Pick’s disease is a type of frontotemporal dementia (FTD) that causes a progressive loss of mental function. It affects the frontal and temporal lobes of the brain and can affect thinking, speech, and behavior.
Previously, this type of dementia was known as Pick’s disease. However, most health experts now refer to it as FTD. This type of dementia is rare and usually develops in people under 65 years of age. However, it can appear in individuals as young as 20 years of age. It causes problems with thinking and speaking and behavioral changes that progressively worsen over time.
Doctors will conduct specific tests that can distinguish Pick’s disease from Alzheimer’s disease and other forms of dementia.
Pick’s disease is an uncommon degenerative type of dementia that Czech neurologist and psychiatrist Arnold Pick first diagnosed in 1892.
The first noticeable symptoms of FTD typically include changes to personality and behavior or difficulties with language. FTD is notable for the difficulty it causes with speech, as this can differentiate it from the early symptoms of more common types of dementia.
Additionally, dementia most commonly affects people over 65. However, FTD tends to start at a younger age — it mostly develops in people ages 45 to 65, although it can also affect younger or older individuals.
Pick’s disease occurs due to certain proteins, which form plaques called Pick bodies in the brain. These proteins include tau, TDP-43, and FET proteins, which build up in the frontal and temporal lobes of the brain.
The brain consists of four lobes, which include the frontal and temporal lobes. The frontal lobe is generally where higher executive functions occur, which is why changes to this lobe can result in personality changes. The temporal lobe processes sensory information, so damage to this lobe can affect speech.
FTD occurs as a result of damage to the frontal or temporal lobes of the brain. When proteins accumulate in either or both the frontal or temporal lobes, it can cause cells in these parts of the brain to die, resulting in symptoms. There are three types of FTD:
- Behavioral variant FTD: This type affects behavior first.
- Progressive non-fluent aphasia: This type affects language first.
- Semantic dementia: This type also affects language first.
Experts also note that genetic factors likely play a role in the development of FTD, as many cases appear to run in families.
The symptoms of Pick’s disease worsen slowly. They may include difficulty speaking, behavioral problems, an impaired ability to think clearly, and memory issues. People with this condition may exhibit unusual or inappropriate behavior in social settings.
Specific symptoms may include:
Language
- an inability to speak
- word searching
- problems speaking or understanding speech
- repeating words that others say to them
- shrinking vocabulary
- weak speech sounds
Behavioral changes
- an inability to keep a job
- compulsive behavior
- impulsive behavior
- inability to interact socially
- personal hygiene issues
- repetitive behavior
- social withdrawal
Emotional changes
- mood changes
- a decreased interest in daily activities
- being unable to recognize changes in behavior
- a lack of emotional warmth
- inappropriate mood
- not caring about events
Nervous system problems
- rigid muscle tone
- memory loss
- movement or coordination difficulty
- weakness
Urinary incontinence may sometimes also occur.
There is no specific staging scale for Pick’s disease, but there are several scales for this dementia type.
The scale that doctors most commonly use is the Global Deterioration Scale (GDS), also called the Reisberg Scale.
The GDS specifies:
- Stages 1 to 3: People in these stages do not meet the criteria for a dementia diagnosis. They have either no cognitive (thinking) decline, very mild cognitive decline, or mild cognitive decline.
- Stage 4: The average duration of this stage is 2 years, and it involves moderate cognitive decline or early stage dementia.
- Stage 5: Moderately severe cognitive decline or mid stage dementia occurs. The average duration of this stage is 1.5 years.
- Stage 6: Severe cognitive decline marks this stage, which lasts an average of 2.5 years.
- Stage 7: This stage involves very severe cognitive decline or late stage dementia. The average duration of this stage is 1.5 to 2.5 years.
To diagnose Pick’s disease, a doctor will perform a complete physical exam and take a person’s medical history. They should perform a neurological exam and ask the individual about their symptoms. They may also order tests to look for other types of dementia. These tests may include:
They may also use tests that check brain metabolism or protein deposits alongside tests that check sensation, thinking, and reasoning.
As FTD is an uncommon form of dementia, and people may not be aware of symptoms or mistake them for other conditions, it can be difficult to diagnose. As such, it is not uncommon for it to take longer than usual to receive a correct diagnosis.
Currently, there are no specific treatments for FTD. However, medications that can help reduce depression, irritability, and agitation may improve a person’s quality of life.
Although symptoms of dementia may cause concern about Alzheimer’s disease, there are some key differences between this condition and Pick’s disease.
People with Pick’s disease tend to have more problems with speech than those with Alzheimer’s disease. Speech difficulties can be an early sign of the former.
The diagnosis of Pick’s disease typically occurs at a younger age than that of Alzheimer’s disease, with most people ages 45 to 65 years at the point of diagnosis.
In the early stages of Pick’s disease, memory loss is not nearly as pronounced as it is with Alzheimer’s disease. However, as Pick’s disease progresses, memory loss will become more acute.
Behavioral changes are an early symptom of Pick’s disease. Although these changes are also a sign of Alzheimer’s disease, they tend to develop later in the course of the disease.
Another difference is that Alzheimer’s disease often causes hallucinations and delusions, whereas Pick’s disease rarely does.
Pick’s disease is a progressive disease that steadily worsens. An individual with the condition will experince increasing loss of function over time. However, the speed of decline will differ from person to person.
Many people with FTD may experience muscle weakness and coordination problems, which can lead to them needing a wheelchair or being unable to leave the bed. These muscle issues can result in problems with chewing, swallowing, moving, and controlling their bladder and bowels.
Typically, those living with FTD will often die due to infection or body system failure.
Pick’s disease, also known as frontotemporal dementia (FTD), is a rare type of dementia that affects the frontal and temporal lobes of the brain. Deposits of proteins accumulate to form plaques, disrupting the ability to speak properly and affecting behavior.
Unlike other types of dementia, FTD generally first presents with speech problems and then changes to behavior. Unlike Alzheimer’s disease, it is less common for FTD to affect memory.
At present, there is no known treatment for Pick’s disease, but medications can treat some of the symptoms, including depression, agitation, and irritability.