Podcast
Questions and Answers
What percentage of synapse density loss is typically observed in patients with Alzheimer's Disease (AD)?
What percentage of synapse density loss is typically observed in patients with Alzheimer's Disease (AD)?
- 20%
- 80%
- 60%
- 40% (correct)
Which cognitive assessment is mentioned as a widely used test of cognitive function in relation to AD?
Which cognitive assessment is mentioned as a widely used test of cognitive function in relation to AD?
- Mini-Mental State Exam (MMSE) (correct)
- Montreal Cognitive Assessment (MoCA)
- Wechsler Adult Intelligence Scale (WAIS)
- Cognitive Assessment Screening System (CASS)
What is the projected number of Canadians living with dementia in 15 years?
What is the projected number of Canadians living with dementia in 15 years?
- 564,000
- 1.1 million
- 937,000 (correct)
- 1.5 million
Which brain structures are primarily associated with early synaptic dysfunction in Alzheimer's Disease?
Which brain structures are primarily associated with early synaptic dysfunction in Alzheimer's Disease?
What is the estimated annual cost to Canadians for caring for those living with dementia?
What is the estimated annual cost to Canadians for caring for those living with dementia?
What describes the typical progression of Alzheimer's Disease in relation to daily living activities?
What describes the typical progression of Alzheimer's Disease in relation to daily living activities?
What is the average global population affected by Alzheimer's Disease?
What is the average global population affected by Alzheimer's Disease?
Which of the following statements is true regarding mild cognitive impairment in AD?
Which of the following statements is true regarding mild cognitive impairment in AD?
What role does synaptic density play in cognitive function decline in Alzheimer's Disease?
What role does synaptic density play in cognitive function decline in Alzheimer's Disease?
What is the projected number of Canadians directly or indirectly affected by Alzheimer's Disease?
What is the projected number of Canadians directly or indirectly affected by Alzheimer's Disease?
Which of the following statements best describes the cause of certain neurological impairments in neurodegenerative conditions?
Which of the following statements best describes the cause of certain neurological impairments in neurodegenerative conditions?
What impact do neurodegenerative disorders have on neural activity?
What impact do neurodegenerative disorders have on neural activity?
What is a major focus for therapeutic interventions in neurological diseases?
What is a major focus for therapeutic interventions in neurological diseases?
What observation about Alzheimer's Disease patients is noted in comparison to control subjects?
What observation about Alzheimer's Disease patients is noted in comparison to control subjects?
What type of diseases are included under neurodegenerative disorders in the lecture outline?
What type of diseases are included under neurodegenerative disorders in the lecture outline?
Which of the following best represents the cyclical nature of network activity in neurodegenerative disorders?
Which of the following best represents the cyclical nature of network activity in neurodegenerative disorders?
Which local circuit condition is associated with neurodegenerative disorders?
Which local circuit condition is associated with neurodegenerative disorders?
What is implied about fluctuations in neurological functions?
What is implied about fluctuations in neurological functions?
Which of the following disorders is classified under trinucleotide repeat diseases?
Which of the following disorders is classified under trinucleotide repeat diseases?
Which neurological disease is associated with fluctuating cognitive abilities and challenging day-to-day recognition?
Which neurological disease is associated with fluctuating cognitive abilities and challenging day-to-day recognition?
What type of disorders does Huntington's Disease belong to?
What type of disorders does Huntington's Disease belong to?
Which condition is characterized by abnormal repetitions of specific nucleotide sequences in the DNA?
Which condition is characterized by abnormal repetitions of specific nucleotide sequences in the DNA?
What neurological disease notably affects motor control and is often linked with tremors?
What neurological disease notably affects motor control and is often linked with tremors?
Which of the following diseases is not typically classified as a channelopathy?
Which of the following diseases is not typically classified as a channelopathy?
Which disorder is primarily linked with challenges in communication and social interaction?
Which disorder is primarily linked with challenges in communication and social interaction?
What mechanism is primarily involved in Amyotrophic Lateral Sclerosis?
What mechanism is primarily involved in Amyotrophic Lateral Sclerosis?
Which of these diseases is specifically categorized under 'Channelopathies'?
Which of these diseases is specifically categorized under 'Channelopathies'?
Which disease is characterized by repetitive elements in the DNA influencing disease severity?
Which disease is characterized by repetitive elements in the DNA influencing disease severity?
