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Types of Dementia

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Pick's Disease or Frontal Lobe Dementia

Pick's Disease, a type of frontal lobe dementia, is named for Dr. Arnold Pick who first identified the condition in 1892.  It is a very rare progressive brain disorder, accounting for between 1 and 5% of all cases of dementia. The usual onset of Pick's Disease is middle age. It has been studied very little and there is no known prevention or cure.

Pick's Disease is characterized by disturbances in behavior, personality and, eventually, memory. Individuals with Pick's Disease exhibit apathy and erratic behavior and may show poor personal hygiene. Since the disease is characterized by dementia, Pick's is often confused with Alzheimer's Disease. The two conditions are quite difficult to distinguish on clinical grounds alone. A final diagnosis can only be confirmed at autopsy.

Causes of Pick's Disease

Pick's Disease is caused by the degeneration of brain cells in 2 specific areas - the frontal and anterior temporal lobes - causing loss of speech and dementia. The disease is marked by 'Pick bodies', rounded, microscopic structures found in affected cells. Neurons swell, taking on a 'ballooned' appearance.

Anyone can develop Pick's Disease. It affects both men and women. Although it is generally a disease of aging, it has been diagnosed in people as young as 20. The disease is less common after age 60 though it has been diagnosed at the age of 80.

As there is so little known about the causes of Pick's it is not possible to identify risk factors. It can exist as an inherited disease in some families, but the majority of cases are sporadic, with no family history. In the familial cases Pick's tends to affect people by about 40 years of age. In these families, there is a 50% chance that children of a sufferer will develop the disease.

Stages of Pick's Disease

The disease has been divided into 3 stages:

Stage 1: disturbances in behavior and judgment
Stage 2: development of symptoms such as speech loss and obsessive behavior
Stage 3: generalized dementia, immobility and incontinence

Symptoms

The early symptoms of Pick's Disease include a general decline in physical and mental function. In addition, there is a personality change as result of which the person either loses their inhibitions and becomes uncharacteristically extroverted or, in contrast, they become withdrawn.

Later symptoms include:

• Difficulty with language. Speech problems range from repetitive speech patterns to a reduction in speech to total speech loss

• Failure to recognize familiar faces

• Compulsive behavior, e.g., endless walking routines

• Other obsessive, childlike behavior

• Excessive cravings for food or alcohol. Sufferers may self-induce vomiting after a food binge.

• Loss of attention span

• Uninhibited sexual behavior caused by changes in the frontal lobes

Towards the end stages of the disease, patients usually become mute and may not respond at all. Eventually, they enter a terminal, vegetative state.

Treatment

Unfortunately, there is currently no cure for Pick's disease, nor can the progression of the disease be slowed down. The average course of Pick's disease is 5
years, but the course can range from 2-15 years.

Drugs can be used to modify behavior. However, the role of a caregiver who understands the disease and the behaviors it causes can be indispensable in helping a person diagnosed with Pick's disease cope with this devastating illness.

Pick's Disease Resources

- Pick's Diease from the National Institutes of Health (US)
- Pick's Disease Support Group from the UK
- Pick's Disease (Lobar Atrophy) from Harvard University