Neurodegenerative Disorders Quiz

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Questions and Answers

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?

  • Alzheimer’s Disease (correct)
  • Parkinson’s Disease
  • Amyotrophic Lateral Sclerosis
  • 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?

<p>Protein aggregation (B)</p> Signup and view all the answers

Which statement accurately describes the progression of dementia?

<p>It typically worsens over time. (C)</p> Signup and view all the answers

What impact do DNA and RNA defects have on neurodegenerative diseases?

<p>They result in dysfunctional proteins. (B)</p> Signup and view all the answers

What is a common characteristic of all neurodegenerative disorders mentioned?

<p>They involve neuronal cell death. (D)</p> Signup and view all the answers

Which of these conditions is specifically associated with the motor neurons?

<p>Amyotrophic Lateral Sclerosis (B)</p> Signup and view all the answers

What is the primary effect of amyloid-beta (Aβ) and neurofibrillary tangles (NFTs) on cognitive function?

<p>Disruption of synaptic signaling and plasticity (C)</p> Signup and view all the answers

Which brain regions are first affected in Alzheimer's Disease?

<p>Cerebral cortex and basal ganglia (D)</p> Signup and view all the answers

Which disease is characterized by the presence of abnormally phosphorylated tau protein in the hippocampus and amygdala?

<p>Argyrophilic Grain Disease (AGD) (C)</p> Signup and view all the answers

What is a common clinical feature associated with the early stages of Alzheimer's Disease?

<p>Dementia and memory loss (D)</p> Signup and view all the answers

In which condition may individuals experience difficulties with balance, movement, and vision?

<p>Progressive Supranuclear Palsy (D)</p> Signup and view all the answers

Which neurotransmitter is primarily targeted by drugs used for the treatment of Alzheimer’s Disease?

<p>Acetylcholine (B)</p> Signup and view all the answers

What is a symptom of Pick's Disease?

<p>Behavioral changes and personality alterations (A)</p> Signup and view all the answers

What genetic factor is associated with familial Alzheimer's disease (Early Onset)?

<p>Mutations in the APP gene (D)</p> Signup and view all the answers

In neurodegenerative disorders, what is a common feature of the neuropathology observed?

<p>Aggregation of specific proteins (C)</p> Signup and view all the answers

What distinguishes Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17) from other tauopathies?

<p>Characterized by MAPT gene mutations (B)</p> Signup and view all the answers

What is the disease concept related to Prion diseases primarily centered on?

<p>Misfolded proteins causing neurodegeneration (C)</p> Signup and view all the answers

What role do Aβ and NFTs play in neuroinflammation?

<p>They activate glial cells, causing inflammation (C)</p> Signup and view all the answers

Which of the following is NOT a typical risk factor for developing Alzheimer's Disease?

<p>Regular physical activity (B)</p> Signup and view all the answers

Which of the following tauopathies is associated with cognitive decline and parkinsonism?

<p>Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (A)</p> Signup and view all the answers

Which clinical feature is least likely observed in the early stages of Alzheimer's Disease?

<p>Severe communication difficulties (D)</p> Signup and view all the answers

What aspect of neurodegenerative diseases do characteristic aggregating proteins relate to?

<p>Mechanisms of cell death (C)</p> Signup and view all the answers

What is a common early symptom of Alzheimer's disease?

<p>Confusion and memory loss (A)</p> Signup and view all the answers

Which of the following is a characteristic of moderate symptoms in Alzheimer's disease?

<p>Anxiety, agitation, and paranoia (A)</p> Signup and view all the answers

What are the two pathological hallmarks of Alzheimer's disease?

<p>Amyloid plaques and neurofibrillary tangles (A)</p> Signup and view all the answers

What leads to the production of beta-amyloid peptides in Alzheimer's disease pathology?

<p>Abnormal processing of Amyloid Precursor Protein (APP) (B)</p> Signup and view all the answers

Which symptom indicates severe Alzheimer's disease?

<p>Loss of bladder and bowel control (A)</p> Signup and view all the answers

Which condition is primarily affected by Alzheimer's disease progression?

<p>Cognitive functions (D)</p> Signup and view all the answers

What is a possible consequence of beta-amyloid aggregation?

<p>Formation of amyloid plaques (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with mild cognitive impairment (MCI) as part of Alzheimer's disease progression?

<p>Loss of speech (C)</p> Signup and view all the answers

What is the consequence of hyperphosphorylation of tau protein?

