USMLE Neurology 23 Neuro Pathology: Degenerative Diseases (Alzheimers)

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This neuro pathology video is on neurodegenerative diseases. These are irreversible diseases that cause neural cell death. As you can imagine, these are diagnosis of exclusion and make sure you first rule out things like delirium, Wilsons, hypothyroidism, syphillis, hydrocephalus, etc.

After ALL that's been ruled out, then we can talk about neurodegenerative diseases. The first and most common one is Alzheimers. While no one is sure what causes Alzheimer's, some theories include deposition of b-amyloid (beta amyloid), as well as tau proteins. This can cause cell death, brain atrophy (especially in the hippocampus which controls memory and emotion, as well as the basal nucleus of meynert which makes Ach). While the majority of Alzheimer's is sporadic, some is genetic. Some causes include trisomy 21 (Downs Syndrome), preselin mutations, apolipoprotein E4/E2 mutations.

Now that you understand Alzheimer's, we can talk about some pharmacology. Pharm for Alzheimers include drugs that try to raise Ach.

Let's move onto some other pathologies, including frontal temporal dementia. This is due to deposition of TDP-43 and tau protein. Symptoms include disinhibition.

Now onto Parkinson's, which is due to deposition of a-synuclein (alpha-synuclein) aka Lewy bodies. This is more known for it's movement symptoms, but know that dementia can come later. If dementia comes earlier, we call it Lewy Body Dementia. Lewy body dementia seems to also have hallucinations.

Prion diseases are proteins that can change normal proteins to their abnormal form. These can deposit as beta pleated sheets. It destroys the cells and causes spongiform encephalopathy.

Last one is vascular dementia, which is degeneration due to infarts of the brain. The best way to differentiate this from others is a history of vascular disease and step-like decline.

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