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BB 2 > Dementia > Flashcards

Dementia Flashcards

1
Q

What differences between a dementia and a non dementia brain can be seen on a PET scan?

A

Neuronal loss
Hypometabolism
Loss of grey matter
Ligher

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2
Q

In which 3 areas of function is there a progressive decline in ability in dementia

A
  • Decline in memory and reasoning
  • Decline in communication skills
  • Inability to carry out daily activities
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3
Q

What behavioural and psychological symptoms are seen in dementia

A 
Agitation
Aggression
Wandering
Shouting
Repeated questioning
Sleep disturbance
Depression
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4
Q

4 non-modifiable risk factors for dementia

A
  • Age
  • Genetic predisposition
  • Family history
  • Downs syndrome
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5
Q

4 modifiable risk factor for dementia

A
  • Vascular risk factor
  • Cognitive inactivity
  • Environment
  • Depression
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6
Q

What 2 structures can be seen in the brain in dementia

A

Plaques

Tangles

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7
Q

What protein is present in senile plaques and cerebral vessels in alzheimers disease

A

Beta-amyloid peptide

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8
Q

What protein is present in neurofibrillary tangles

A

Hyperphosphorylated tau protein

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9
Q

Do cholinergic cells increase or decrease in number in AD

A

Decrease significantly

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10
Q

What % of AD cases are classified as early onset

A

<5%

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11
Q

Name the 3 genes identified to be involved in early onset AD

A 
Amyloid precursor protein (APP)
Presenilin 1 (PSEN1)
Presenilin 2 (PSEN2)
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12
Q

What kind of protein is amyloid precursor protein

A

Single transmembrane protein

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13
Q

Where is APP expressed normally (4)

A

Neurones
Glial cells
Endothelial cells
SMC

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14
Q

What is APP cleaved to form

A

Amyloidogenic A-beta peptides

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15
Q

What are mutations in APP associated with

A

Familial forms of early onset Alzheimers

Cerebral amyloid angiopathy

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16
Q

What does A673T mutation do

A

Decreases a-beta production and it protective of AD

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17
Q

What does PSEN1 encode for

A

PSEN1 encoding presenilin-1

This is a subunit of gamma secretase

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18
Q

How much mutations have been reported in

a) PSEN1
b) PSEN2
c) APP

A

a) 189
b) 24
c) 29

19
Q

What does PSEN2 encode for

A

Gamma sacretase- aspartyl protease responsible for A-beta generation

20
Q

What enzymes cleave APP (transmembrane polypeptide)

A

alpha, beta and gamma secretase

21
Q

Describe the APP processing pathway that is non-pathogenic

A
  • Alpha and gamma secretase cleave APP
  • Derives P3 and C83
  • No AD
22
Q

Describe APP processing pathway that is pathogenic

A
  • Beta and gamma secretase and generates a beta amyloid peptide (39-43)
  • This is a pathogenic peptide
23
Q

What 2 explanations have been suggested to explain amyloid proteins involvement in AD

A
  • Overproduction of amyloid and oligomers

- Inability to remove amyloid

24
Q

What are the sequence of steps that result in familial forms of AD (10)

A
  • Genetic missence mutations in APP, PS1, PS2
  • Increased proteolysis and production of APP
  • Progressive accumulation of a-beta in brain interstitial fluid
  • Deposition of aggregated A-beta40/ a-beta42 as plaques
  • Inflammatory response
  • Progressive neuritic injury within amyloid plaques
  • Disruption of neuronal metabolism and ionic homeostasis
  • Altered kinase/ phosphatase activity– hyperphosphorylated tau
  • Formation of hyperphosphorylated tau protein
  • Widespread neuronal/ neuritic dysfunction and death in hippocampus and cerebral cortex
25
Q

What is the inflammatory response seen in familial forms of AD

A

microglial activation

astrocytosis and acute phase protein release

26
Q

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

A

Apolipoprotein E

27
Q

What is apolipoprotein E

A

Secreted lipoprotein involved in cholesterol metabolism

28
Q

What are the 3 isoforms of ApoE and which is the greatest risk

A

ApoE2, E3 and E4

29
Q

Where is ApoE4 polymorphorphism located

A

Chromosome 19

30
Q

What does ApoE4 protein do

A

Decreases clearance of extracellular a beta

31
Q

What is the normal function of Tau protein

A

Stabilises microtubules through 4 tubulin binding domains in case of the longer isoform

32
Q

What is the effect of phosphorylating tau

A
  • Binding of tau to microtubules normally maintained in equilibrium by kinases and phosphatases
  • Phosphorylation regulates activity to bind to microtubules and can affect axonal transport
33
Q

What is MAPT

A

Encodes microtubule associated protein Tau

34
Q

What form of dementia are MAPT mutations related to

A

Frontotemporal dementia

35
Q

How do amyloid csf levels change as disease progresses and why

A

They decrease because all amyloid goes into the plaques

36
Q

How do tau csf levels change as disease progresses

A

Increases

37
Q

3 blood based biomarkers seen in AD

A

Protein
DNA/ RNA
Lipids

38
Q

What are MRI used for in AD?

A

See things such as hippocampal loss

Ruling out of other causes

39
Q

Which cholinergic pathways degenerate in AD

A

Forebrain pathways innervating cortical and limbic structures

40
Q

Effect of blocking acetylcholinesterase

A

Increases failing cholingeric signal

41
Q

2 categories of drugs used to treat AD

A

Acetylcholinesterase inhibitors

NMDA receptor antagonists

42
Q

Name 3 acetylcholinesterase inhibitors

When are they used

A

Donepezil, galantamine and rivastigmine

Used for management for mild to moderate Alzheimers disease

43
Q

Name a NMDA receptor antagonist

When is it used

A

Memantine

Moderate Alzheimer’s disease who are intolerant/ contraindication to AChE inhibitors

44
Q

Name some examples of disease modification therapies

A 
Anti-fibrillation
Secretase inhibitors
Increased clearance
Immunisation
GSK3 inhibitors

BB 2 (28 decks)

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