<p>It detaches tau from microtubules. (A)</p> Signup and view all the answers

Which of the following is a primary feature of neurofibrillary tangles in Alzheimer's disease?

<p>They consist of aggregated hyperphosphorylated tau. (A)</p> Signup and view all the answers

What role does the amyloid precursor protein (APP) play under normal physiological conditions?

<p>It contributes to neural growth and repair. (D)</p> Signup and view all the answers

How does β-amyloid affect neuronal function?

<p>It induces oxidative stress and impairs communication. (B)</p> Signup and view all the answers

What is the primary pathological form of β-amyloid associated with Alzheimer's disease?

<p>Hard, insoluble fibrils. (A)</p> Signup and view all the answers

What is the result of chronic inflammation in the context of neurodegeneration?

<p>Enhanced glial cell activation causing toxicity. (C)</p> Signup and view all the answers

What primarily triggers the production of neurotoxic oligomers of β-amyloid?

<p>Abnormal processing of APP. (B)</p> Signup and view all the answers

What effect does the formation of amyloid plaques have on surrounding brain tissues?

<p>It leads to local inflammatory tissue response. (D)</p> Signup and view all the answers

What is the role of β-secretase in the formation of β-amyloid?

<p>It cleaves the APP to form abnormal Aβ1-42. (A)</p> Signup and view all the answers

What is the result of soluble oligomers disrupting neuronal membrane integrity?

<p>Loss of synapses and neuron death. (D)</p> Signup and view all the answers

What type of protein forms neurofibrillary tangles in Alzheimer's disease?

<p>Tau protein. (A)</p> Signup and view all the answers

Which of the following secretases is primarily responsible for normal APP processing?

<p>α-secretase. (A)</p> Signup and view all the answers

How do Aβ peptides and tau tangles interact in Alzheimer's disease?

<p>Tau tangles can exacerbate Aβ aggregation. (A)</p> Signup and view all the answers

What happens to the microtubule structure in neurons during Alzheimer's disease?

<p>It collapses and loses functionality. (D)</p> Signup and view all the answers

What is the primary consequence of activating cell death pathways in neurons?

<p>Neuron death. (D)</p> Signup and view all the answers

What does the term 'amyloidogenic' refer to in the context of APP processing?

<p>Leads to the formation of toxic Aβ proteins. (C)</p> Signup and view all the answers

What is a primary consequence of disruptions in cytoskeletal structure within neurons?

<p>Impaired cellular shape and function (C)</p> Signup and view all the answers

Which factor is most closely associated with an increased risk of Alzheimer's disease?

<p>Family history of dementia (C)</p> Signup and view all the answers

What characterizes the progression of vascular dementia compared to Alzheimer's disease?

<p>Stepwise or fluctuating cognitive decline (D)</p> Signup and view all the answers

What is a hallmark feature of amyloid plaques in Alzheimer's disease?

<p>Impairment of synaptic transmission between neurons (C)</p> Signup and view all the answers

What is the significance of aberrant proteostasis in neurodegenerative diseases?

<p>It maintains balance in protein synthesis, folding, and degradation. (B)</p> Signup and view all the answers

How is the average lifespan after an Alzheimer's disease diagnosis characterized?

<p>4-8 years with individual variations (C)</p> Signup and view all the answers

Which symptom is particularly associated with the initial stages of vascular dementia?

<p>Gradual onset of judgment impairments (A)</p> Signup and view all the answers

What primarily leads to the neuronal death observed in Alzheimer's disease?

<p>Formation of neurofibrillary tangles (D)</p> Signup and view all the answers

Which disorder is characterized by the presence of neurofibrillary tangles predominantly in the brainstem and basal ganglia regions?

<p>Progressive Supranuclear Palsy (PSP) (B)</p> Signup and view all the answers

What symptom is most commonly associated with Argyrophilic Grain Disease (AGD)?

<p>Cognitive decline, particularly in memory (A)</p> Signup and view all the answers

Which tauopathy is specifically linked to mutations in the MAPT gene located on chromosome 17?

<p>Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17) (C)</p> Signup and view all the answers

Which condition is primarily characterized by behavioral changes and language difficulties due to tau protein aggregates?

<p>Pick's Disease (Frontotemporal Dementia) (C)</p> Signup and view all the answers

Which of the following disorders does NOT typically involve symptoms such as cognitive decline and movement difficulties?

