Overview 3 Flashcards
1
Q
Most common form of dementia is?
A
AD
2
Q
Four non-modifiable risk factors for dementia are?
A
Age
Genetics
Family history
Down syndrome
3
Q
Greatest risk factor for onset of dementia is?
A
Age
4
Q
Four modifiable risk factors leading to dementia?
A
Vascular - cholesterol, hypertension
Cognitive inactivity
Environment - head injury
Depression
5
Q
Two protein components that are characteristic of AD are?
A
Beta-amyloid plaques
Neurofibrillary tangles of protein Tau
6
Q
Significant loss of what cells occurs in the brain of someone with AD?
A
Loss of cholinergic cells
7
Q
Genes causing early onset AD? x3
A
APP
PSEN1
PSEN2
8
Q
APP is on which chromosome?
A
21
9
Q
PSEN1 is on which chromosome?
A
4
10
Q
PSEN2 is on which chromosome?
A
1
11
Q
Why are those with Downs syndrome more susceptible to the development of AD?
A
Three lots of chromosome 21 - more chance of mutation of APP gene
12
Q
Function of PSEN proteins?
A
Cleavage of APP
13
Q
APP stands for?
A
Amyloid precursor protein
14
Q
APP expressed in which cells? x4
A
Neurones
Glial cells
Endothelial cells
Smooth muscle cells
15
Q
Number of mutations in APP that are possible?
A
29
16
Q
APP mutation that is protective of AD is?
A
A673T
17
Q
PSEN1 and PSEN2 are subunits of what?
A
Gamma-secretase
18
Q
PSEN1 and PSEN2 - which is common and which is rare?
A
PSEN1 - common
PSEN2 - rare
19
Q
What is the type of mutation that occurs in PSEN2?
A
Missense
20
Q
What are the three different secretase enzymes that can cleave APP protein?
A
Alpha-secretase
Beta-secretase
Gamma-secretase
21
Q
Two possible amyloid pathways are?
A
Amyloidogenic
Non-amyloidogenic
22
Q
Which of the amyloidogenic pathways are pathological?
A
Amyloidogenic
23
Q
Secretase enzymes involved in the non-amyloidogenic pathway is? x2
A
Alpha-secretase
Gamma-secretase
24
Q
Secretase enzymes involved in the amyloidogenic pathway is? x2
A
Beta-secretase
Gamma-secretase
25
Toxic species generated from the amyloidogenic pathway is?
Oligomers
26
Why are oligomers dangerous?
These are neurotoxic
27
Inflammatory response occurs in AD - what cells are activated?
Microglia
28
Activated microglia release what component?
TNF-alpha
29
Why are oligomers toxic?
Can signal to normal beta-amyloid protein to misfold itself and adopt the mutated form of beta-amyloid that is formed from the amyloidogenic pathway
30
Gene resulting in development of late onset AD is?
Apolipoprotein E
31
Apolopoprotein E found on which chromosome?
19
32
Early onset AD occurs at what age?
40-50 years
33
Late onset AD occurs at what age?
60+ years
34
Three isoforms of ApoE are?
ApoE2
ApoE3
ApoE4
35
Isoform of ApoE causing development of late onset AD is?
ApoE4
36
Isoform of ApoE that is protective to the development of AD is?
ApoE2
37
Tangles of what form in AD?
Neurofibrillary tangles of the protein Tau
38
Normal function of Tau is?
Stabilisation of microtubules to ensure neurones receive the correct components e.g. ATP required for their function
39
Consequence of hyperphosphorylation of Tau?
Causes Tau to dissociate off of the microtubules
40
What is the gene that encodes the protein Tau?
MAPT
41
Are mutations in the MAPT gene associated with the development of AD?
No
42
Looking at CSF - what will be seen in someone with AD?
Less amyloid present in the CSF
Amyloid is accumulating in the brain as plaques
43
MRI scan for diagnosis for AD will show?
Neuronal loss - cortex and hippocampus
| Enlarged ventricles
44
Loss of what neurones in AD?
Cholinergic
45
How can the cholinergic effects of AD be treated?
