neuro disorders

Question 1

Degenerative disorders

Answer 1

dementia
alzheier’s disease
multiple sclerosis
amyotrophic lateral sclerosis

Question 2

char of degenerative disorders (neuro)

Answer 2

progressive decline over decades (not solely d/t age

-fewer are rapid (months or years)

Question 3

dementia is a…

where does dementia present in r/t what

Answer 3

l/o neural fx

presents in varying unrelated disorders

Question 4

alzheimers disease (AD)

Answer 4

type of dementia (64% of all dementia)
progressive and irreversible
incidence inc w age (>65))

inc 2x with every 5yrs from 65-75 the incidence is 10-15%, >85 48%

Question 5

etiology of AD

Answer 5

~90% idiopathic (sporadic form)
apolipoprotein E gene? (implicated but unsure how)
~10% familial (genetic)
onset

Question 6

what is APP how is it involved in AD
PS1
PS2
chr 21

Answer 6

amyloid precursor protein gee. in type 2 DM when amyloid deposits it indicates damage

PS1-pre senelin 1 and 2

chr 21-if Downs pts lived long enough theyd likely dev AD

Question 7

patho of AD

Answer 7

atrophy of cerebral cortex
prominent sulci and slender gyri

amygdala and hippocampus affected (both are in temporal lobe)

sensory cortex unaffected

Question 8

where are amygdala and hippocampus. what are they. what do they do

Answer 8

theyre both in the temporal lobe. they are nuclei. they are a collection of special ganglion. these groups of ganglion have several types of connections to brain allowing response to env
hippocampus is beneath floor of ventricles fx is memory retention

Question 9

lesions of AD

Answer 9

1. neuritic plaques
   deposits of amyloid protein
2. neurofibrillary tangles (more of a problem
   resistant to breakdown
   persist after necrosis
   fibrous proteins in cytoplasm (this will change the shape of the cell)
   dec ACH

Question 10

how does the brain compensate for the loss in mass of the brain w AD

Answer 10

w the tissue dec in mass the ventricles will inc in size

Question 11

mnfts of AD

Answer 11

insidious onset

stage based progression over ~10yr

Question 12

mnft of mild AD (when does this last from

Answer 12

2-4yr
memory problems (often diff to detect as it could be from aging. usually detected by those around person not person themself)
-careless work habits
-familiar routine is manageable eg self care

Question 13

moerate AD mnfts (when does this occur)

Answer 13

2-10yr

• decline in cognition
• confusion
• language problems (speech and speech reception, comprehension)
  
  1. they will repeat words repetitive speech
  2. paraphasias-use of words int he wrong context
• some motor disturbance (usually w use of daily objects.) not all of these will present in all indiv
• indifference
• problems w ADLs

Question 14

severe ADmnfts.

lasts…

Answer 14

~2yrs

• severe mental impairment
• minimal voluntary movement
• no self care
• incontinence
• rigid, flexor posturing (hands clenched, elbows bent)

Question 15

Dx of AD

Answer 15

very diff to Dx

• no definitive test
• clinical presentation (detailed hx) person may present w 6-12mo depression beforehand
• exclude dementia from other causes
• EEG,CT, MRI, labs (also will look at HIV, syphilis, infarcts in brain)

Question 16

what labs are looked at to make AD Dx

Answer 16

CBC for anemia, CRP, dec B12, lytes

Question 17

what is an EEG

Answer 17

electroencephlogram-radiographic image of brain which meas fx

Question 18

Tx of AD and dementia

Answer 18

no cure

• symptomatic
• behavioural and env manipulations (eg safety)
• glutamate receptor blocker (in CNs glutamate is stimulatory. it enhances NTM fx. One aspect of AD may be a buildup of this drug eg Memantine $)
• Acetylcholinesterase inhibitors (this inc fx of Ach)
• low dose antipsychotics