<p>Argyrophilic Grain Disease (AGD) (D)</p> Signup and view all the answers

What is the primary consequence of neuroinflammation triggered by Aβ and NFTs?

<p>Damage to neurons (B)</p> Signup and view all the answers

Which symptom is unlikely to be present in early-stage Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)?

<p>Severe motor dysfunction (C)</p> Signup and view all the answers

What type of protein accumulation is characteristic of Pick's Disease?

<p>Pick bodies (B)</p> Signup and view all the answers

Which brain region is first affected in most neurodegenerative disorders?

<p>Cerebral cortex (C)</p> Signup and view all the answers

What clinical feature is most commonly associated with the early stages of Alzheimer's Disease?

<p>Memory loss (A)</p> Signup and view all the answers

Which type of proteins are identified as characteristic of neurodegenerative diseases?

<p>Aggregating proteins (B)</p> Signup and view all the answers

Which of the following is a common drug class used for Alzheimer's Disease treatment?

<p>Cholinesterase inhibitors (A)</p> Signup and view all the answers

What type of pathological change is primarily linked to Alzheimer's Disease?

<p>Amyloid plaque formation (D)</p> Signup and view all the answers

What is the primary cause of memory loss in Alzheimer's Disease?

<p>Disruption of synaptic transmission (B)</p> Signup and view all the answers

Which condition is primarily characterized by the presence of misfolded proteins affecting neuronal function?

<p>Prion diseases (C)</p> Signup and view all the answers

Which of the following features is least likely to be observed in the early stages of Alzheimer's Disease?

<p>Significant behavioral changes (B)</p> Signup and view all the answers

Which symptom is characteristic of severe Alzheimer's disease?

<p>Loss of speech (B)</p> Signup and view all the answers

What is a common symptom during the moderate stage of Alzheimer's disease?

<p>Difficulty with personal care (D)</p> Signup and view all the answers

Which of the following best describes the role of amyloid precursor protein (APP) in Alzheimer's disease?

<p>It is involved in the abnormal processing leading to beta-amyloid peptides. (B)</p> Signup and view all the answers

What leads to the formation of neurofibrillary tangles in Alzheimer's disease?

<p>Hyperphosphorylation of tau protein. (C)</p> Signup and view all the answers

Which symptom would most likely indicate the onset of mild cognitive impairment (MCI)?

<p>Confusion and memory loss (D)</p> Signup and view all the answers

What is the pathological significance of amyloid plaques in Alzheimer's disease?

<p>They disrupt cell membrane integrity. (C)</p> Signup and view all the answers

Which of the following options lists a symptom that typically progresses to severe stage Alzheimer's disease?

<p>Difficulty in routine tasks (B)</p> Signup and view all the answers

What is the initial trigger in the process involving beta-amyloid production in Alzheimer's disease?

<p>Abnormal APP processing (C)</p> Signup and view all the answers

What is the primary mechanism by which hyperphosphorylation of tau protein contributes to neurodegeneration?

<p>It facilitates the detachment of tau from microtubules. (C)</p> Signup and view all the answers

Which of the following factors is exacerbated by chronic inflammation in Alzheimer's disease?

<p>Neurotoxic environment. (D)</p> Signup and view all the answers

What is the consequence of beta-amyloid monomers aggregating into oligomers?

<p>They cause oxidative stress. (A)</p> Signup and view all the answers

What leads to the formation of neurofibrillary tangles within neurons?

<p>Hyperphosphorylation of tau protein. (B)</p> Signup and view all the answers

Which pathological feature is primarily associated with the cleavage of amyloid precursor protein (APP) in Alzheimer's disease?

<p>Formation of insoluble beta-amyloid plaques. (B)</p> Signup and view all the answers

What role do microglia and astrocytes play in the context of amyloid and tau pathologies?

<p>They respond to and exacerbate inflammation. (B)</p> Signup and view all the answers

Which form of beta-amyloid is primarily associated with initiating Alzheimer's disease pathology?

<p>Aβ42. (A)</p> Signup and view all the answers

What effect does the formation of amyloid plaques have on synaptic function?

<p>They disrupt synaptic function. (A)</p> Signup and view all the answers

What abnormal form of beta-amyloid is primarily associated with amyloid plaque formation in Alzheimer's disease?

<p>Aβ1-42 (C)</p> Signup and view all the answers

Which secretase is responsible for cleaving APP in the Alzheimer’s disease mechanism, resulting in abnormal processing?

