1.

Alzheimer disease
Is common neurologic disorder. Biasanya terjadi di seseorang yang umurnya lebih dari
65tahun(familial, early dementia). Al zheimer merupakan kasus yang nyebabin severe cognitive
dysfunction in older adults. Familial Alzheimer disease, Late onset AD, sporadic AD are known
as senile dementia.
Alzheimer disease juga assoc with down syndrome.
Early onset Alzheimer:
- Amyloid precursor protein (APP) gene di chromosome 21
- Presenilin 1 (PSEN1) di chromosome 14
- PSEN di chromosome 1
Late onset Alzheimer:
- Defect in apoE4 alelle gene on chromosome 19. Adanya apoE4 ini sbg marker ada
increase risk of al zheimer disease.
Risk factor:
- Atherosclerosis
- Low education
- Head injury
- CVD
- Elevated serum homocysteine
- Elevated cholesterol
- Deficit of female esterogen

 Senile plaques :

- Accumulation of antibiotics
 Tangles :

- Biasanya deposit di cerebral arteries juga bisa bakal causing amyloid angiopathy.
 Tangles banyak di cerebral
cortex dan hippocampus.
Makin banyak tangles sama plak makin parah tingkat al zheimernya

Clinical manifestation
1. Forgetfulness, emotional upset, other illness.
2. Memory loss increases.
3. Disoriented and confused person
4. Mental status and behavior changes : irritability, agitation, restlessness, mood changes,
anxious, deteriation in cognition.

2. Huntington disease
Namanya chorea. Involving the basal ganglia and cerebral cortex degenerative. Onsetnya
biasanya 25-45 tahun. Biasanya 2-8 per 100.000 persons occurs in all races.

Merupakan jenis autosomal dominant, defect di chromosome 4. Ada abnormalitas di long

polyglutamine tract di huntingtin protein that is toxic to neurons caused by cystosine adenine
guane (CAG). Biasanya nyerang si basal ganglia terutama putamen nuclei, frontal cerebral cortex,
dan caudate.

Manifested :
- Hypotonia
- Hyperkinesia ) involuntary, fragmentary movements : chorea)
- Dementia
- Choreiform movement begin in the face, arms, eventually affecting entire body
 - Frontal lobe dysfunction : executive attention deficit, short term memory loss(working
memory), reduced capacity to plan, organize, sequence, bradyphrenia(slow thinking),
apathy.

3. Parkinson disease
Commonly occurring degenerative disorder of the basal ganglia (corpus striatum, globus pallidus
subthalmic nucleus, and substantia nigra) involving the dopaminergic (dopamine secreting)
nigrostriatal pathway. Nah, nigrostriatal disorder produces a syndrome of abnormal movement
called parkinsonism(Parkinson syndrome). Biasanya PD biasa terjadi di umur yang >40 tahun.
Usually unknown causes, but sometimes ada mutasi di genetic yaitu mutasi di PINK1, PARKIN
ALPHA SYNUCLEIN.

- Bakal ada lewy

bodies di substantia nigra
sebelum substantia nigra
tersebut mati.

Clinical features
- Resting termor :pil rolling
- Rigidity
- Movement : bradykinesia ( slow) – hypokinesia ( lessened) – akinesia (absence)
semua ini from difficulty initiating movement, biasanya legs nya freeze up terus
shuffling gait ( kalo jalan kecil kecil)
- Postural instability
 - Depression
- Dementia
- Sleep disturbances
- Difficulty of smelling
 nah bisa kejadian gejala diatas juga kalo misalnya ada dopaminergic yang dysfuction below
the substantia nigra contohnya di other parts of the brain contohnya di prefrontal cortex, atau
dysfunction di neurotransmitter contohnya acetylcholine

treatment
- Levodopa
- Amantadine : antiiral medication dan bisa increases endogenous dopamine
production
- Dopamine agonist : stimulate dopamine receptor
o Bromocriptine, pramipexole, ropinirole
- Inhibitos of COMT (Cathecolamine o methyltransferase) : inhibit enzyme/protein
yang harus nya mendegradasi dopamine jadinya dopaminenya ada deh.
o Entacapone & tolcapone
- Selegilene : inhibit MAO-B(monoamine oxidase B) , jadinya dopamine ada deh di
otak.
- Anticholinergic : biasa nya diberikan kalo misalnya ACH jumlahnya lebih banyak
daripada dopamine. Harusnya kan dopamine samaa ACH itu levelnya tuh sama.
Jadi dikasih benztropine deh buat benerin trmornya di pasien ini
- Deep brain stimulation