Administer acetylcholinesterase inhibitors
46
Name three acetylcholinesterase inhibitors
Donepezil
Rivastigmine
Galantamine
Don't Rivers Galantamine
47
Contraindication of AChE inhibitors in patient - what drug might be used?
NMDA receptor antagonists
48
Indication for use of AChE inhibitors vs. NMDA receptor antagonists?
AChE inhibitors - mild to moderate AD
NMDA receptor antagonists - moderate to late disease
49
NMDA receptor antagonist main one used is?
Memantine
50
Why are NMDA receptor antagonists used to treat AD?
Some form of excitotoxicity occurs in AD and this prevents htis
51
Nucleus that controls the sleep wake cycle i.e. circadian rhythm is?
Suprachiasmatic nucleus
52
Suprachiasmatic nucleus is located where?
Hypothalamus
53
Two neuronal systems involved in wakefulness are?
Cholinergic systems
| Monoaminergic systems
54
Neuronal system involved in sleep is?
GABA
55
One sleep cycle lasts how long?
90 minutes
56
What are the three stages of the sleep-wake cycle?
REM
NMREM
SWS
57
What is SWS in the sleep-wake cycle?
Slow wave sleep
58
Function of sleep on memories?
Consolidation of memories
59
Three forms of insomnia are?
Transient - jet lag
Short term - illness
Chronic - underlying cause
60
Two drugs used to treat insomnia are?
Benzodiazepines
| Z-drugs
61
Main difference between benzodiazepines and z-drugs?
Benzodiazepines - long half life - not good for short period of sleep
Z-drugs - short half life
62
Benzodiazepines/z-drugs - which is more popular for treatment of insomnia?
Z-drugs (short half life)
63
Unwanted side effects of benzodiazepines? x5
```
Change in sleep patterns
Daytime sedation
Insomnia
Tolerance
Dependence
```
64
Why should prolonged usage of hypnotics be avoided?
Dependence
65
Treatment for chronic insomnia is?
CBT
66
What is orexin?
Peptide
67
Where is orexin produced?
Hypothalamus
68
Two forms of orexin?
A and B
69
Orexin is also known as?
Hypocretin (1 and 2)
70
Three functions of orexin?
Arousal regulation
Appetite regulation
Wakefulness regulation
71
Deficiency in orexins results in?
Narcolepsy
72
What is narcolepsy?
Excess sleepiness - falling asleep in the day
73
Anxiety disorders are more common in m or f?
Female
74
Two neurotransmitters involved in anxiety are?
GABA
| Monoamines
75
Key region in the brain related to anxiety?
Amygdala
76
Five genes associated with anxiety development?
```
COMT
CCK
Adenosine A2
MAOa
5-HT2
```
77
Anxiolytic group that is no longer used is?
Barbituates
78
Four groups of anxiolytics?
Benzodiazepines
5-HT1a agonists
Beta-adrenoreceptor antagonists
SSRIs
79
Function of barbituates?
Very strong CNS depressants
80
Four adverse effects o barbituates?
Major drug dependence
Tolerance
Fatal in overdose
Withdrawal syndrom
81
Key target of most anxiolytic drugs is?
GABAergic synapse
82
Function of benzodiazepines at GABAa receptor?
Positive allosteric modulators - causes the channel to open more frequently
83
Function of barbituates at GABAa receptor?
Positive allosteric modulators - causes the channel to open for longer
84
Function of benzodiazepines vs. barbituates?
Benzo - increase frequency
| Barbituate - increase duration
85
Drug that should be given in a benzodiazepine overdose is?
Flumazenil
86
Function of flumazenil?
Antagonist at benzodiazepine receptor
87
Flumazenil - short or long half life?
Short
88
What is buspirone?
Anxiolytic
89
Five issues of benzodiazepine use in the elderly?
```
Psychomotor impairment
Increased risk of falls
Daytime drowsiness
Intoxication
Amnesia
Depression
```
90
Z drugs bind to which subunits of GABAa receptor?
Alpha subunit
91
Z drugs bind to which subunits of GABAa receptor for hypnotic purpose?
alpha-1
92
Z drugs bind to which subunits of GABAa receptor for anxiolytic purpose?
alpha-3
93
Long term memory involves what region of the brain?
