Podcast
Questions and Answers
What primary symptom is associated with Parkinson’s Disease?
What primary symptom is associated with Parkinson’s Disease?
- Uncontrolled movements
- Severe memory loss
- Slow movements and tremor (correct)
- Weakness and paralysis
Which neurodegenerative disorder is primarily linked to dementia?
Which neurodegenerative disorder is primarily linked to dementia?
- Alzheimer’s Disease (correct)
- Parkinson’s Disease
- Amyotrophic Lateral Sclerosis
- Huntington’s Disease
What is a characteristic feature of Huntington’s Disease?
What is a characteristic feature of Huntington’s Disease?
- Gradual muscle weakness
- severe tremor
- Uncontrolled movements (correct)
- Progressive loss of memory
What process contributes to neuronal cell death in neurodegenerative disorders?
What process contributes to neuronal cell death in neurodegenerative disorders?
Which statement accurately describes the progression of dementia?
Which statement accurately describes the progression of dementia?
What impact do DNA and RNA defects have on neurodegenerative diseases?
What impact do DNA and RNA defects have on neurodegenerative diseases?
What is a common characteristic of all neurodegenerative disorders mentioned?
What is a common characteristic of all neurodegenerative disorders mentioned?
Which of these conditions is specifically associated with the motor neurons?
Which of these conditions is specifically associated with the motor neurons?
What is the primary effect of amyloid-beta (Aβ) and neurofibrillary tangles (NFTs) on cognitive function?
What is the primary effect of amyloid-beta (Aβ) and neurofibrillary tangles (NFTs) on cognitive function?
Which brain regions are first affected in Alzheimer's Disease?
Which brain regions are first affected in Alzheimer's Disease?
Which disease is characterized by the presence of abnormally phosphorylated tau protein in the hippocampus and amygdala?
Which disease is characterized by the presence of abnormally phosphorylated tau protein in the hippocampus and amygdala?
What is a common clinical feature associated with the early stages of Alzheimer's Disease?
What is a common clinical feature associated with the early stages of Alzheimer's Disease?
In which condition may individuals experience difficulties with balance, movement, and vision?
In which condition may individuals experience difficulties with balance, movement, and vision?
Which neurotransmitter is primarily targeted by drugs used for the treatment of Alzheimer’s Disease?
Which neurotransmitter is primarily targeted by drugs used for the treatment of Alzheimer’s Disease?
What is a symptom of Pick's Disease?
What is a symptom of Pick's Disease?
What genetic factor is associated with familial Alzheimer's disease (Early Onset)?
What genetic factor is associated with familial Alzheimer's disease (Early Onset)?
In neurodegenerative disorders, what is a common feature of the neuropathology observed?
In neurodegenerative disorders, what is a common feature of the neuropathology observed?
What distinguishes Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17) from other tauopathies?
What distinguishes Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17) from other tauopathies?
What is the disease concept related to Prion diseases primarily centered on?
What is the disease concept related to Prion diseases primarily centered on?
What role do Aβ and NFTs play in neuroinflammation?
What role do Aβ and NFTs play in neuroinflammation?
Which of the following is NOT a typical risk factor for developing Alzheimer's Disease?
Which of the following is NOT a typical risk factor for developing Alzheimer's Disease?
Which of the following tauopathies is associated with cognitive decline and parkinsonism?
Which of the following tauopathies is associated with cognitive decline and parkinsonism?
Which clinical feature is least likely observed in the early stages of Alzheimer's Disease?
Which clinical feature is least likely observed in the early stages of Alzheimer's Disease?
What aspect of neurodegenerative diseases do characteristic aggregating proteins relate to?
What aspect of neurodegenerative diseases do characteristic aggregating proteins relate to?
What is a common early symptom of Alzheimer's disease?
What is a common early symptom of Alzheimer's disease?
Which of the following is a characteristic of moderate symptoms in Alzheimer's disease?
Which of the following is a characteristic of moderate symptoms in Alzheimer's disease?
What are the two pathological hallmarks of Alzheimer's disease?
What are the two pathological hallmarks of Alzheimer's disease?
What leads to the production of beta-amyloid peptides in Alzheimer's disease pathology?
What leads to the production of beta-amyloid peptides in Alzheimer's disease pathology?
Which symptom indicates severe Alzheimer's disease?
Which symptom indicates severe Alzheimer's disease?
Which condition is primarily affected by Alzheimer's disease progression?
