Diagnosis, Treatment & Prognosis of Pick's Disease
Pick's disease is a rare form of dementia which accounts for about 5% of all dementia types. The clinical picture is fairly similar to Alzheimer's but differences can be detected at autopsy. Pick's disease differs in some important respects:
Changes in the Brain in Pick's Disease
In Pick's disease the brain tissue changes and loss occurs in focal areas rather than the generalized damage of Alzheimer's. Pick's disease affects the frontal and temporal lobes of the brain. Marked shrinkage, called atrophy, of the frontal lobes of the brain occurs that can be seen on brain scans.
Pick's disease is marked by the presence of abnormalities in brain cells called Pick's bodies. These are found in the affected areas as well as elsewhere in the brain. Pick's bodies are fibres that look very different from the neurofibrillary tangles found in Alzheimer's disease. Pick's bodies are straight rather than paired and helical.
Symptoms of Pick's Disease
Many of the early symptoms of Pick's disease are frontal lobe symptoms. It is these symptoms that tend to mark out the differences between Pick's dementia and the other types, such as Alzheimer's. In Alzheimer's disease the initial symptoms tend to be memory impairment. In Pick's disease because the frontal lobes of the brain are affected, the first symptoms occur in emotional and social functioning. It is the mood changes, often biased towards euphoria, disinhibition and a deterioration in social skills that are so noticeable.
A person with Pick's disease may become extrovert or withdrawn. They can be rude, impatient, aggressive and make inappropriate remarks in public. They may change their sexual behavior. An increased interest in sex may be marked. This can be linked to loss of inhibition and can be very disturbing. It can bring the person in contact with law enforcement agencies.
Behavioral changes can sometimes be very subtle at first and it is only when behavior becomes more bizarre that, on reflection, dementia was the reason for those changes. Because of the type of brain damage other features of the disease are gluttony, gross over eating increased alcohol intake. People with Pick's disease may compulsively put objects in their mouth.
Problems with language can occur in the early stages but are not as striking as occur in the early stages of Alzheimer's. Difficulty finding words, naming difficulties happen but it is only as the disease progresses that memory and apraxia occur and become more marked. Someone suffering from Pick's disease will have difficulty maintaining a line of thought, be easily distracted and have difficulty maintaining conversation for any length of time.
Pick's disease generally occurs between the ages of forty and sixty years of age.
Pick's disease affects slightly more women than men.
Diagnosis of Pick's Disease
Diagnosis by a doctor is important to rule out other diseases or conditions that may be treatable or cured. A psychologist can help establish the type of dementia.
Treatment of Pick's Disease
At the present time there are no drugs available that cure or help with Pick's disease. The drugs used in Alzheimer's disease generally do not help as they tend to increase aggression.
As with Alzheimer's disease and other types of dementia maximizing quality of life is the key area for treatment. Drugs can be helpful to try to deal with some of the more disturbing behavior that can occur. Good nursing and caregiver skills, occupation activities and support groups help manage this type of dementia. It is important that families of people with Pick's disease get as much support to help them cope.
Prognosis in Pick's Disease
Sadly someone with Pick's disease will show a progressive decline in their abilities. The length of progression varies in individuals from less than 2 years to 10 years in some.