Dementia:
Dementia is ... ?
Dementia is ... ?
Name the (4) main types of dementia that exist.
Vascular Dementia
Frontotemporal Dementia
Lewy Body Dementia
Alzheimer's (Dementia)
The pathological effects of obesity originate from which complication of excess adipose tissue? (0-1st step of obesity pathophys.)
Fat spillover from overgrown adipocytes.
The main difference between DM1 and DM2?
DM1 is autoimmune, immune sys. created antibodies that atck beta-cells
DM2 is largely due to developped insulin resistance (through unhealthy lifestyle) often preluded by obesity and metabolic syndrome
Which lipoprotein is the "healthy" one? and why?
HDL (high density) it can absorb more cholesterol to bring back to the liver
Name (the) 5 risk factors for atherosclerosis.
Overweight (high BMI)
Hypertension
(old) Age
DM
Hypercholesterolemia
The symptom "reduced inhibition of sexual impulses" and general inappropriate behaviour is most associated with ... ?
Frontotemporal Dementia
"Metabolic Syndrome" is defined as .... ?
Having 3/5 of the following:
Elevated glucose (>100 mg/dl)
Hypertension (>130/85)
Elevated TGAs (>150 mg/dl)
Waist circumference >40 in (=101 cm) (XY) & >35 in (=89 cm) (XX)
Low HDL lvls. (<40 mg/dl XY & <50 mg/dl XX)
Diabetes tends to come with a few (3) common symptoms, these are....?
3 Ps:
1. polyphagia (increased hunger)
2. polyuria (increased urine)
3. polydipsia (increased thirst)
Explain Diabetic Ketoacidosis.
Hypoglycemic state pushes body to lipolysis and eventually ketogenesis (for brain)
Main complication of atherosclerosis?
Thrombosis (ruptured plaque) that lodges itself in an artery/arteriole
Describe the symptom that differentiates a "Lewy Body dementia" from a "Alzheimer's disease" diagnosis
Cognitive function fluctuation throughout the day, regardless of sleep quality
Name the prominent (5) complications of obesity.
1. Hypertension (+tachycardia)
2. Athersclerotic plaques
3. DM2
4. Obstructive sleep apnea (OSA) and(/or) obesity hypoventilation syndrome (OHS)
5. Non-Alcoholic fatty liver disease
(6. Leptin resistance)
(7. Insulin resistance)
Explain how the "state of starvation" in DM2 creates a negative feedback loop contributing to "tired out" pancreatic beta cells.
"starvation" -> lipolysis and FFAs production -> +++ FFAs -> lipotoxicity inhibiting GLUT2 glucose transport in beta cells -> beta cells can't recognize glucose levels -> decrease insulin secretion -> further "starvation"
Precursor and Product(s) of Aldolase B (enzyme) activity? (3 answers)
Precursor: Fructose-1-phospate
Products: (x2) Glyceraldehyde + DHAP
Name the main diagnostic modalities for Athersclerosis. (3/5 gets the points)
1. US/ doppler US
2. CT
3. MRI
4. intravasc. US
(5. Optical coherence tomography)
Primary diagnosis method for dementia + what are you looking for?
MRI: atrophy (hippocampal, frontal, temporal, parietal) + lacunar/strategic (MCA/PCA) infracts, WMLs (white matter lesions)
FDG-PET: rate of metabolism (for Alzheimer's vs. FTD)
What are the 4 physiological effects of excess adipokines:
(Hint: efx on: pancreas, RAAS/SNS, Liver, fat distrib.)
Insulin resistance
Hypertension (+tachycardia via SNS activation, +vasoconstriction via RAAS stimulation)
+++ vLDL & TGAs (--- HDL)
Waist circumference increase (increase adipose tissue cell size)
Which 3 components lead to the development of insulin resistance in DM2?
Inflammatory mediators, FFAs and adipokines (Leptin, resistin, IL-6, TNF-alpha)
The process of "lipogenesis" describes (3 processes) ...? (2/3 gets points)
1. DHAP -> glycerol
2. Acetyl-CoA -> 3x FAs
3. x3 FAs + glycerol -> TGA
Recommended treatment options for atherosclerosis?
Lifestyle advice
Lipid-lowering medication ( statins or PCSK 9 inhibitors)
Anti-platelet medication
Name the 3 (+1) pathophysiological processes associated with "vascular dementia"
(Hint: large art., small art., capillaries, + cortical art.&capillaries)
Athersclerosis of LARGE arteries --> teritorial infracts
Arteriosclerosis of small arterioles --> lacunar infracts
Microvascular disease --> disrupted capillary functions
(accumulation of amyloid-beta in cortical arteries and capillaries)
Explain the first line treatment and the various accessory (pharmacological and surgical) treatment options that exist for obese patients (+ when they can be used/applied)
Points ALL: 1st line, 1/4 pharma, 2/3 surg. + cutoff
First line: physical activity (1 hr moderate-intensity activity/day) + diet changes (reduce caloric intake)
Pharmacological: orlistat, semaglutides, naltrexone, phenteremine
Surgical (>35 BMI + 1 comorbidity / >40 BMI): sleeve gastrectomy (---stomach vol.), gastric banding (---d. esophagus>stomach), gastric bypass (bypass stomach, eso.>SI)
Name 9 micro- and macro- complications of DM:
(7/9 gets points)
Oral health, Risk of infection, Peripheral vascular disease, Stroke, Hypertension, Ischemic heart disease, Diabetic retinopathy, Diabetic nephropathy, Diabetic neuropathy
The two physiological effects when fructokinase is not performing its action properly? (Fructokinase Deficiency)
Fructourea, fructoaemia
How are foam cells formed, what are their precursors?
Foam cells are made from;
macrophages (migrated monocytes in tunica intima) which absorbed oxidized LDLs