Which condition is primarily affected by Alzheimer's disease progression?
What is a possible consequence of beta-amyloid aggregation?
What is a possible consequence of beta-amyloid aggregation?
Which symptom is NOT typically associated with mild cognitive impairment (MCI) as part of Alzheimer's disease progression?
Which symptom is NOT typically associated with mild cognitive impairment (MCI) as part of Alzheimer's disease progression?
What is the consequence of hyperphosphorylation of tau protein?
What is the consequence of hyperphosphorylation of tau protein?
Which of the following is a primary feature of neurofibrillary tangles in Alzheimer's disease?
Which of the following is a primary feature of neurofibrillary tangles in Alzheimer's disease?
What role does the amyloid precursor protein (APP) play under normal physiological conditions?
What role does the amyloid precursor protein (APP) play under normal physiological conditions?
How does β-amyloid affect neuronal function?
How does β-amyloid affect neuronal function?
What is the primary pathological form of β-amyloid associated with Alzheimer's disease?
What is the primary pathological form of β-amyloid associated with Alzheimer's disease?
What is the result of chronic inflammation in the context of neurodegeneration?
What is the result of chronic inflammation in the context of neurodegeneration?
What primarily triggers the production of neurotoxic oligomers of β-amyloid?
What primarily triggers the production of neurotoxic oligomers of β-amyloid?
What effect does the formation of amyloid plaques have on surrounding brain tissues?
What effect does the formation of amyloid plaques have on surrounding brain tissues?
What is the role of β-secretase in the formation of β-amyloid?
What is the role of β-secretase in the formation of β-amyloid?
What is the result of soluble oligomers disrupting neuronal membrane integrity?
What is the result of soluble oligomers disrupting neuronal membrane integrity?
What type of protein forms neurofibrillary tangles in Alzheimer's disease?
What type of protein forms neurofibrillary tangles in Alzheimer's disease?
Which of the following secretases is primarily responsible for normal APP processing?
Which of the following secretases is primarily responsible for normal APP processing?
How do Aβ peptides and tau tangles interact in Alzheimer's disease?
How do Aβ peptides and tau tangles interact in Alzheimer's disease?
What happens to the microtubule structure in neurons during Alzheimer's disease?
What happens to the microtubule structure in neurons during Alzheimer's disease?
What is the primary consequence of activating cell death pathways in neurons?
What is the primary consequence of activating cell death pathways in neurons?
What does the term 'amyloidogenic' refer to in the context of APP processing?
What does the term 'amyloidogenic' refer to in the context of APP processing?
What is a primary consequence of disruptions in cytoskeletal structure within neurons?
What is a primary consequence of disruptions in cytoskeletal structure within neurons?
Which factor is most closely associated with an increased risk of Alzheimer's disease?
Which factor is most closely associated with an increased risk of Alzheimer's disease?
What characterizes the progression of vascular dementia compared to Alzheimer's disease?
What characterizes the progression of vascular dementia compared to Alzheimer's disease?
What is a hallmark feature of amyloid plaques in Alzheimer's disease?
What is a hallmark feature of amyloid plaques in Alzheimer's disease?
What is the significance of aberrant proteostasis in neurodegenerative diseases?
What is the significance of aberrant proteostasis in neurodegenerative diseases?
How is the average lifespan after an Alzheimer's disease diagnosis characterized?
How is the average lifespan after an Alzheimer's disease diagnosis characterized?
Which symptom is particularly associated with the initial stages of vascular dementia?
Which symptom is particularly associated with the initial stages of vascular dementia?
What primarily leads to the neuronal death observed in Alzheimer's disease?
What primarily leads to the neuronal death observed in Alzheimer's disease?
Which disorder is characterized by the presence of neurofibrillary tangles predominantly in the brainstem and basal ganglia regions?
Which disorder is characterized by the presence of neurofibrillary tangles predominantly in the brainstem and basal ganglia regions?
What symptom is most commonly associated with Argyrophilic Grain Disease (AGD)?
What symptom is most commonly associated with Argyrophilic Grain Disease (AGD)?
Which tauopathy is specifically linked to mutations in the MAPT gene located on chromosome 17?
Which tauopathy is specifically linked to mutations in the MAPT gene located on chromosome 17?
Which condition is primarily characterized by behavioral changes and language difficulties due to tau protein aggregates?
