NURS 337: Exam #3 - Neuro-Pathology

What is the chronic, progressive failure of many cerebral functions including impairment of intellectual processes?

Dementia

What happens usually during dementia?

- Losses of orientation

- Memory

- Language

- Judgement

- Decision-making

- Alteration in behavior

T/F: Dementia is a specific disease?

False, they are a group of symptoms caused by brain damage

Who is at risk of getting dementia?

Older people

Is dementia a normal aging process? (True or False)?

False, it is not a normal aging process

What is usually gone first in regards of short term or long term memory during dementia?

Short-term is usually

Clinical judgement and simple tasks are loss?

Dementia

What does dementia degenerate?

Neuron degeneration (chronic long-term thing)

In dementia, tissue can die off what part of the body?

Compression of brain tissue

Atherosclerosis in dementia occurs in what type of vessels?

Cerebral vessels, can lead to ischemia and eventually infarction

Does brain trauma cause dementia? (T/F)

True

Dementia can also be predisposed?

Genetics

What example of CNS infections are seen in dementia?

Syphilis (neuro)

What example of neuroinflammation are seen in dementia?

Long-term alcohol usage

What is the MOST COMMON cause of dementia?

Alzheimer's Disease

What is the progressive, neurological deterioration and continuing decline affecting memory, thinking skills, the inability to carry out simplest tasks?

Alzheimer's Disease

What is the most common type of dementia in older persons?

Alzheimer's Disease

What is a key factor that leads to the progression of Alzheimer's Disease?

Increase in age

What are the 2 forms of Alzheimer's disease?

- Late onset

- Early onset

What is the percentage of late onset Alzheimer's disease?

95%

Which type of late onset Alzheimer's disease is the most common?

Sporadic

What type of chromosome is affected in late onset Alzheimer's disease?

Alteration in apolipoprotein E (chromosome 19)

What are the two types of Early-Onset Alzheimer's disease?

- Familial

- Nonfamilial

What is the percentage of Early Onset Alzheimer's disease?

5%

What type of gene pattern is Familial Early Onset Alzheimer's Disease?

Autosomal Dominant

What type of chromosome is affected with Early Onset Alzheimer's Disease?

Chromosome 1 and 14

What type of chromosome is affected with Nonfamilial Early Onset Alzheimer's Disease?

Chromosome 21 (Down Syndrome)

What is the extracellular deposition in Alzheimer's Disease?

Beta-amyloid

What type of plaque is seen in Alzheimer's Disease?

Senile (Neuritic)

What is the intracellular accumulation in Alzheimer's Disease?

Tau protein

What is Neurofibrillary Tangles seen in what disease?

Alzheimer's Disease

What degenerates in Alzheimer's Disease?

Basal forebrain cholinergic neurons

What is lost in Alzheimer's disease?

Acetylcholine

Alzheimer's Disease contributes to what type of impairment?

Cognitive

How long is Alzheimer's Disease progressive?

10 - 20 years

What are the symptoms of Early Alzheimer's Disease?

- Forgetfulness

- Emotional upset

Overtime what are the other symptoms of Alzheimer's Disease?

- Memory loss

- Disorientation

- Confusion

- Lack of concentration

- Decline in problem-solving and judgement

How can we diagnose Alzheimer's Disease?

Complete and thorough history, physical examination, neurological and mental status exam along with psychiatric assessment. This also helps with the exclusion of other disorders.

There is a definitive clinical diagnostic tests for Alzheimer's Disease? (T/F)

No, definitive clinical diagnostic test

How do we confirm Alzheimer's Disease?

Post-mortem brain biopsy for end of life

What type of scans will be used for diagnosing Alzheimer's Disease?

- CT Scan

- PET Scan

- Flortuacipir (Tauvid)

What is the treatment for Alzheimer's Disease?

No specific treatment

What are the goals for Alzheimer's Disease?

- Maintain mental functions

- Treat underlying disease process

- Managing behavioral symptoms

What type of drug does temporary improvement for Alzheimer's Disease?

Anticholinesterase drug

What is a amyloid beta-directed monoclonal antibody?

Aducanumab

What is needed to support patients and caregivers caring for Alzheimer's?

A team approach, support by the family process will be easier if family is willing to cooperate

What is the progressive, neurodegenerative disease of the basal ganglia with the loss of dopamine-producing neurons?

Parkinson's Disease

What is the pathogenesis of Parkinson's Disease?

Intraneuronal Lewy bodies inclusions composed of a-synuclein are commonly

What are the types of Parkinson's Disease?

- Primary

- Secondary

Primary Parkinson's disease is associated with what age group?

Majority increase with age above 60 years

What type of Parkinson's Disease has a genetic association?

Primary Parkinson's Disease

What type of Parkinson's Disease is involved in environmental factors such as pesticides and herbicides?

Secondary Parkinson's Disease

What type of medications causes Secondary Parkinson's Disease?

Anti-psychotic

Who had Secondary Parkinson's Disease and what type?

Pseudo-Parkinsonism - Muhammad Ali

What is the treatment for Parkinson's Disease?

- Dopamine replacement therapy (Levodopa)

- Monoamine oxidase B inhibitors

- Anticholinergic drugs

- Amantadine

What is the team approach for Parkinson's Disease?