<p>β-secretase (A)</p> Signup and view all the answers

In the context of tau pathology, what is the consequence of the collapse of the microtubule structure?

<p>Disruption of intracellular transport (C)</p> Signup and view all the answers

What interaction occurs between Aβ peptides and tau tangles in Alzheimer's disease?

<p>Mutual promotion (B)</p> Signup and view all the answers

What is one main consequence of soluble oligomers disrupting neuronal membrane integrity?

<p>Synaptic loss (B)</p> Signup and view all the answers

What is the role of tau protein under normal physiological conditions?

<p>Stabilization of microtubules (D)</p> Signup and view all the answers

Which pathological feature is primarily linked to the neurodegeneration associated with Alzheimer's disease?

<p>Formation of neurofibrillary tangles (A)</p> Signup and view all the answers

What type of fragmentation occurs during the pathological processing of APP in Alzheimer's disease?

<p>Amyloidogenic fragmentation (C)</p> Signup and view all the answers

Flashcards

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

Common symptoms of Alzheimer's include dementia, memory loss, disorientation, mood changes, and communication difficulties.

Neurodegenerative Disorders

A group of brain diseases characterized by progressive loss of neurons and brain function.

Neurodegenerative Processes Study

Focuses on the brain regions first affected during neurodegenerative disorders, the pathology of Alzheimer's disease (including biochemistry), risk factors for Alzheimer's, treatment of Alzheimer's, and the concept of prion diseases, including pathophysiology.

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Alzheimer's hallmark

Characteristic proteins and genes linked to the affected brain regions.

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Risk factors

Factors that increase the likelihood of developing Alzheimer's disease.

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Alzheimer's Treatment

The drugs used to treat Alzheimer's disease.

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Prion Diseases

Diseases caused by misfolded proteins that aggregate and cause brain damage.

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Synaptic Dysfunction

Impairment of communication between neurons, disrupting cognitive function.

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Neuroinflammation

Inflammation in the brain, damaging neurons and worsening brain diseases.

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Argyrophilic Grain Disease (AGD)

A brain disorder with abnormal tau protein and possible memory loss.

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Progressive Supranuclear Palsy (PSP)

Neurological disorder affecting movement, balance, and vision, progressing into dementia.

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Pick's Disease

Dementia affecting behaviour, personality, and language, with Pick bodies.

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Frontotemporal Dementia

Dementia affecting frontal and temporal lobes, and linked to Parkinson's-like symptoms.

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Chromosome 17 (FTDP-17)

Genetic link to frontotemporal dementia and Parkinsonism, impacting tau protein.

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Familial Alzheimer's Disease

Early-onset Alzheimer's disease, with various genetic links.

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Parkinson's Disease

A neurodegenerative disease affecting the basal ganglia and midbrain, causing slow movements, tremors, and rigidity.

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Huntington's Disease

A neurodegenerative disease affecting the basal ganglia (striatum), causing uncontrolled movements.

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Amyotrophic Lateral Sclerosis (ALS)

A neurodegenerative disease affecting motor neurons, leading to weakness and paralysis.

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Creutzfeldt-Jakob Disease (CJD)

A neurodegenerative disease affecting the cerebral cortex, basal ganglia, and cerebellum, resulting in dementia and movement disorders.

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Dementia

Significant, progressive loss of intellectual abilities—memory, focus, and judgment—that severely interferes with daily tasks.

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Protein Aggregation

Abnormal protein folding that causes harmful aggregate buildup in neurons, implicated in neurodegeneration.

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Alzheimer's disease symptoms

Symptoms of Alzheimer's disease include memory loss, confusion, personality changes, difficulty with routine tasks, disorientation, and eventually loss of speech, appetite, bladder/bowel control, and complete dependence.

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AD symptom progression

Alzheimer's disease symptoms worsen over time, progressing from mild cognitive impairment (MCI) to severe stages, affecting various aspects of daily life.

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Neurofibrillary tangles

Abnormal protein structures inside nerve cells in the brain, a hallmark of Alzheimer's disease.

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Amyloid plaques

Abnormal protein deposits outside nerve cells in the brain, another hallmark of Alzheimer's disease.

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Amyloid Precursor Protein (APP)

A protein in the brain that, when processed abnormally, can lead to the formation of beta-amyloid.