Which condition is primarily characterized by behavioral changes and language difficulties due to tau protein aggregates?
Which of the following disorders does NOT typically involve symptoms such as cognitive decline and movement difficulties?
Which of the following disorders does NOT typically involve symptoms such as cognitive decline and movement difficulties?
What is the primary consequence of neuroinflammation triggered by Aβ and NFTs?
What is the primary consequence of neuroinflammation triggered by Aβ and NFTs?
Which symptom is unlikely to be present in early-stage Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)?
Which symptom is unlikely to be present in early-stage Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)?
What type of protein accumulation is characteristic of Pick's Disease?
What type of protein accumulation is characteristic of Pick's Disease?
Which brain region is first affected in most neurodegenerative disorders?
Which brain region is first affected in most neurodegenerative disorders?
What clinical feature is most commonly associated with the early stages of Alzheimer's Disease?
What clinical feature is most commonly associated with the early stages of Alzheimer's Disease?
Which type of proteins are identified as characteristic of neurodegenerative diseases?
Which type of proteins are identified as characteristic of neurodegenerative diseases?
Which of the following is a common drug class used for Alzheimer's Disease treatment?
Which of the following is a common drug class used for Alzheimer's Disease treatment?
What type of pathological change is primarily linked to Alzheimer's Disease?
What type of pathological change is primarily linked to Alzheimer's Disease?
What is the primary cause of memory loss in Alzheimer's Disease?
What is the primary cause of memory loss in Alzheimer's Disease?
Which condition is primarily characterized by the presence of misfolded proteins affecting neuronal function?
Which condition is primarily characterized by the presence of misfolded proteins affecting neuronal function?
Which of the following features is least likely to be observed in the early stages of Alzheimer's Disease?
Which of the following features is least likely to be observed in the early stages of Alzheimer's Disease?
Which symptom is characteristic of severe Alzheimer's disease?
Which symptom is characteristic of severe Alzheimer's disease?
What is a common symptom during the moderate stage of Alzheimer's disease?
What is a common symptom during the moderate stage of Alzheimer's disease?
Which of the following best describes the role of amyloid precursor protein (APP) in Alzheimer's disease?
Which of the following best describes the role of amyloid precursor protein (APP) in Alzheimer's disease?
What leads to the formation of neurofibrillary tangles in Alzheimer's disease?
What leads to the formation of neurofibrillary tangles in Alzheimer's disease?
Which symptom would most likely indicate the onset of mild cognitive impairment (MCI)?
Which symptom would most likely indicate the onset of mild cognitive impairment (MCI)?
What is the pathological significance of amyloid plaques in Alzheimer's disease?
What is the pathological significance of amyloid plaques in Alzheimer's disease?
Which of the following options lists a symptom that typically progresses to severe stage Alzheimer's disease?
Which of the following options lists a symptom that typically progresses to severe stage Alzheimer's disease?
What is the initial trigger in the process involving beta-amyloid production in Alzheimer's disease?
What is the initial trigger in the process involving beta-amyloid production in Alzheimer's disease?
What is the primary mechanism by which hyperphosphorylation of tau protein contributes to neurodegeneration?
What is the primary mechanism by which hyperphosphorylation of tau protein contributes to neurodegeneration?
Which of the following factors is exacerbated by chronic inflammation in Alzheimer's disease?
Which of the following factors is exacerbated by chronic inflammation in Alzheimer's disease?
What is the consequence of beta-amyloid monomers aggregating into oligomers?
What is the consequence of beta-amyloid monomers aggregating into oligomers?
What leads to the formation of neurofibrillary tangles within neurons?
What leads to the formation of neurofibrillary tangles within neurons?
Which pathological feature is primarily associated with the cleavage of amyloid precursor protein (APP) in Alzheimer's disease?
Which pathological feature is primarily associated with the cleavage of amyloid precursor protein (APP) in Alzheimer's disease?
What role do microglia and astrocytes play in the context of amyloid and tau pathologies?
What role do microglia and astrocytes play in the context of amyloid and tau pathologies?
Which form of beta-amyloid is primarily associated with initiating Alzheimer's disease pathology?
Which form of beta-amyloid is primarily associated with initiating Alzheimer's disease pathology?
What effect does the formation of amyloid plaques have on synaptic function?
What effect does the formation of amyloid plaques have on synaptic function?
What abnormal form of beta-amyloid is primarily associated with amyloid plaque formation in Alzheimer's disease?
