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Disease/Parkinson
disease
Alzheimer Disease
1) Neuritic plaques:
Focal, spherical collections of dilated,
tortuous, silver-staining neuritic processes
(dystrophic neurites), around a central
amyloid core.
Size - 20 to 200 m in diameter.
Found in hippocampus, amygdala, neocortex,
later in primary motor and sensory cortices.
Microglial cells and reactive astrocytes present
at their periphery.
Amyloid core contains A.
A deposits can be found that lack
surrounding neuritic reaction diffuse
plaques.
2) Neurofibrillary tangles:
Bundles of paired helical filaments visible as
basophilic fibrillary structures in cytoplasm of
neurons that displace or encircle nucleus.
Can remain after neurons die.
Found in cortical neurons, other sites-
pyramidal cells of hippocampus, amygdala,
basal forebrain, and raphe nuclei.
A major component is abnormally
hyperphosphorylated forms of protein tau.
AD. A, Neuritic plaque with a rim of dystrophic neurites surrounding an
amyloid core. B, Congo red stain of cerebral cortex showing amyloid
deposition in blood vessels and amyloid core of neuritic plaque (arrow).
C, Neurofibrillary tangles (arrowheads) are present within neurons (H &
E). D, Silver stain showing a neurofibrillary tangle within neuronal
cytoplasm.
Parkinson Disease (PD)
(https://www.youtube.com/watch?v=0-
t4RTQ0EsM)
Similar symptoms of motor disturbance is
seen in a number of conditions that have in
common damage to nigrostriatal
dopaminergic system.
Also can be pharmacologically induced by
dopaminergic antagonists or by toxins that
damage dopaminergic system.
Presumptive diagnosis of PD can be based
on presence of central triad of
parkinsonism (large part on presence of
motor symptoms, which reflect decreased
dopaminergic innervation of striatum)
tremor, rigidity, and bradykinesia in
absence of a toxic or other known
underlying etiology.
There is also evidence of degeneration of
substantia nigra (which results in motor
symptoms) represents a mid-stage in a
progressive disease that begins lower in
brainstem progress to involve cerebral
cortex, leading to cognitive impairment.
Dopaminergic neurons of substantia nigra
project to striatum, and their degeneration in
PD is associated with a reduction in striatal
dopamine content.
Severity of motor syndrome is proportional to
dopamine deficiency.
Molecular Genetics and
Pathogenesis.
DJ-1:
-ln oxidative stress it can relocate to
mitochondria have cytoprotective
effects.
PINK1:
-a kinase that is degraded in mitochondria
under normal circumstances;
-with mitochondrial dysfunction, it recruits
parkin E3 ubiquitin ligase.
-Under normal circumstances, the
combination of PINK1 and parkin results in
clearance of dysfunctional mitochondria
through mitophagy.
Intriguingly, levels of mitochondrial
complex I, a component of oxidative
phosphorylation cascade, are reduced in
the brains of patients with sporadic PD.
Mutations in gene encoding LRRK2
(leucine-rich repeat kinase 2)- a
cytoplasmic kinase.
Pathogenic mutations increase kinase
activity of LRRK2, suggesting that gains in
LRRK2 function either
hyperphosphorylation of normal targets or
emergence of novel targets.
Morphology
A characteristic finding:
Pallor of substantia nigra and locus
ceruleus, due to loss of pigmented,
catecholaminergic neurons in these regions.
Lewy bodies may be found in remaining
neurons.
These are single or multiple cytoplasmic,
eosinophilic, round to elongated inclusions
that have a dense core surrounded by a pale
halo.
Ultrastructurally, Lewy bodies are composed
of fine filaments, densely packed in the core
but loose at the rim; these filaments are
composed of -synuclein.
Lewy bodies may also be found in
cholinergic cells of basal nucleus of Meynert,
in other brainstem nuclei including the locus
ceruleus and dorsal motor nucleus of vagus.
Areas of neuronal loss also show gliosis.
Lewy neurites are dystrophic processes
that contain aggregated -synuclein.
Dementia with Lewy Bodies