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Beta-amyloid aggregation

The buildup of beta-amyloid peptides, leading to the formation of amyloid plaques, a characteristic of Alzheimer's disease.

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Beta-amyloid (Aβ)

A peptide that leads to amyloid plaque formation in Alzheimer's disease.

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Brain atrophy in AD

Brain shrinkage (atrophy) occurs in Alzheimer's disease, impacting brain structure and function.

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Tau Protein

A protein that helps stabilize microtubules, which are important for transporting nutrients and other molecules within neurons.

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Hyperphosphorylation

A process where a protein has too many phosphate groups attached to it, changing its shape and function.

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Oligomers

Small, soluble clumps of beta-amyloid that are particularly toxic to neurons.

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β-secretase

An enzyme that cleaves APP in a way that leads to the production of β-amyloid. This is an abnormal processing of APP.

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γ-secretase

An enzyme that cleaves APP both in normal and Alzheimer's processing. It's involved in creating the abnormal Aβ1-42 form, which is amyloidogenic.

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Amyloidogenic

Referring to the formation of amyloid plaques, which are a hallmark of Alzheimer's disease.

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Microtubules

Structures inside neurons responsible for transporting proteins and organelles. They are disrupted in Alzheimer's due to the abnormal phosphorylation of tau.

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What is the relationship between amyloid plaques and neurofibrillary tangles?

They are linked to each other in a vicious cycle. Amyloid plaques can induce tau pathology (causing tangles) and tangles can exacerbate amyloid aggregation.

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Synaptic Dysfunction in AD

When amyloid plaques and neurofibrillary tangles disrupt communication between neurons, causing problems with learning, memory, and thinking.

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Neuroinflammation in AD

Immune cells (glia) in the brain become overactive, attacking neurons and causing more damage like a fire.

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Frontotemporal Dementia and Parkinsonism linked to Chromosome 17 (FTDP-17)

A genetic disorder where a specific gene causes abnormal tau protein, leading to dementia, personality changes, and Parkinson's symptoms.

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Familial AD (Early Onset)

Alzheimer's disease that starts at a younger age due to inherited genetic mutations.

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Common Alzheimer's symptoms

Common symptoms of Alzheimer's include dementia, memory loss, disorientation, mood changes, and communication difficulties.

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What proteins aggregate in Alzheimer's?

Alzheimer's disease is marked by the aggregation of two key proteins: amyloid-beta (Aβ) and tau.

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How does amyloid-beta aggregate?

Amyloid-beta (Aβ) is derived from a larger protein called amyloid precursor protein (APP). Abnormal processing of APP leads to the production of Aβ peptides that clump together, forming amyloid plaques.

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What happens to tau protein in Alzheimer's?

Tau protein normally helps stabilize microtubules, which are important for transporting nutrients and other molecules within neurons. In Alzheimer's, tau becomes hyperphosphorylated, causing it to detach from microtubules and clump together, forming neurofibrillary tangles.

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What are some risk factors for Alzheimer's Disease?

Risk factors for Alzheimer's Disease include age, genetics, family history, lifestyle factors (e.g., diet, exercise, smoking), and medical conditions (e.g., diabetes, high blood pressure).

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What are prion diseases?

Prion diseases are caused by misfolded proteins called prions. These prions can convert normal proteins into misfolded versions, leading to the formation of aggregates that damage brain cells.

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What are some common drugs used to treat Alzheimer's?

The most common drugs used to treat Alzheimer's Disease aim to improve cognitive function, although they don't cure the disease. These include cholinesterase inhibitors (e.g., donepezil, rivastigmine) and memantine, which is an NMDA receptor antagonist.

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Cytoskeletal Abnormalities

Changes in the structure of the neuronal cytoskeleton, which is vital for keeping the neuron's shape, transporting important molecules, and communication within the cell. These changes can disrupt these essential functions and contribute to neurodegeneration.

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Aberrant Proteostasis

An imbalance in the creation, folding, movement, and breakdown of proteins within a neuron. This imbalance is critical because proteins are essential for neuronal survival and function. Disrupted proteostasis is involved in neurodegenerative diseases.

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Alzheimer's Disease

A neurodegenerative disease characterized by memory loss, disorientation, mood changes, and communication difficulties. It's the most common form of dementia, affecting 60-80% of cases. Key pathological features include amyloid plaques and neurofibrillary tangles.