What abnormal form of beta-amyloid is primarily associated with amyloid plaque formation in Alzheimer's disease?
Which secretase is responsible for cleaving APP in the Alzheimer’s disease mechanism, resulting in abnormal processing?
Which secretase is responsible for cleaving APP in the Alzheimer’s disease mechanism, resulting in abnormal processing?
In the context of tau pathology, what is the consequence of the collapse of the microtubule structure?
In the context of tau pathology, what is the consequence of the collapse of the microtubule structure?
What interaction occurs between Aβ peptides and tau tangles in Alzheimer's disease?
What interaction occurs between Aβ peptides and tau tangles in Alzheimer's disease?
What is one main consequence of soluble oligomers disrupting neuronal membrane integrity?
What is one main consequence of soluble oligomers disrupting neuronal membrane integrity?
What is the role of tau protein under normal physiological conditions?
What is the role of tau protein under normal physiological conditions?
Which pathological feature is primarily linked to the neurodegeneration associated with Alzheimer's disease?
Which pathological feature is primarily linked to the neurodegeneration associated with Alzheimer's disease?
What type of fragmentation occurs during the pathological processing of APP in Alzheimer's disease?
What type of fragmentation occurs during the pathological processing of APP in Alzheimer's disease?
Flashcards
First affected brain region (Alzheimer's)
First affected brain region (Alzheimer's)
Cerebral cortex, basal ganglia, and hippocampus are typically the first brain regions affected in Alzheimer's Disease.
Alzheimer's symptoms
Alzheimer's symptoms
Common symptoms of Alzheimer's include dementia, memory loss, disorientation, mood changes, and communication difficulties.
Neurodegenerative Disorders
Neurodegenerative Disorders
A group of brain diseases characterized by progressive loss of neurons and brain function.
Neurodegenerative Processes Study
Neurodegenerative Processes Study
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Alzheimer's hallmark
Alzheimer's hallmark
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Risk factors
Risk factors
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Alzheimer's Treatment
Alzheimer's Treatment
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Prion Diseases
Prion Diseases
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Synaptic Dysfunction
Synaptic Dysfunction
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Neuroinflammation
Neuroinflammation
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Argyrophilic Grain Disease (AGD)
Argyrophilic Grain Disease (AGD)
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Progressive Supranuclear Palsy (PSP)
Progressive Supranuclear Palsy (PSP)
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Pick's Disease
Pick's Disease
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Frontotemporal Dementia
Frontotemporal Dementia
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Chromosome 17 (FTDP-17)
Chromosome 17 (FTDP-17)
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Familial Alzheimer's Disease
Familial Alzheimer's Disease
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Parkinson's Disease
Parkinson's Disease
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Huntington's Disease
Huntington's Disease
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Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis (ALS)
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Creutzfeldt-Jakob Disease (CJD)
Creutzfeldt-Jakob Disease (CJD)
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Dementia
Dementia
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Protein Aggregation
Protein Aggregation
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Alzheimer's disease symptoms
Alzheimer's disease symptoms
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AD symptom progression
AD symptom progression
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Neurofibrillary tangles
Neurofibrillary tangles
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Amyloid plaques
Amyloid plaques
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Amyloid Precursor Protein (APP)
Amyloid Precursor Protein (APP)
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Beta-amyloid aggregation
Beta-amyloid aggregation
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Beta-amyloid (Aβ)
Beta-amyloid (Aβ)
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Brain atrophy in AD
Brain atrophy in AD
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Tau Protein
Tau Protein
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Hyperphosphorylation
Hyperphosphorylation
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Oligomers
Oligomers
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β-secretase
β-secretase
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γ-secretase
γ-secretase
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Amyloidogenic
Amyloidogenic
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Microtubules
Microtubules
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What is the relationship between amyloid plaques and neurofibrillary tangles?
What is the relationship between amyloid plaques and neurofibrillary tangles?
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Synaptic Dysfunction in AD
Synaptic Dysfunction in AD
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Neuroinflammation in AD
Neuroinflammation in AD
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Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)
Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)
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Familial AD (Early Onset)
Familial AD (Early Onset)
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Common Alzheimer's symptoms
Common Alzheimer's symptoms
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What proteins aggregate in Alzheimer's?
What proteins aggregate in Alzheimer's?
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How does amyloid-beta aggregate?
How does amyloid-beta aggregate?
