Neurological Disorders

Question 1

Degenerative Disorders a type of neurological disorder, are they usually progressive, or rapid?

Answer 1

Usually progressive decline over decades.

Some are rapid (few years)

Question 2

Define Dementia:

Answer 2

Loss of ordered neural function (loss of cognition, memory, language etc.)

Question 3

Is Dementia a disease?

Answer 3

No. Dementia is a manifestation of several unrelated disease

Question 4

Alzheimer(‘s) Disease (AD) is a form of what? Explain the term ADT?

Answer 4

Form of Dementia.

Dementia of the Alzheimers Type

Question 5

Is AD progressive? What else is it?

Answer 5

Progressive and Irreversible

Question 6

At what age do the incidence of AD increase?

Answer 6

65 and above

Question 7

What is the Et of AD?

Answer 7

1. 90% idiopathic

2. 10 % familiar

Question 8

1. What gene does the idiopathic Et involve?

2. At what age would idiopathic AD present?

Answer 8

1. Apolipoprotein on E gene (APOE)

3. over 65

Question 9

What does apolipoprotein cause to form?

Answer 9

Lipoproteins

Question 10

1. The familiar etiology of AD usually occurs at what age?
2. What Chrm are involved?
3. What 3 Genes are involved?

Answer 10

1. Before 65 years
2. 1, 12, 14, 19, 21
3. APP, PS1, PS2

Question 11

1. APP stands for what? What chrm is it on?
2. What does this form a precurser to?
3. If the gene is defective, what occurs?

Answer 11

1. Amyloid Precussor Protein, Chrm 21
2. Forms precurser to amyloid
3. Accumulation of Amyloid

Question 12

PS 1 /2 stands for what?

Answer 12

Presenilin Gene

Question 13

1. PS1 is on what Chrm?

2. PS2 is on what Chrm?

Answer 13

1. Chrm 14

2. Chrm 1

Question 14

Since AD has chromosome 21 involved, what does this link the disorder to?

Answer 14

Down Syndrome

Question 15

Pathophysiology of AD involves what?

Answer 15

Atrophy of Cerebral Cortex

Question 16

The cortex is affected in the sulci and the gyri, what does it cause to occur to each of these?

Answer 16

1. Sulci = prominant dips

2. Gyri = Thinner tissue

Question 17

What 2 Part of the brain are affect in AD?

1. A
2. H

3.What are both of these? (the term for specialized ganglia in a group)

Answer 17

1. Amygdala
2. Hippocampus
3. Nuclei

Question 18

Where is the Amygdala? What is it involved in?

Answer 18

Temporal Lobe, involved in response to our enviorment

Question 19

Where is the hippocampus? What is it involved in?

Answer 19

Temporal Lobe, involved in maintaining memory

Question 20

Is the sensory cortex affected in AD?

Answer 20

No, the person is still able to feel touch

Question 21

The lesions in AD develop d/t to what?

Answer 21

Accumulation of proteins in the neurons

Question 22

What are the 2 Lesions involved in AD?

Answer 22

1. Neuritic Placques

2. Neurofibrillary Tangles

Question 23

What are the Neuritic Placques? Where are they?

Answer 23

Deposits of Amyloid Protein, usually at the terminal ends of a neuron

Question 24

What are the neurofibrillary Tangles? Where are they?

Are they resistant to breakdown? This means that what happens after you die?

Answer 24

Fibrous proteins in cytoplasm

Yes, still present after death

Question 25

The lesions cause an increase or decrease of ACH?

Answer 25

Decrease

Question 26

What does the decrease of ACH stand for? | What is it?

Answer 26

Acetylcholine | Neurotransmitter

Question 27

1. Describe the Mnft's of AD? | 2. What are the stages based on? Over how long?

Answer 27

1. Insidious onset | 2. Based on Progression (~10 yrs)

Question 28

What are the 3 stages of AD classified as? How long does each stage last? Is there a distinct change between one stage and the next?

Answer 28

1. Mild (2-4 yrs) 2. Moderate (2-10yrs) 3. Severe (2 yrs) There is no distinct change. They overlap

Question 29

The Mnfts of mild AD are what 3 things?

Answer 29

1. Memory problems (often family member notices this) 2. Careless work habits 3. Familiar routine manageable (ADL's are not affected)

Question 30

What are the Manifestations of Moderate AD? (6)

Answer 30

1. Declining in cognition 2. Confusion (where am i? what am I doing?) 3. Language problems (receptive, ability to speak, same question) 4. Some motor disturbance (using knife/fork) 5. Indifference (lack of interest) 6. Problems with ADLS

Question 31

What are the manifestations of sever AD? (5)

Answer 31

1. Severe mental impairment 2. minimal voluntary movement 3. no self care (requires hep with all ADLS) 4. incontinence 5. Rigid, flexor posturing

Question 32

Explain what a patient with sever AD would flex like?

Answer 32

Flexed at elbows and writs qlenched

Question 33

How do you Dx AD? Is it easy?

Answer 33

Very difficult to dx. 1. Dx on clinical presentation (initially very vague in the beginning stages of the disease) 2. Exclude the other ways that dementia can be caused (example exclude vascular or toxic dementia) 3. EEG, CT, MRI, Labs

Question 34

Is there a difinivite test for AD?

Answer 34

No

Question 35

Explain the following: 1. EEG: 2. Labs:

Answer 35

1. Electroencephalogram = test or record of brain activity | 2. Ex. Vitamin B12 associated with dementia, so look for these levels

Question 36

What does the treatment for AD include?

Answer 36

1. no cure 2. Symptomatic 3. Behavioral / Enviornmental Manipulations 4. Pharmacologic

Question 37

What are the pharmacologic interventions?

Answer 37

1. Glutamate Receptor Blocker 2. Ach-esterase Inhibitors 3. Low dose antipyschotic drugs (ex: risperidone) 4. Antidepression Drugs (ex: effexor) May also be on.... Statins (cholesterol lowering drugs), ASA (blood thinner) and symptomatic management

Question 38

What does the Glutamate Receptor Blocker do? Is it a good thing in small levels? (explain why) What is an example?

Answer 38

Blocks the receptor, therefore it cant bind because high levels of the glutamate can become neurotoxic. It is good in small levels because it increases neurofunction, problem occurs if it builds up. Ex: Memantine

Question 39

What does the Ach-esterase inhibitor do? What is an example?

Answer 39

Inhibits enzyme that breaks up ACh, therefore the small ammoutns that are present are not broken down. Ex: Aricept