Which of the following best describes the symptoms of fluctuating cognitive functions in patients?
Which of the following best describes the symptoms of fluctuating cognitive functions in patients?
What percentage of synapse density is typically lost in patients with Alzheimer's Disease?
What percentage of synapse density is typically lost in patients with Alzheimer's Disease?
Which of the following cognitive tests is correlated with synaptic density loss in Alzheimer's Disease?
Which of the following cognitive tests is correlated with synaptic density loss in Alzheimer's Disease?
What is the current annual cost to Canadians for caring for those living with dementia?
What is the current annual cost to Canadians for caring for those living with dementia?
What is a significant early symptom of Alzheimer's Disease often linked to brain structures?
What is a significant early symptom of Alzheimer's Disease often linked to brain structures?
How many Canadians are projected to live with dementia in 15 years?
How many Canadians are projected to live with dementia in 15 years?
Which brain structures are primarily affected by early synaptic dysfunction in Alzheimer's Disease?
Which brain structures are primarily affected by early synaptic dysfunction in Alzheimer's Disease?
What describes the overall trajectory of Alzheimer's Disease in patients?
What describes the overall trajectory of Alzheimer's Disease in patients?
How many people worldwide are currently living with Alzheimer's Disease?
How many people worldwide are currently living with Alzheimer's Disease?
Which statement best explains the relationship between synaptic loss and cognitive performance in Alzheimer's Disease?
Which statement best explains the relationship between synaptic loss and cognitive performance in Alzheimer's Disease?
What is the expected number of Canadians affected directly or indirectly by Alzheimer's Disease?
What is the expected number of Canadians affected directly or indirectly by Alzheimer's Disease?
Which neurological disease is associated with significant fluctuations in patients' cognitive states throughout a single day?
Which neurological disease is associated with significant fluctuations in patients' cognitive states throughout a single day?
Which type of mechanism is primarily responsible for cognitive impairments observed in neurodegenerative diseases?
Which type of mechanism is primarily responsible for cognitive impairments observed in neurodegenerative diseases?
What characteristic symptom is typically observed in patients suffering from Alzheimer's Disease?
What characteristic symptom is typically observed in patients suffering from Alzheimer's Disease?
Which disorder listed is classified as a trinucleotide repeat disease?
Which disorder listed is classified as a trinucleotide repeat disease?
In the context of fluctuating cognitive abilities, what behavior might be observed in an Alzheimer's patient?
In the context of fluctuating cognitive abilities, what behavior might be observed in an Alzheimer's patient?
Which of the following conditions is known to decline in cognitive function and might have caregivers describing wide fluctuations in patient performance?
Which of the following conditions is known to decline in cognitive function and might have caregivers describing wide fluctuations in patient performance?
Which statement best reflects the experience of caregivers of patients with Alzheimer’s Disease?
Which statement best reflects the experience of caregivers of patients with Alzheimer’s Disease?
Which neurological condition is primarily characterized by cognitive impairments and is not primarily classified under channelopathies?
Which neurological condition is primarily characterized by cognitive impairments and is not primarily classified under channelopathies?
Among the following, which condition involves challenges with social interactions, but is distinct from Alzheimer’s Disease?
Among the following, which condition involves challenges with social interactions, but is distinct from Alzheimer’s Disease?
Which of the following causal pathways is less likely to be a focus in addressing neurological disease mechanisms?
Which of the following causal pathways is less likely to be a focus in addressing neurological disease mechanisms?
What is the primary cause of some neurological impairments associated with neurodegenerative conditions?
What is the primary cause of some neurological impairments associated with neurodegenerative conditions?
Which of the following statements accurately reflects the impact of neurodegenerative disorders on neural activity?
Which of the following statements accurately reflects the impact of neurodegenerative disorders on neural activity?
What might be a consequence of abnormal network activities in neurodegenerative disorders?
What might be a consequence of abnormal network activities in neurodegenerative disorders?
Which of the following best describes the effects of neurodegenerative disorders on synaptic networks?
Which of the following best describes the effects of neurodegenerative disorders on synaptic networks?
What is a significant characteristic of Alzheimer's Disease related to synaptic integrity?
What is a significant characteristic of Alzheimer's Disease related to synaptic integrity?
Which of these disorders is a type of trinucleotide repeat disease?