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What happens to tau protein in Alzheimer's?
What happens to tau protein in Alzheimer's?
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What are some risk factors for Alzheimer's Disease?
What are some risk factors for Alzheimer's Disease?
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What are prion diseases?
What are prion diseases?
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What are some common drugs used to treat Alzheimer's?
What are some common drugs used to treat Alzheimer's?
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Cytoskeletal Abnormalities
Cytoskeletal Abnormalities
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Aberrant Proteostasis
Aberrant Proteostasis
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Alzheimer's Disease
Alzheimer's Disease
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Vascular Dementia
Vascular Dementia
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Tau Protein's Role
Tau Protein's Role
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How Tau Goes Wrong
How Tau Goes Wrong
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What are Neurofibrillary Tangles?
What are Neurofibrillary Tangles?
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What is Beta-Amyloid?
What is Beta-Amyloid?
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What are Amyloid Plaques?
What are Amyloid Plaques?
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How do Amyloid Plaques Harm Neurons?
How do Amyloid Plaques Harm Neurons?
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What is the Vicious Cycle?
What is the Vicious Cycle?
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What are the two hallmarks of Alzheimer's disease?
What are the two hallmarks of Alzheimer's disease?
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What is amyloid precursor protein (APP)?
What is amyloid precursor protein (APP)?
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What does 'beta-amyloid aggregation' mean in Alzheimer's disease?
What does 'beta-amyloid aggregation' mean in Alzheimer's disease?
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What causes brain atrophy in Alzheimer's?
What causes brain atrophy in Alzheimer's?
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How are amyloid plaques and neurofibrillary tangles linked?
How are amyloid plaques and neurofibrillary tangles linked?
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What are the effects of neurofibrillary tangles on neurons?
What are the effects of neurofibrillary tangles on neurons?
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How does abnormal processing of APP lead to Alzheimer's?
How does abnormal processing of APP lead to Alzheimer's?
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What is β-amyloid?
What is β-amyloid?
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What is the Amyloid Precursor Protein (APP)?
What is the Amyloid Precursor Protein (APP)?
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What are the roles of β-secretase and γ-secretase?
What are the roles of β-secretase and γ-secretase?
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How does tau protein contribute to Alzheimer's?
How does tau protein contribute to Alzheimer's?
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What is the effect of these abnormal proteins on neurons?
What is the effect of these abnormal proteins on neurons?
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How do these abnormal proteins affect the brain overall?
How do these abnormal proteins affect the brain overall?
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Study Notes
Neurodegenerative Processes
- CNS Year 2 Semester 1 Course
- Lecturer: Niamh Connolly (RCSI-IE): Dr. Colin Greengrass (RCSI-BH)
- Date: 27.11.2023
Contents of the Slides
- Learn the mechanisms, systems, and principles shown on the slide, but not all the detail
- Understand context and linked context
- Recognize the signs of the condition
- Outline brain regions affected by common neurodegenerative disorders
- Outline neuropathology and biochemistry of Alzheimer's disease
- Discuss risk factors for Alzheimer's disease
- List common drugs for treating Alzheimer's disease
- Describe the disease concept and pathophysiology of Prion diseases
Neurodegenerative Disorders
- Brain regions
- Aggregating proteins
- Genetics
Hallmarks of Neurodegenerative Diseases
- Genes and characteristic aggregating proteins linked to and affected brain regions in neurodegenerative disorders (NDDs)
- Examples include Parkinson’s disease, dementia, Huntington’s disease, Tauopathies, a-synuclein, Pick’s disease, tau, MAPT, SNCA, PINK1, PARK7/DJ1, PRKN/Parkin, ATP13A2, VPS35, LRRK2, GBA, HTT, APP, PSEN1, PSEN2, PRNP, SCA, ALS (SOD1), FUS, TARDP, TDP43, FTD, GRN, VCP, TBK1, ANXA11, CHMP2B, SQSTM1, C9ORF72, UBQLN2, PFN1, KIF5A, VAPB, HNRNPA1, NEK1, OPTN, and TUBA4A
Neurodegeneration and Specific Areas Affected
- Table with diseases, brain regions affected, and clinical presentations: Alzheimer's disease, Parkinson's Disease, Huntington's Disease, Amyotrophic Lateral Sclerosis (ALS, Motor neuron disease), and Creutzfeldt-Jakob Disease (CJD)
Dementia
- Significant loss of intellectual abilities (memory, concentration, judgment), causing impairment in daily activities
- Not temporary confusion or forgetfulness
- Typically worsening over time
- Associated with many neurodegenerative disorders, with Alzheimer's being the leading cause (dementia is not the same as Alzheimer's)
- Atrophy of the brain is observed in advanced stages
Neurodegenerative Disorders (General)
- Gradual dysfunction of neurons over time leads to death
- Examples: Alzheimer's, Parkinson's, and Huntington’s diseases
- Chronic, progressive, pathological disorders, including sporadic and rare inherited (familial) forms
Alzheimer's Disease Pathology (AD)
- Two hallmarks: neurofibrillary tangles and amyloid plaques
- Significant Brain atrophy in the advanced stages of AD
Pathophysiology of Alzheimer's Disease
- Amyloid Precursor Protein (APP) processing leads to beta-amyloid (Αβ) peptide production.