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Vascular Dementia

Caused by brain damage due to cerebrovascular disease, such as stroke or chronic ischemia. It accounts for 10-20% of dementia cases. Symptoms include impaired judgment, inability to plan, and stepwise decline in cognitive abilities.

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Tau Protein's Role

Tau protein normally helps stabilize microtubules, which are like transport highways inside neurons, moving nutrients and essential materials.

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How Tau Goes Wrong

In Alzheimer's, tau becomes hyperphosphorylated, meaning it gets too many phosphate groups attached, changing its shape and making it detach from microtubules.

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What are Neurofibrillary Tangles?

Hyperphosphorylated tau forms twisted fibers that clump together inside neurons, creating tangled structures called neurofibrillary tangles.

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What is Beta-Amyloid?

Beta-amyloid (Aβ) is a fragment of APP that is produced when the protein is processed abnormally. It clumps together, forming amyloid plaques.

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What are Amyloid Plaques?

Amyloid plaques are clumps of Aβ that build up outside neurons. They disrupt cell function and cause inflammation.

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How do Amyloid Plaques Harm Neurons?

Plaques can trigger a chain reaction, leading to the creation of neurofibrillary tangles. They also directly disrupt the function of neurons.

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What is the Vicious Cycle?

Amyloid plaques and neurofibrillary tangles create a vicious cycle where each worsens the other, leading to more neuronal damage.

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What are the two hallmarks of Alzheimer's disease?

The two hallmarks of Alzheimer's disease are neurofibrillary tangles and amyloid plaques. Neurofibrillary tangles are twisted fibers of a protein called tau inside nerve cells, while amyloid plaques are clumps of a protein called beta-amyloid outside nerve cells.

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What is amyloid precursor protein (APP)?

Amyloid precursor protein (APP) is a protein normally present in the brain. In Alzheimer's, it's processed abnormally, producing beta-amyloid peptides.

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What does 'beta-amyloid aggregation' mean in Alzheimer's disease?

Beta-amyloid aggregation refers to the process where beta-amyloid peptides stick together to form clumps called amyloid plaques. This aggregation is abnormal and harmful to brain cells.

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What causes brain atrophy in Alzheimer's?

Brain atrophy, or shrinkage, in Alzheimer's is caused by the progressive loss of nerve cells (neurons) due to amyloid plaques and neurofibrillary tangles, disrupting brain structure and function.

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How are amyloid plaques and neurofibrillary tangles linked?

Amyloid plaques can induce the formation of neurofibrillary tangles, and tangles can worsen amyloid aggregation, creating a vicious cycle of damage in the brain.

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What are the effects of neurofibrillary tangles on neurons?

Neurofibrillary tangles disrupt the transport of nutrients and other vital molecules within neurons. They interfere with normal function and eventually lead to neuronal death.

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How does abnormal processing of APP lead to Alzheimer's?

Abnormal processing of APP leads to an increase in the production of beta-amyloid peptides. These peptides aggregate and form amyloid plaques, which are toxic to brain cells.

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What is β-amyloid?

A peptide produced from the abnormal processing of the Amyloid Precursor Protein (APP), by β-secretase and γ-secretase enzymes. It forms amyloid plaques that are toxic to neurons and contribute to Alzheimer's disease.

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What is the Amyloid Precursor Protein (APP)?

A protein found in the brain that is normally processed in a way that doesn't lead to Alzheimer's disease. However, when processed abnormally, it can be broken down into β-amyloid, which is toxic.

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What are the roles of β-secretase and γ-secretase?

They are enzymes that process APP. β-secretase cleaves APP in a way that leads to the production of β-amyloid, an abnormal processing. γ-secretase is involved in both normal and abnormal processing of APP.

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How does tau protein contribute to Alzheimer's?

Normally, tau helps stabilize the microtubule system, which is vital for transporting materials within neurons. However, in Alzheimer's, tau becomes abnormally phosphorylated (with too many phosphate groups), causing it to tangle. This disrupts microtubule function and leads to neuron death.

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What is the effect of these abnormal proteins on neurons?

Both amyloid plaques and neurofibrillary tangles disrupt communication between neurons (synaptic dysfunction) and contribute to neuron death. This ultimately leads to cognitive decline.

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How do these abnormal proteins affect the brain overall?

The accumulation of β-amyloid, forming amyloid plaques, and the formation of neurofibrillary tangles contribute to brain atrophy (shrinkage) and cognitive decline. These changes underlie many of the symptoms of Alzheimer's disease.

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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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