Hippocampus
94
Two types of long term memory are?
Declarative/explicit
| Non-declarative/implicit
95
Declarative memory is?
Conscious and intentional memory of factual information and experiences
96
Non-declarative memory is?
Memory acquired unconsciously e.g. skills/behaviours
97
Two types of declarative memory?
Episodic memory
| Semantic memory
98
Episodic memory is?
Form of declarative memory - going back in time to remember personal events
99
Semantic memory is?
Recalling general facts and facts about the world e.g. 2+2=?
100
Is short term memory involved with 'learning and memory'?
No
101
Spatial memory is?
Memory responsible fo recording information based on one's environment and spatial orietnation
102
Spatial memory involves what part of teh brain?
Hippocampus
103
Three types of amnesia?
Anterograde
Retrograde
Dissociative
104
Amnesia is?
Partial or complete loss of memory
105
Anterograde amnesia is?
Cannot transfer new events into long term memory (Henry M)
106
Retrograde amnesia is?
Cannot recall events that occurred prior to onset of amnesia
107
Dissociative amnesia is?
Blocking out critical personal information of a traumatic/stressful nature
108
Long term potentiation is?
Strengthening of synapses due to repetition
109
Receptors involved in LTP?
NMDA glutamate
110
Long term depression is?
Reduction in strength of synapses due to lack of repetition
111
Definition of consciousness is?
Ability of an individual to react appropriately to a stimuli in the outside world
112
Consciousness measured via?
Glasgow Coma scale
113
Part of the brain controlling consciousness is?
Cerebral cortex
114
EEG shows what?
Activity of neurones in the cerebral cortex
115
EEG of someone in coma?
No electrical activity
116
EEG of someone in sleep?
In certain stages - EEG represents that of someone awake and at some points, represents that of someone that is unconscious
117
Normal sleep is known as which stage of sleep?
Slow wave sleep
118
Function of slow wave sleep? x3
Increased growth and rejuvenation of the immune system
of the nervous system
of skeletal and muscular systems
REST AND REPAIR
119
What hormone is secreted during slow wave sleep? x2
Growth hormone
| Leptin
120
Cortisol levels during sleep?
Decreased
121
Blood pressure during normal/slow wave sleep?
Reduced - nocturnal dipping
122
Lack/diminished nocturnal dipping indicates what?
Predictor of cardiovascular disease
123
How many stages are there in sleep?
4 + 1 stage of REM
124
Stages 1-4 repeat how often?
Every 90 minutes
125
EEG of REM sleep represents?
EEG of REM is similar to that of someone that is awake
126
More synchronisation on EEG represents?
Less conscious the individual
127
Key control centre of sleep located where?
Reticular formation of the PONS
128
Reticular formation of the pons is regulated by what?
Hypothalamus
129
Effect of ghrelin on sleep?
Inhibitory action on sleep
130
Effect of CCK on sleep?
Increases sleepiness
131
Effect of adenosine on sleep?
High adenosine induces sleep
132
Effect of caffeine on adenosine?
Caffeine - antagonist at A1 adenosine receptor
133
Reticular formation located where?
Pons
134
Why does caffeine effect sleep?
Adenosine - induces sleep
| Caffeine - antagonist of adenosine at A1 receptor
135
Histaminergic neurones located in which nucleus?
Tubermamillary nucleus
136
Histamine neurones during wake/sleep?
Active during wake
| Silent during sleep
137
Effect of antihistamines on wake/sleep?
Cause drowsiness - histamine is silent during sleep
138
Diurnal rhythms controlled by which nucleus?
Suprachiasmatic
139
Reticular formation is key control of what?
Sleep
140
Cause of narcolepsy?
Lack of orexins
141
Orexins are found where in the brain mainly?
Posterior hypothalamus
142
Orexins cause release of which four neurotransmitters?
Acetylcholine
Noradrenaline
Serotonin
Dopamine
143
Pedunculopontine nuclei neurones project to where?
Thalamus
144
Nucleus basalis/basal forebrain nucleus contains neurones of which neurotransmitter?