- Imbalance in Aβ production and clearance results in aggregation and amyloid plaque formation.
- Abnormal tau phosphorylation detaches tau from microtubules, forming neurofibrillary tangles.
- Amyloid plaques and neurofibrillary tangles disrupt synaptic function and contribute to neuronal loss, especially in the hippocampus and cortex, leading to brain atrophy.
Amyloid Precursor Protein (APP)
- Large transmembrane protein that contributes to neural growth and repair
- Essential for development, survival, post-injury repair, and synaptic plasticity
Beta (β) Amyloid
- Pathophysiological extracellular accumulation leading to amyloid plaques
- Hard, insoluble plaques between cells cause inflammation
- Monomers or oligomers of β-Amyloid may be more toxic to cells
Toxicity of Beta Amyloid Forms
- Formation of soluble neurotoxic oligomers from beta-amyloid monomers
- Disrupts synaptic communication and plasticity (crucial for memory)
- Induce oxidative stress by disrupting calcium homeostasis and triggering cell death pathways.
Secretases
- Proteases that cleave APP into amyloid-β peptides
- Normal AP processing is by a-secretase then y-secretase (generating Aβ1-40), while improper processing by β-secretase generates Aβ1-42 associated with AD progression
Neurofibrillary Tangles
- Insoluble fibres inside neurons (intracellular)
- Consist of an abnormally phosphorylated protein, Tau (p-Tau)
- Tau normally supports microtubule function, but in AD, tau is hyperphosphorylated and disrupts microtubules, leading to neuronal collapse
Interactions between Amyloid/Neurofibrillary Pathologies
- Aβ peptides can induce tau pathology, potentially exacerbating Aβ aggregation.
- Both Aβ and NFTs disrupt synaptic signaling and plasticity, leading to cognitive decline.
- Aβ and NFTs activate glial cells, leading to inflammation that damages neurons and supports further pathology
Tauopathies
- A group of disorders involving abnormal tau protein aggregation
- Examples: Argyrophilic Grain Disease, Progressive Supranuclear Palsy, Pick's Disease (Frontotemporal dementia), and Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)
Familial Alzheimer's Disease (Early Onset)
- Rare (<5%)
- Early onset (<65 years)
- Inherited through autosomal dominant inheritance, often appearing in families with multiple affected individuals
- Caused by mutations or gene duplications in APP, PSEN1, or PSEN2 genes
Down's Syndrome and Increased Alzheimer's Risk
- Trisomy 21 causes overexpression of APP, leading to increased amyloid-β production and younger-onset accumulation of amyloid plaques.
- Results in disrupted endosomal-lysosomal function, affecting protein clearance.
Risk Factors for Dementia (Based on Lancet Commission 2020)
- 12 potentially modifiable risk factors account for ~40% of worldwide dementia cases.
- Factors include: early life factors (less education, hearing loss), midlife factors (undiagnosed conditions), and later life factors (physical inactivity, diabetes, depression).
Sporadic Alzheimer's Disease
- Cause is unknown, represents 90% of all cases.
- Usually develops after age 65.
- Age is the primary risk factor.
Apolipoprotein E (APOE)
- Gene found on chromosome 19
- Encodes a protein important for cholesterol transport
- Exists in different alleles, with APOE ε4 being associated with a higher risk of AD
Genetic Risk Factors - APOE
- APOE ε4 allele is linked to increased amyloid plaques and tau NFTs in affected people, although the exact mechanism is still unclear
Regional Specificity: Impact of Amyloid Plaques in the Hippocampus
- Occupy physical space in the densely packed hippocampus, disrupting neural connections.
