until 4th-5th decade of life
What are the symptoms of Huntington Disease?
Dementia and Chorea (jerky movements)
With Huntington disease, what repeats are present?
CAG – polyglutamine trinucleotide repeats
With Huntington Disease, what repeats are present and what does more repeats correlate with?
CAG – polyglutamine trinucleotide repeats
= More repeats = Earlier age of onset
What chromosome encodes the Huntington Protein?
Chromosome 4
What types of neurons are lost with Huntington Disease?
Loss of medium spiny striatal neurons that normally dampen motor activity
What type of mutation does the Huntington protein get and where does it accumulate?
Gain of function mutation
– intranuclear aggregates
What part of the brain is usually atrophied with Huntington Disease?
Atrophy of the CAUDATE NUCLEUS
– later the putamen and frontal lobes
What part of the brain is usually atrophied with Huntington Disease?
Atrophy of the CAUDATE NUCLEUS
– later the putamen and frontal lobes
Anticipation: repeat expansions during spermatogenesis leads to an earlier onset of this disease
Huntington Disease