Which of these disorders is a type of trinucleotide repeat disease?
Which condition is characterized by a decline in cognitive abilities that fluctuate unpredictably?
Which condition is characterized by a decline in cognitive abilities that fluctuate unpredictably?
What type of condition does Amyotrophic Lateral Sclerosis primarily influence?
What type of condition does Amyotrophic Lateral Sclerosis primarily influence?
Which option is NOT typically associated with channelopathies?
Which option is NOT typically associated with channelopathies?
What therapeutic focus is highlighted in treating neurological diseases as per recent research?
What therapeutic focus is highlighted in treating neurological diseases as per recent research?
What aspect of neuronal activity does neurodegenerative disorders primarily disrupt?
What aspect of neuronal activity does neurodegenerative disorders primarily disrupt?
Which phenomenon may exacerbate neurological impairments in neurodegenerative conditions?
Which phenomenon may exacerbate neurological impairments in neurodegenerative conditions?
Which of the following best characterizes the relationship between neuronal function and neurodegenerative disorders?
Which of the following best characterizes the relationship between neuronal function and neurodegenerative disorders?
What is a common misconception about the causes of neurological impairments in neurodegenerative conditions?
What is a common misconception about the causes of neurological impairments in neurodegenerative conditions?
Which of the following conditions does NOT mainly relate to neurodegenerative disorders?
Which of the following conditions does NOT mainly relate to neurodegenerative disorders?
Which term is associated with the decline in synaptic health observed in patients with Alzheimer's Disease?
Which term is associated with the decline in synaptic health observed in patients with Alzheimer's Disease?
What defines the term 'channelopathies' in the context of neurological diseases?
What defines the term 'channelopathies' in the context of neurological diseases?
Which of the following best illustrates gradual neurological decline?
Which of the following best illustrates gradual neurological decline?
What is a potential consequence of neuronal dysfunction in neurodegenerative diseases?
What is a potential consequence of neuronal dysfunction in neurodegenerative diseases?
Which statement about synaptic health and Alzheimer’s Disease is accurate?
Which statement about synaptic health and Alzheimer’s Disease is accurate?
What condition is associated with abnormal repetitions of specific nucleotide sequences in the DNA?
What condition is associated with abnormal repetitions of specific nucleotide sequences in the DNA?
What description best represents caregiver observations of patients with fluctuating cognitive abilities?
What description best represents caregiver observations of patients with fluctuating cognitive abilities?
Which disease is particularly classified under the category of Channelopathies?
Which disease is particularly classified under the category of Channelopathies?
In the context of neurodegenerative diseases, what primary mechanism is often implicated in cognitive impairments?
In the context of neurodegenerative diseases, what primary mechanism is often implicated in cognitive impairments?
Which neurological disorder is classified as a trinucleotide repeat disease characterized by motor control issues?
Which neurological disorder is classified as a trinucleotide repeat disease characterized by motor control issues?
What symptom is commonly attributed to patients suffering from Parkinson’s Disease?
What symptom is commonly attributed to patients suffering from Parkinson’s Disease?
Which disorder is specifically noted for challenges in communication and social interaction?
Which disorder is specifically noted for challenges in communication and social interaction?
Which condition is primarily associated with amyloid-beta protein accumulation in the brain?
Which condition is primarily associated with amyloid-beta protein accumulation in the brain?
What mechanism is often a therapeutic target in treating neurodegenerative diseases?
What mechanism is often a therapeutic target in treating neurodegenerative diseases?
What characteristic is commonly observed in ALS (Amyotrophic Lateral Sclerosis)?
What characteristic is commonly observed in ALS (Amyotrophic Lateral Sclerosis)?
What is the primary cause of mild cognitive impairment in the early stages of Alzheimer's Disease?
What is the primary cause of mild cognitive impairment in the early stages of Alzheimer's Disease?
Which of the following statistics reflects the projected growth of dementia cases in Canada over the next 15 years?
Which of the following statistics reflects the projected growth of dementia cases in Canada over the next 15 years?
Which cognitive test is most closely correlated with synaptic density loss in patients with Alzheimer's Disease?
Which cognitive test is most closely correlated with synaptic density loss in patients with Alzheimer's Disease?
What aspect of Alzheimer's Disease is most closely associated with synapse density loss in cognitive function?