Cholinergic neurons
145
What percentage of AD patients have sleep disorders?
70%
146
Serotonin - increase or decrease during sleep?
Decrease
147
Noradrenaline - increase or decrease during sleep?
Decrease
148
Acetylcholine - increase or decrease during sleep?
Increase
149
Acetylcholine activates what two areas of the brain?
Thalamus
| Cortex
150
Lack of memory of dreams is due to lack of production of which neurotransmitter?
Noradrenaline
151
Amphetamine/cocaine - prevents sleep due to the production of which neurotransmitter?
Dopamine
152
SSRis interfere with which stage of sleep?
REM sleep
153
TCAs promote sleep how?
Block histamine H1 receptors
154
Function of REM sleep? x2
Memory consolidation
| Removal of junk and defragmentation of memories
155
Motor cortex - active or inactive during sleep?
Active
156
What normally prevents e.g. sleep walking during seep?
Inactivation of LMNs
157
Inactivation of LMNs during sleep is mediated via which two neurotransmitters?
Serotonin
| Dopamine
158
Unconditioned stimulus is?
Stimulus that already elicits a response e.g. food
159
Unconditioned response is?
A response that does not need to be learned e.g. salivating to food
160
Conditioned stimulus is?
Previously neutral stimulus which the individual now responds to e.g. bell
161
Conditioned response?
Learned response e.g. salivating to sound of a bell
162
What is the Garcia effect?
Avoid eating certain food/drink due to past unpleasant experience
163
Theory of tolerance (in classical conditioning) is?
Cessation of conditioned stimulus intake does not break the association of the conditioned response from the conditioned stimulus
164
What is 'flooding'?
Place client into a situation which is anxiety inducing but where no harm can come to them
165
Operant conditioning - what is fixed ratio reinforcement?
Positive/negative reinforcement given after every response
166
Operant conditioning - what is variable ratio reinforcement?
Reinforcement is not stable and is randomised - most effective
167
Mortality rate of severe head injury?
25%
168
Munroe-kelly doctorine states what?
Fixed cranial compartment (skull) - if one of the constituents increase then there is a rise in ICP
169
Three constituents stated by the Munro-kelly doctorine are?
Brain
CSF
Blood
170
Equation of ICP and cerebral perfusion?
CPP = MAP - ICP
171
Effect of increased ICP on cerebral perfusion?
Cerebral perfusion will decrease
172
Uncus is part of what lobe?
Temporal lobe
173
Two layers of the dura mater are?
Periosteal layer
| Meningeal layer
174
High ICP - good or poor outcome?
Poor
175
How is the pain tolerance ratio calculated?
Time in trial 1 (experiment) / time in the baseline (control)
176
How is the pain intensity ratio calculated?
Mean score in trial 1 / mean score in the baseline
177
What region of the brain is specifically effected in MS?
Medial longitudinal fasciculus (MLF)
178
Region responsible for memory relay/transmission prior to storage is?
Fornix
179
Region responsible for memory storage is?
Hippocampus
180
Region responsible for memory formation is?
Cingulate cortex
181
Middle meningeal artery enters the cranial cavity via which foramen?
Foramen spinosum
182
Uncal herniation occurs where?
Lateral to brainstem
183
Tonsillar herniation occurs where?
Posterior - by the cerebellar tonsils
184
Subfalcine herniation occurs where?
Posterior by the cerebellum
185
What passes through the cribriform plate?
CNI
186
What passes through the optic canal?
CNII
187
What passes through the superior orbital fissure? x4
CN III
CN IV
CNV1
CNVI
188
What passes through the sella turcica?
Hypophysis
189
What passes through the foramen rotundum?
CNV2
190
What passes through the foramen ovale?
CNV3
191
What passes through the foramen lacerum?
Petrosal nerve
192
What passes through the foramen spinosum?
Middle meningeal artery
193
What passes through the internal auditory meatus? x2
CNVII
| CNVIII
194
What passes through the jugular foramen? x4
Internal jugular vein
CNIX
CNX
CNXI
195
What passes through the hypoglossal canal?
CNXII