- Speech and language pathologist

- Physical therapy

- Occupational therapy

- Improves balance, coordination

What do we need to monitor for Parkinson's disease?

Respiratory and urinary tract infections

What is the progressive, debilitating neurodegenerative inherited disease?

Huntington's Disease

What type of gene is Huntington's Disease?

Autosomal Dominant

What is another name for Huntington's Disease?

Huntington's Chorea (artistic movement of the limb)

What is the defective chromosome affected in Huntington's Disease?

Chromosome 4

What are the other defective genes in Huntington's Disease?

Huntington (HTT) gene signaling, transport, anti-apoptosis, DNA repair

When does Huntington Disease usually manifest?

Until the individual is older than 40 years

What is usually a hyperkinetic disorder?

Huntington's Disease

Involves the basal ganglia (caudate nucleus) and frontal cortex?

Huntington's Disease

What is the depletion of gamma-aminobutyric acid (GABA) in the basal nuclei (caudate nucleus and putamen)

Huntington's Disease

What happens to the acetylcholine levels in the brain seen in Huntington's Disease?

Reduced

What is usually the result of Huntington's Disease?

Progressive atrophy of the brain

What are the usual signs and symptoms of Huntington's Disease?

- Mood swings, personality changes

- Restlessness, choreiform (purposeless) movements without conscious efforts

- Emotional changes

- Dementia

How do we diagnose Huntington's Disease?

DNA analysis

What is the treatment for Huntington's Disease?

Currently, no specific treatment but you can only treat the symptoms

What usually happens if Huntington's disease is left untreated (Mortality)?

- Suicide

- Infection

- Heart Disease

What is the rapidly progressive and fatal neurodegenerative disease of the upper and lower motor neurons?

Amyotrophic Lateral Sclerosis (ALS)

What is another name for Amyotrophic Lateral Sclerosis (ALS)?

Lou Gehrig's Disease

There is no indication of inflammation around nerves?

Amyotrophic Lateral Sclerosis (ALS)

What type of impairment is caused in Amyotrophic Lateral Sclerosis (ALS)?

Cognition

What type of gene mutation is seen in Amyotrophic Lateral Sclerosis?

SOD I gene mutation

What damage does SOD I mutation cause?

Glutamate uptake channels in astrocytes

What type of population is triggered in Amyotrophic Lateral Sclerosis (ALS)?

Military Veteran (Gulf War)

Who is at risk for Amyotrophic Lateral Sclerosis (ALS)?

Repeated trauma in athletes

What is the loss of upper motor neurons and spastic paralysis and hyperreflexia?

Amyotrophic Lateral Sclerosis (ALS)?

What is damaged to lower motor neurons in Amyotrophic Lateral Sclerosis (ALS)?

- Flaccid paralysis

- Decreased muscle tone and reflexes

What is the progressive muscle weakness and loss of fine motor coordination? This also causes stumbling and falls which are common?

Amyotrophic Lateral Sclerosis (ALS)

What is the causes of death for Amyotrophic Lateral Sclerosis? (ALS)

Respiratory failure

What are the clinical manifestations for Amyotrophic Lateral Sclerosis? (ALS)

- Limb cramping or weakness

- Incoordination

- Slurring of speech

- Difficulty swallowing

- Single muscle group paresis that spreads

- Hypotonia

What is the mean survival for Amyotrophic Lateral Sclerosis (ALS)?

3-5 years from time of diagnosis

What are the drugs used for treatment or options for treatment for Amyotrophic Lateral Sclerosis (ALS)?

- Riluzole

- Edavarone

- Relyvrio

- Stem cell

- Maintain quality of life

- Involve family in the treatment

The drug Riluzole (Rilutek) what is the function? What is another type of Riluzole (Rilutek)?

Antiglutamate prolongs life for months but does not cure. This also slows the further damage to neurons

What is a free radical scavenger for treatment for ALS?

Edavarone

What is a cell that is used under investigation for treatment for ALS?

Stem cell

Frequently occurring neurological disorders caused by pathological processes in the blood vessels?

Cerebrovascular Disease (CVA)

What is the pathogenesis of Cerebrovascular Disease (CVA)?

- Ischemia

- Hemorrhagic

- Vascular malformation

- Arteriovenous (AV) malformation

What are the characteristics of Cerebrovascular Disease (CVA) in ischemia?

- With or without infarction

- Global or local

What is the increased intracranial pressure (ICP) will cause local ischemia and generalized symptoms?

Hemorrhagic (CVA)

What are the types of Cerebrovascular Disease?

- Transient Ischemic Attacks (TIA)

- Cerebral vascular accident (CVA) stroke

What are the 3 types of strokes in CVA?

- Thrombotic stroke

- Embolic stroke

- Hemorrhagic stroke

What is the transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction?

Transient Ischemic Attacks (TIAS)

How long does neurological dysfunction from an ischemic event in Transient Ischemic Attacks?

Less than 1 hour

Is Transient Ischemic Attacks reversible or irreversible?

Reversible

What are the causes of Transient Ischemic Attacks?

- Atherosclerosis

- Partial occlusion of an artery (small embolus)

- Vascular spasm

- Arteritis

- Mass lesions