What aspect of Alzheimer's Disease is most closely associated with synapse density loss in cognitive function?
What annual financial burden does caring for Canadians living with dementia impose?
What annual financial burden does caring for Canadians living with dementia impose?
According to research, what is the average percentage of synapse density loss observed in patients with Alzheimer's Disease?
According to research, what is the average percentage of synapse density loss observed in patients with Alzheimer's Disease?
How does Alzheimer's Disease progression typically impact daily living activities?
How does Alzheimer's Disease progression typically impact daily living activities?
Which of the following best characterizes the cognitive impairments seen in Alzheimer's Disease?
Which of the following best characterizes the cognitive impairments seen in Alzheimer's Disease?
What is the estimated global prevalence of individuals currently living with Alzheimer's Disease?
What is the estimated global prevalence of individuals currently living with Alzheimer's Disease?
In Alzheimer's Disease, which regions of the brain are primarily affected by early synaptic dysfunction?
In Alzheimer's Disease, which regions of the brain are primarily affected by early synaptic dysfunction?
Flashcards
Neurological Diseases
Neurological Diseases
A class of diseases characterized by dysfunction or damage to the nervous system, often leading to cognitive and motor impairments.
Alzheimer's Disease
Alzheimer's Disease
A type of neurological disease marked by progressive decline in cognitive function, affecting memory, language, and reasoning.
Parkinson's Disease
Parkinson's Disease
A progressive neurodegenerative disorder affecting motor control, characterized by tremors, rigidity, slow movements, and postural instability.
Channelopathies
Channelopathies
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Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis (ALS)
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Trinucleotide Repeat Diseases
Trinucleotide Repeat Diseases
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Huntington's Disease
Huntington's Disease
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Fragile X Syndrome
Fragile X Syndrome
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Autism Spectrum Disorders
Autism Spectrum Disorders
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Functional Fluctuations
Functional Fluctuations
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Alzheimer's Disease (AD)
Alzheimer's Disease (AD)
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Synapses
Synapses
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Synaptic Loss
Synaptic Loss
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Mild Cognitive Impairment (MCI)
Mild Cognitive Impairment (MCI)
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Hippocampus
Hippocampus
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Entorhinal Cortex
Entorhinal Cortex
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Mini-Mental State Exam (MMSE)
Mini-Mental State Exam (MMSE)
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Midfrontal Cortex (MF)
Midfrontal Cortex (MF)
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Late-Stage AD
Late-Stage AD
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Brain Structures Essential for Memory
Brain Structures Essential for Memory
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Rapid Neurological Changes
Rapid Neurological Changes
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Neurodegenerative Impact on Brain
Neurodegenerative Impact on Brain
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Vicious Cycle in Neurodegenerative Disorders
Vicious Cycle in Neurodegenerative Disorders
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Neurodegenerative Impact on Brain Function
Neurodegenerative Impact on Brain Function
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Neuronal Dysfunction
Neuronal Dysfunction
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Neuronal Function Targeted Therapy
Neuronal Function Targeted Therapy
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Synaptic Loss in Alzheimer's Disease
Synaptic Loss in Alzheimer's Disease
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Neurodegenerative Disorder Symptoms
Neurodegenerative Disorder Symptoms
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What are channelopathies?
What are channelopathies?
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What is Amyotrophic Lateral Sclerosis (ALS)?
What is Amyotrophic Lateral Sclerosis (ALS)?
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What are Trinucleotide Repeat Diseases?
What are Trinucleotide Repeat Diseases?
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What is Alzheimer's Disease?
What is Alzheimer's Disease?
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What is Parkinson's Disease?
What is Parkinson's Disease?
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What are Functional Fluctuations?
What are Functional Fluctuations?
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What are synapses?
What are synapses?
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What is Synaptic Loss?
What is Synaptic Loss?
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What is Mild Cognitive Impairment (MCI)?
What is Mild Cognitive Impairment (MCI)?
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What is the hippocampus?
What is the hippocampus?
