Intro Flashcards
When was dementia clinically recognised and by who and how?
It was recognised as a medical term in 1797 by Philippe Pinel when we realised memory loss and physiological confusion across patients.
How did Alzheimers disease become identified, when and by who?
In 1906 by Alzheimer when he had a women patient that had symptoms of short-term amnesia, memory loss, disorientation and dysphasia (impairment in speech).
After her death, he monitored the brain and found pathological changes in the brain which he termed plaques and tangles, along side an enhanced neuroinflammation.
These were within the cerebral cortex.
However, it only became termed Alzheimers by his collaborateor Kraepelin.
What is the cerebral cortex important for?
memory, language, judegemnt, thinking
What are the prevalence statistics of AD?
~500,000 in UK
60% of cases
reach 1.1 million by 2030
1.6 million by 2050
List the modifiable and non-modifiable risk factors of AD.
Modifiable - diet, educatonal level, social interaction, comorbidities, physical exercise
Non-modifiable - genetics, age, sex
How can diets be a risk factor? How have they shown this?
They have monitored mediterranean diets or groups of poplethat have a high intake of vitamen E and C and monitored their association with developnent of AD.
They found that these diets had a reduced risk of developing AD – perhaps due to antioxidants egffects.
How might education cause a greater cognitive reserve?
It is thought that the higher education will result in a brain that has greater neuronal synaptoc strength with strong connections.
How can type 2 diabetes increase the risk of developing AD?
It can by 50%
insulin and AB compete for use of insulin degrading enzyme - this is an enzyme that can work to degrade AB which therefore will end up in the accumulation in the brain.
Increased formation of advanced glycosylation end products which increase neuronal damage upon action on their receptors.
How can sports cause increases risk of AD?
becuae it causes tramatic brain injury which will cause an increase in pathological functions in the brain.
Havign apoe4 is thought to enhance this risk.
What does dichotomous disease mean?
This means there are two forms of the disease.
What are the two types of AD and how arer they characterised?
Familial - less dominent form, highly genetic background, early onset, mutations in PSEN and APP
Sporadic - more dominent, late onset, combination of genetic and environmental factors
What is mendelian inhertance?
This refers to how the genes have been passed through a damily based on the laws of Mendel.
It means that gene inherited from either parent segregates into gametes at an equal frequency.
What does autosomal dominent mean?
Autosomal dominant traits pass from one parent onto their child. Autosomal recessive traits pass from both parents onto their child.
Hardy and Higgons are big players how and why?
In 1991, Hardy’s team uncovered the first mutation directly implicated in Alzheimer’s disease leading to the formulation of the highly influential ‘amyloid-cascade’ hypothesis.
Higgons also involved in devlopment on this hypotheiss.
What is APP and what mutations were found?
Amyloid precursor prtoesin that is found on chromosome 21
Dutch - Frangionne
London - first link to AD - Goate 1991
and more
This tends to clustres in regions of the gene which cause enhanced cleavage and production of long fibrillogenic forms.
What is PSEN and what mutations were found?
PSEN is the presenelin protein which are subunits of the gamma-secretase enzyme.
Several mutations have been found which tend to involve a loss of function gamma secretase, impairing the cleavage of APP and therefore, promotirng abnormal AB secretion
What are GWAS? What have they found?
This is an approach used to find genetic mutations in diseased patients. THey use the full genome of humans and search for small variations called single nucleotide polymorphims
This SNP is when one nucleotide in the DNA chain is swapped for another, thereby affecting transcription and normal activity of the protein.
For SAD, they have foound APOE. complement receptor 1. clusterin, PICALM.
What is APOE and what are the different alleles?
APOE is a gene which generates apolipoprotein E which is a glycoprtoein that is involved in transport of choleterol trhough the CNS. It is generally produced by immine cells. It has also been found to bind to AB and promote its transport around the brain, while regulating metabolidm and clearance.
It has been found to have 3 major alleles which are basically three different mutated forms of the gene and involve residues 112 ans 158.
e4 is the biggest risk and increases it by 40fold with one copy and 10-fold with two copies.
What is the allelic ratio?
The likelihood that the allele will occur, calculated by creating a ratio of the area under the curve for the allele and the wild-type gene.
What is trem2?
A gene that is a transmembrane lipoptotein sensor that is largely involved in the regulation of microglia. It forms a receptor-signalling complex with TYROBO.
What mutations in trem2 have been found?
missense mutation (where the change un nuelcotide will change the amino acid) which loses regulation of microglia and increases neurodegeneration.
What are the statistics with age risk factor?
Why is it thougt this occurs?
1 in 14 over 65
1 in 6 over 80
Age related changes in the brain –> atrophy, inflammation, vasculat damage, oxidative stress
Why might oestrogen be protective for females? How did they determine this?
strogen affects cholesterol and lipid transport, and in the brain, estrogen regulates the expression of low-density lipoprotein receptor-related protein, which has been implicated in Aβ processin
It also binds to its ERalpha/beta recpetors which can be found on glial cells, specifically microglia and promote their regulation.
In some sutdies its effect have promoted normal regulation of microglia, preventing its effect on oxidative stess and preventing acitvation of receptors by AB.
What do the genetic studies show for sex differences?
They show differences in neuroinflammatory pathways, synaptic function and apoptosis.
How? ,.