Week 11 (Test 4) Flashcards
What are the characteristic gross findings in an Alzheimer’s brain?
neuritic plaques and neurofibrillary tangles are the characteristic findings in Alzheimer’s disease
Which parts of the brain are primarily effected by Alzheimer’s?
temporal and parietal lobes
Alzheimer’s has been linked to what allele?
ApoE4 allele
What’s the most common frontotemporal dementia?
Pick’s disease
Personality changes & disinhibition are often present initially, rather than appearing later as in other types of dementia.
frontotemporal dementias
What’s the triad of symptoms for normal pressure hydrocephalus?
Wet, wacky, and wobbly
(Triad of dementia, gait apraxia, & incontinence)
- Can include mutism, vision disturbances
- Associated with movement findings
- Gait disturbance
- Myoclonic jerks
CJD
- Macrocytic anemia
- Glove stocking sensory loss and loss of vibratory sense
- Dementia can be presenting symptom
Vitamin B 12 deficiency
What are the 3 Acetylcholinesterase Inhibitors used to treat dementia?
Donepezil, rivastigmine, galantamine
the only FDA approved agent with glutamate blockade for dementia
memantine
What’s the mechanism of action of Memantine?
NMDA receptor antagonist; prevents glutamate-mediated cell death via excitotoxicity.
- memory for events, experiences or facts that are available to conscious recall.
- Episodic – recollection of contextually specific events (e.g., place, time, environment, happenings, etc…).
- Semantic – knowledge of facts (e.g., vocabulary, statistics, etc…).
declarative long term memory
behavioral learning, skill acquisition, habit formation, classical conditioning; operating without conscious awareness.
procedural long term memory
inability to learn or recall new information
anterograde amnesia
– inability to recall previously learned information
retrograde amnesia
Patients with _____ have difficulty in retaining verbal material (e.g., prose, word lists, verbal paired associate learning).
left medial temporal lesions
Patients with ______ have difficulty learning nonverbal, patterned stimuli like geometric figures, faces, tonal patterns, and visual and tactile mazes.
right medial temporal lesions
What’s the main characteristic to remember with delirium?
symptoms are WAXING AND WANING
What class of medications is considered the most “deliriogenic”?
Anticholinergics
What’s the mainstay med for treating delirium?
Haloperidol (Haldol)
What drug class do you avoid when treating delirium?
benzos
EtOH/sedative withdrawal presents a special case of delirium and __________ are used for management
benzodiazepines
What are the Atypical Antipsychotics used to treat delirium?
risperidone, quetiapine, olanzapine, ziprasidone, and aripiprazole.
How would a mutation in Presenilin-1 lead to Alzheimer’s?
Presenilin-1 (PS-1) is a membrane protein in the endoplasmic reticulum (ER);
- Mutations in PS-1 increase Ca2+ release
- Enhanced Ca2+ release triggers further Ca2+ influx through Ca2+ channels
- Altered Ca2+ homeostasis leads to apoptosis and excitotoxicity
- Increased Ca2+ also alters APP processing to increase Aß protein production.
The ApoE gene associated with Alzheimers is located on which chromosome?
19
Which ApoE allele is considered protective ?
ApoE e2
Which ApoE allele is associated with an increased risk of Alzheimers?
ApoE e4
What are Neurofibrillary tangles (in Alzheimers) composed of?
Composed of tau protein, a micro-tubule-associated protein (MAP)
In Alzheimer’s, what’s wrong with the Tau proteins?
tau protein is excessively phosphorylated, interfering with its normal function and resulting in tangled neurofilament fibers
What’s the observed pathology in Huntington’s?
- Pathology: Atrophy of caudate nucleus in basal ganglia, diffuse cortical atrophy
- Loss of cholinergic and GABAergic neurons in the caudate and putamen
Lewy body dementia has prominent ______.
visual hallucinations
cause loss of executive function, disinhibition and poor social functioning with relatively well preserved memory.
frontotemporal dementias (like Pick’s disease
- due to problems with Tau proteins
What are Lewy bodies composed of?
composed of alpha-synuclein
Patients who can speak fluently but have trouble understanding and whose speech makes no sense
Wernicke’s aphasia
Patients who can understand but have trouble getting words out or speaking fluently
Broca’s aphasia
What would you find in the CSF of a patient with meningitis?
CSF: normal or elevated pressure,
- increased WBCs
- increased protein
- normal or low glucose.