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Neurological disease impact on brain
Neurological disease impact on brain
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Neuron function
Neuron function
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Symptoms of neurological disorders
Symptoms of neurological disorders
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Synaptic loss in Alzheimer's
Synaptic loss in Alzheimer's
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Synapse Density Loss in Alzheimer's Disease
Synapse Density Loss in Alzheimer's Disease
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Synaptic Loss and Cognitive Decline in AD
Synaptic Loss and Cognitive Decline in AD
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Cognitive Decline in Alzheimer's Disease
Cognitive Decline in Alzheimer's Disease
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Synapse Density Loss in AD
Synapse Density Loss in AD
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Cognitive Decline in AD
Cognitive Decline in AD
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Midfrontal Cortex
Midfrontal Cortex
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Neurological Disorder Impact on Brain
Neurological Disorder Impact on Brain
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Study Notes
Molecular Mechanisms of Disease
- Course Title: Molecular Mechanisms of Disease
- Course Code: NROC36H3F
- Lecturer: Arruda Carvalho UTSC
- Date: 2024-11-27
Lecture Outline (Framework)
- Alzheimer's Disease
- Parkinson's Disease
- Channelopathies
- Amyotrophic Lateral Sclerosis
- Trinucleotide Repeat Diseases
- Huntington's Disease
- Fragile X Syndrome
- Autism Spectrum Disorders
Functional Fluctuations in Neurological Disease and Underlying Mechanisms
- Caregiver accounts of patient's best and worst performances (in the same day) can show inconsistency.
- Neuronal number changes are unlikely to explain these rapid, reversible function variations.
- Neurological conditions' impairments can be due to neuronal dysfunction, not necessarily cell loss.
Neurodegenerative Disorders Affect Neural Activity at Multiple Levels
- Neurodegenerative conditions can disrupt molecular pathways, synapses, neuronal subpopulations, local circuits and higher-order neural networks.
- Disruptive network activity can be a vicious cycle further impacting neuronal integrity.
Mechanisms of Neuronal Dysfunction in AD Models
- Activity-regulated gene expression - immediate-early genes like Fos and activity-regulated cytoskeletal protein.
- Cell-surface receptors - integrins, cell adhesion molecules, metabotropic glutamate receptors, nicotinic acetylcholine receptors, NMDA receptors.
- Neurotransmitter release - synaptic vesicle cycling, exocytosis.
- Signalling cascades - kinase pathways (mitogen-activated protein kinase superfamily, cyclin-dependent kinase 5, tyrosine kinases), phosphatases (calcineurin, striatal-enriched phosphatase), scaffolding molecules at the postsynaptic density.
- Synaptic integrity - presynaptic terminals, postsynaptic dendritic spines.
- Synaptic transmission and plasticity - basal synaptic transmission, long-term potentiation, paired-pulse modification.
Neuronal Function as a Major Therapeutic Target in Neurological Disease
- Disease Progression: shows a general decline in function.
- Functional Fluctuations: fluctuations exist during progression.
Alzheimer's Disease: Numbers
- 30 million worldwide with AD.
- 564,000 Canadians currently living with dementia.
- 937,000 Canadians predicted to live with dementia in 15 years.
- 1.1 million Canadians directly/indirectly affected by dementia.
- $10.4 billion annual cost to Canadians.
Alzheimer's Disease: Symptoms and Etiology
- Mild cognitive impairment initially, possibly from early synaptic dysfunction (hippocampus & entorhinal cortex).
- Progressive memory and cognitive decline.
- Typically, within a decade or so, patients become unable to perform daily tasks and are reliant on others.
- Genetic component in a small proportion of cases (<5%).
- Etiology is largely unknown, but likely includes genetic and environmental factors.
Alzheimer's Disease: Plaques and Tangles
- Amyloid plaques and neurofibrillary tangles consist of amyloid fibrils, with APP and tau as components.
- Amyloid plaques form from APP cleavage by β- and γ-secretase.
- Neurofibrillary tangles arise from tau protein misfolding.
- Tau and amyloid fibrils share similar tertiary protein structures.
Parkinson's Disease
- Second most common neurodegenerative disorder after Alzheimer's Disease.
- Average age of onset is 64.4 years with diagnosis 1.9 years later (at 66.2).
- Affects 1 in every 500 Canadians, with over 100,000 currently living with it.
- Around 6,600 new cases diagnosed in Canada annually.
Parkinson's Disease: Symptomatology
- Tremor: Involuntary, 4-6Hz rhythmic movement, prevalent during rest and in emotional situations, can improve with purposeful movements.
- Rigidity: Increased resistance to limb movement.
- Bradykinesia: Slowness of movement, difficulty initiating movement.
