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with an 18-month history of progressive loss of recent memory and inattentiveness.
At this time she is having difficulty speaking, her judgment appears to be impaired, and she occasionally evidences paranoid behavior. In addition to neurofibrillary tangles, the neuropathologic findings in this condition include plaques made of
A) low-density lipoprotein
B) unesterified cholesterol
C) beta-amyloid protein
D) immunoglobulin proteins
E) protease inhibitor
XIII-39. A 68-year-old man
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sory about this part:XIII-39. A 68-year-old man
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here is the qs 2
A 68-year-old man develops a rest tremor of the right hand and arm. The patient moves slowly and has a diminished range of facial expressions. He has no postural abnormalities. Which of the following drugs would be most appropriate at this time?
A) Deprenyl
B) Levodopa
C) Carbidopa-levodopa (Sinemet)
D) Bromocriptine
E) Benztropine
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for the first qs
The answer is C.
Alzheimer™s disease is the most common cause of dementia in the elderly. It is highly prevalent, affecting up to 45% of those over age 85. In a relatively small percentage of cases, the disease occurs in a familial pattern; this is thought to be due to autosomal dominant inheritance with linkage to chromosome 21 or 19. The clinical beginnings of the disease tend to be subtle. The initial symptoms are usually limited to loss of recent memory.
Psychiatric symptoms may then supervene and can include depression, anxiety, delusions,
and paranoid behavior. An extrapyramidial component exists so that patients walk in a
shuffling manner with short steps. Radiographic evaluation usually reveals neuronal atrophy.
Neuropathologically, the disease is characterized by neurofibrillary tangles, which
may contain an abnormally phosphorylated form of a microtubular protein known as tau,
as well as spherical deposits known as senile plaques. A protein known as -amyloid can
be found in these plaques. Certain families with inherited Alzheimer™s disease have been
found to harbor a point mutation in the amyloid precursor protein. From a neurotransmitter
standpoint, acetylcholine, a neurotransmitter that is important in memory formation, is
synthesized at abnormally low levels. The current model for the pathogenesis of Alzheimer™s
disease is that altered cleavage of the amyloid precursor protein generates the socalled
beta-amyloid protein, which then binds to a protease inhibitor“ enzyme complex, in
turn preventing the normal inactivation of extracellular proteases. It is these abnormally
activated extracellular proteases that may mediate the neuronal degeneration characteristic
of Alzheimer™s disease. Therapeutic strategies that could inhibit the generation of b-amyloid
are of potential therapeutic interest.
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for the 2nd qs
levodopa n carbiddopa seems appropriate..
parkinsons
