INP final - MENTAL HEALTH

Question 1

What can neuroimaging tell us about brain health status?

Answer 1

• Indicator of normal vs. abnormal neuropsychological functioning (ie. measures of metabolism such as glucose/oxygen consumption)
• Identify pathological features may be clinically meaningful/ aid in diagnosis (biomarkers: ie. lesions/abnormal proteins)
• Elucidate biological substrates of specific mental processes

Question 2

What is the clinical definition of Alzheimer’s disease?

Answer 2

• Most common form of dementia
• Gradual and progressive loss of cognition (memory) that impacts one’s ability to take care of oneself
• Cognitive decline is not attributable to other brain abnormalities
• Defined as presence of amyloid plaques and tangles (Tau); independent of cognitive function
• Atrophy of the brain, sometimes

Question 3

What is the amyloid cascade hypothesis?

Answer 3

Sporadic Alzheimers or familial Alzheimers

↑ Aβ levels, Aβ aggregation, ↓ Aβ clearance

Aβ oligomers and deposits cause inflammation and oxidative stress, as well as tau hyperphosphorylation and NFT formation

tau hyperphosphorylation and NFT formation lead to neuronal dysfunction which then leads to dementia

Question 4

What are general risk factors for the development of Alzheimer’s disease?

Answer 4

• Age
• Genes: ApoE4, Presenilin 1 & 2, APP (amyloid precursor protein)
• Female
• African American/Hispanic

Question 5

What are the vascular risk factors for AD development?

Answer 5

• Diabetes
• Insulin resistance
• Hypertension
• Atrial fibrillation
• Hypercholesterolemia
• Midlife central adiposity
• Apo

Question 6

Has diet been shown to reduce the risk of developing Alzheimer’s disease (AD)?

Answer 6

• Conflicting data on association between diet and AD

- nothing to support specific dietary reccs to modify AD risk

Question 7

What are the vascular risk factors for AD development?

Answer 7

• Diabetes
• Insulin resistance
• Hypertension
• Atrial fibrillation
• Hypercholesterolemia
• Midlife central adiposity
• Apo

Rationale: conditions listed above increase burden on brain vasculature. In particular, white matter is vulnerable because it is perfused by delicate arterioles. Damage to capillaries reduces delivery of nutrients and allows entry of toxic materials, increasing risk of neuronal damage.

Question 8

How well does the amyloid hypothesis apply to patient care?

Answer 8

• High proportion of non-demented older adults have significant amyloid deposition
• Amyloid reduction has failed to improve cognition
• Tau-related changes can occur before or in the absence of beta-amyloid

Question 9

Discuss the association with both micronutrients and macronutrients.

Answer 9

• Micronutrients: Neither dietary, supplemental, nor total intake of carotenes and vitamins C and E was associated with a decreased risk of AD (Luchesinger study)
• Macronutrients (fats): Supplementation with DHA compared with placebo did not slow the rate of cognitive and functional decline in patients with mild to moderate Alzheimer disease (Quinn study)
• Macronutrients (alcohol): Consumption of up to 3 servings of wine daily is associated with a lower risk of AD in elderly individuals without the APOE epsilon-4 allele.