- Postural instability: Difficulty maintaining balance, often when disturbed.
Parkinson's Disease: A Long Journey
- Detailed timeline of Parkinson's Disease research spanning different years and discoveries.
Parkinson's Disease: Mechanisms
- Progressive loss of dopaminergic neurons in the substantia nigra leading to motor defects.
- Lewy bodies are cytoplasmic protein-rich inclusions (mostly α-synuclein).
Parkinson's Disease: Mechanisms
- Misfolded α-synuclein potentially spreads from cell to cell, leading to disease progression.
- Proteins such as ubiquitin and Hsp70 are associated with Lewy bodies, but their precise role is unclear.
MPTP and Parkinson's Disease
- MPTP is a toxin that selectively destroys dopaminergic neurons and can cause Parkinsonism.
- Mitochondrial dysfunction, Reactive Oxygen Species (ROS) elevation, and defects in protein clearing are implicated mechanisms.
Parkinson's Disease: Molecular Mechanisms
- Deficiencies in protein quality control, mitochondrial respiration, and/or proteasomal and lysosomal pathways.
- Increased Reactive Oxygen Species affect cellular energy pathways, possibly leading to cell-to-cell transmission by misfolded α-synuclein.
Parkinson's Disease: Circuit Mechanisms
- Direct and indirect pathways are involved; direct pathway is excitory, indirect is inhibitory.
- Substantia nigra pars compacta are affected leading to dopamine loss.
Parkinson's Disease: Plasticity Mechanisms
- Long-term depression (LTD) is impaired in the indirect pathway in Parkinson's Disease animal models.
Channelopathies
- Inherited disorders of ion channel function.
- Affect diverse neurological areas: epilepsy, movement disorders, headache, peripheral nerve, pain, and myology
- Common feature: discrete attacks or episodes, function is normal between episodes.
Epilepsy
- Ion channel mutations cause focal and generalized seizures ranging from neonatal convulsions to severe encephalopathies.
- Genetic factors play a role but are not the sole determinant in many cases, while some are not fully inheritable.
- GABA receptors and their internalization is affected by seizures; reduced GABA receptors could potentially lead to increased activity.
Trinucleotide Repeat Diseases (TRDs)
- Genetic disorders characterized by expansion of unstable trinucleotide repeats.
- Repeat instability during DNA replication leads to insertions and deletions.
Huntington's Disease
- Autosomal dominant neurodegenerative disease due to abnormal expansion of CAG repeats in huntingtin.
- Affects about 5 to 10 per 100,000 individuals, causing motor and cognitive impairments, behavioral and psychiatric disturbances.
Huntington's Disease: Mechanisms
- Mutant huntingtin interferes with:
- Transcriptional regulation
- Protein degradation.
- Protein folding
- Neuronal circuitry
- Mitochondrial dysfunction.
Huntington's Disease: Synaptic Mechanisms
- Mutant huntingtin decreases corticostriatal BDNF release and transport, affecting neurotransmitter release.
Huntington's Disease: Excitotoxicity
- Loss of striatal medium-sized spiny neurons, and reduction in glutamate transporter expression, leading to glutamate accumulation.
- High glutamate levels, oxidative stress through ROS, and cellular damage are consequences.
Fragile X Syndrome
- Caused by abnormal expansion of a CGG trinucleotide repeat in the FMR1 gene on X chromosome.
- Affecting cognitive function, social interaction skills, and frequently associated with autism spectrum disorder.
Fragile X Syndrome: Mechanisms
- The abnormal CGG repeat expansion in the FMR1 gene results in the loss of transcription leading to an epigenetic modification, silencing the gene, causing a fragile X-chromosome.
Autism Spectrum Disorders (ASD)
-
A complex set of heterogeneous neurodevelopmental disorders characterized by early-onset difficulties in social communication and restricted, repetitive behaviors or interests.
-
Prevalence worldwide is about 1% of total population.
-
Genetic factors and early environmental influences are key etiological aspects.
-
Additional information regarding proteins, their interactions, and their binding partners in ASDs and their relation to synaptic mechanisms is included.
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Description
Test your knowledge on the molecular mechanisms underlying various neurological diseases, including Alzheimer's, Parkinson's, and Huntington's disease. This quiz will cover key concepts and functional fluctuations in these disorders, emphasizing neuronal dysfunction rather than cell loss.
