Alternate Names: Lobar sclerosis; Circumscribed brain atrophy;Fronto-temporal dementia Arnold Pick's disease; Cerebral atrophy
Causes and Risks: Pick’s disease is a rare disorder similar to senile dementia/Alzheimer’s type. It affects about 1 out of 100,000 people. It affects both sexes, but it is more common in women than men. It may occur as early as 20 years old, but usually begins between ages 40 to 60. The average age of onset is 54 years.
The onset is usually slow and insidious. The disorder involves shrinking of the tissues (atrophy) of the frontal and temporal lobes of the brain. The neurons (nerve cells) in the affected areas contain abnormal material (Pick’s bodies). There are no plaques but there are tangles made of tau protein. The exact cause is unknown.
The symptoms are similar to senile dementia/Alzheimer’s type, with aphasia (loss of language abilities), agnosia (loss of ability to recognize objects or people), and apraxia (loss of skilled movement abilities). Behavioral changes are prominent with loss of inhibition and change in personality as opposed to Alzheimer’s Disease where memory loss is the primary feature.
Risk factors may include a having a personal or family history of Pick’s disease or senile dementia, though the genetic basis of the disease has not yet been determined.
Prevention: There is no known prevention for this rare disorder.
Symptoms: Movement/coordination difficulties (apraxia)--may be one of the earliest symptoms
Mood changes, personality changes:
- striking loss of concern and lack of anxiety
- loss of initiative
- flat affect (does not display any emotion)
- indecision
- inappropriate mood
- lack of spontaneity
- decreased interest in daily living activities
- impaired judgment
Behavior changes:- excessive manual exploration of the environment
- withdrawal from social interaction
- inability to function or interact in social or personal situations
- inability to maintain employment
- decreased ability to function in self care
- behavior that is inappropriate relative to the environment
Language changes:- echolalia (repetition of anything spoken to the person)
- speech is incomprehensible jargon
- aphasia (decreased language ability, difficulty speaking or understanding speech)
- inability to comprehend speech
- inability to speak
- inability to repeat a phrase
- poor enunciation
- decreased ability to read or write
- inability to name objects
Other changes:- loss of cognitive/intellectual skills
- specific disorders of problem solving/learning:
- inability to generalize
- loss of abstract thinking
- impaired calculating ability
- inability to learn
- weakness
- increased muscle tone
- urinary incontinence
- progressive dementia
- memory loss
Signs and Tests: The health care provider bases on initial diagnosis on history and symptoms, signs, and tests, and by ruling out other causes of dementia including dementia due to metabolic causes. Neurologic examination may reveal signs that vary according to the anatomic site of involvement. Temporal and frontal lobe signs are most common, with resulting behavioral and language changes. There may be other abnormalities, including frontal release signs (presence of abnormal reflexes) and abnormal levels of "normal" reflexes. Psychologic studies and tests of sensation, cognitive function, and motor function may be abnormal.
Treatment: There is no proven effective treatment for Pick’s disease. Monitoring and assistance with care may be required depending on symptoms exhibited and progression of the disorder.
Progressive care of personal needs may be required. Eventually, there may be a need for 24-hour care and monitoring at home or in an institutionalized care setting to provide a safe environment and meet the individual’s physiological needs.
Discontinuation or change in medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. This may include medications such as anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.
Disorders that contribute to confusion should be treated as appropriate. These may include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often gives great improvement in mental function.
Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others.
Sensory function should be evaluated and augmented as needed by the use of hearing-aids, glasses, cataract surgery, and so on.
Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Formal psychotherapy treatment is seldom effective, because it may overload limited cognitive resources. Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation. Family counseling may help in coping with the changes required for home care.
Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person. In some communities, there may be access to support groups (such as the Alzheimer’s - support group, elder care - support group, or others).
Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with Pick’s disease.
Prognosis: The probable outcome is poor. The disorder progresses steadily and rapidly. Total disability occurs early. Commonly, Pick’s disease results in death within 2 to 10 years, usually from infection and occasionally from general failure of body systems.
Complications:
- loss of ability to care for self or perform normal activities
- progressive loss of ability to function
- loss of ability to interact with others
- infection
- reduced life span
- abuse by an over-stressed caregiver
- side effects of medications used to treat the disorder
Call your health care provider if symptoms of Pick’s disease develop.
Call your health care provider or go to the emergency room if acute deterioration in mental function occurs (this symptom may indicate development of another disorder).