- Trigger neuroinflammation, particularly harmful to the dense neuronal network in the hippocampus.
- Cause energy deficits in the highly metabolic hippocampal neurons, affecting memory processing.
Regional Specificity: Impact of Neurofibrillary Pathology in the Hippocampus
- Tau pathology leads to microtubule destabilization, negatively impacting nutrient transport.
- Impairs axonal transport, leading to a deficiency in synaptic molecules (neurotransmitters, neuropeptides, and ion channels)
Why is early diagnosis of Alzheimer's disease important?
- Significant neuronal loss and widespread pathology often present.
- Treatment is less effective once clinical symptoms become evident.
- Early markers like tau and amyloid may be present before symptoms manifest, enabling earlier interventions and potentially slowing the progression.
Early Detection of Alzheimer's Disease: The Role of Biomarkers
- Biofluid biomarkers (e.g., CSF analysis) can analyze tau and amyloid-β levels.
- Imaging biomarkers such as PET scans for visualizing tau/β-amyloid and MRI for structural brain changes can assist in early diagnosis.
- Genetic screening can identify mutations (e.g., in APP, PSEN1, PSEN2, and APOE) for early- and late-onset disease.
Alzheimer's Disease - Course
- Identifiable biomarker changes of Aβ42, p-Tau can precede clinical symptoms by 20+ years.
- These include preclinical and clinical phases.
Neuropsychological Testing for AD Diagnosis
- Various tests evaluate specific cognitive domains: memory (word list recall), problem-solving (Wisconsin Card Sorting), attention (digit span), vision-motor coordination (Trail Making Test), and abstract thinking (similarities)
Current Pharmacological Therapy of AD
- Primarily symptomatic treatment (e.g., cholinesterase inhibitors, NMDA antagonists)
- Little evidence affects underlying pathology.
- Disease-modifying therapies are under development, with controversial efficacy.
Acetylcholinesterase (AChE) Inhibitors
- Address cholinergic neurotransmission loss, increasing acetylcholine availability.
- Examples: Donepezil, rivastigmine, and galantamine.
Cholinesterase Inhibitors: Clinical Considerations
- Improve cognition, behavior, and daily functional ability,
- But benefits are limited and only delays cognitive deterioration by approximately one year, often controversial.
- Cholinergic side effects such as nausea, anorexia, vomiting, and diarrhea are possible
NMDA Antagonists (e.g., Memantine)
- Non-competitive antagonists that bind to NMDA receptor-calcium channels.
- Prevent excessive calcium influx caused by abnormal glutamate activity, thus protecting neurons from excitotoxicity.
- Potentially slow neurodegeneration, improving cognitive function.
NMDA Antagonists: Clinical Considerations
- Effective for moderate to severe Alzheimer's disease.
- Clinical studies show improvement in cognition, social behavior, and functional ability (~60–70% response rate), though benefits are often controversial.
- Often used in conjunction with cholinesterase inhibitors
NMDA Antagonists: Adverse Effects
- Dizziness, headache, constipation, and confusion
Recent Approvals and Therapies Under Development
- Lecanemab (Leqembi)
- Donanemab
- Saracatinib
- Beta-secretase Inhibitors
- Tau Therapies
- Anti-Inflammatory agents
Prion Diseases
- Transmissible, untreatable, fatal brain diseases of mammals.
- The normal Prion protein (PrP) is a membrane protein without known physiological function .
- Abnormal, misfolded forms (PrPSc) are highly infectious, insoluble, and cause a chain reaction, leading to other PrP to misfold.
- Creutzfeldt-Jakob Disease (CJD) is the most common human prion disease (incidence ~1/1,000,000).
Other Neurodegenerative Diseases
- Huntington's disease, characterized by AD (autosomal dominant inheritance in Huntingtin protein mutation), degeneration of GABAergic neurons, chorea, and trinucleotide repeats of CAG.
- Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease), characterized by degeneration of upper and lower motor neurons and sporadic and familial forms due to mutations in SOD, angiogenin, and RNA processing genes.
Case Studies
- Case 1: Sean F. – Deputy CEO, 55-years-old, presenting with progressive cognitive decline
- Case 2: Mary D. – former school bus driver, 69-years-old, presenting with gradual forgetfulness, apathy, and decreased appetite
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