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.
FTD is rare and usually develops in people aged 40–60 years. However, it can appear in people as young as 20 years of age. It causes problems with thinking and speaking, as well as 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.
This article examines Pick’s disease in more detail, including the causes, signs and symptoms, stages, diagnosis, and treatment. It also considers the outlook for people with Pick’s disease.
Pick’s disease is a degenerative type of dementia that Czech neurologist and psychiatrist Arnold Pick first diagnosed in 1892.
Pick’s disease is notable for the difficulty it causes with speech, which may present as an initial symptom. Other forms of dementia may present with behavioral or personality changes as primary symptoms.
Pick’s disease occurs as a result of tau proteins, which form plaques called Pick bodies in the brain.
Although Tau proteins are also present in the brains of people with Alzheimer’s disease, only one form of them exists in those with Pick’s disease. However, the difference between the two conditions is only detectable during an autopsy.
People with Pick’s disease have a buildup of tau proteins inside the brain. These are called tangles, Pick bodies, or Pick cells, and they exist inside nerve cells.
Experts are unsure why some people are predisposed to tangles. However, they believe that genetic factors may play a role, as Pick’s disease appears to run in families.
The symptoms of Pick’s disease worsen slowly. They may include difficulty speaking, behavioral problems, and an impaired ability to think clearly. People with Pick’s disease may exhibit unusual or inappropriate behavior in social settings.
Specific symptoms may include:
Language
- inability to speak
- word searching
- problems speaking or understanding speech
- repeating words that others say to them
- shrinking vocabulary
- weak speech sounds
Behavioral changes
- inability to keep a job
- compulsive behavior
- impulsive behavior
- inability to interact socially
- poor personal hygiene
- repetitive behavior
- social withdrawal
Emotional changes
- mood changes
- decreased interest in daily activities
- failure to recognize changes in behavior
- 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 dementia.
The scale that doctors most commonly use is the Global Deterioration Scale (GDS), also called the Reisberg Scale.
The GDS specifies:
- Stages 1–3: People in these stages do not meet the criteria for a dementia diagnosis. They have either no cognitive 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, including taking a medical history. They should perform a neurological exam and ask the person about their symptoms. They may also order tests to look for other types of dementia. These tests may include:
- brain MRI
- electroencephalogram (EEG)
- lumbar puncture to examine the cerebrospinal fluid
- CT scan of the head
- PET scan of the brain
They may also use tests that check brain metabolism or protein deposits, alongside tests that check sensation, thinking, and reasoning.
No treatments specific to Pick’s disease are available, but 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 Pick’s disease.
The diagnosis of Pick’s disease typically occurs at a younger age than that of Alzheimer’s disease, with most people aged 40–60 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. The individual will become increasingly disabled over time.
Death commonly occurs within 6–8 years, often due to infection or body system failure.
Pick’s disease is a rare type of dementia that affects the frontal lobe and temporal lobe.
Deposits of tau protein accumulate to form plaques, disrupting the ability to speak properly and affecting behavior.
The exact cause of Pick’s disease is unknown, but the condition may have a genetic component. It generally first presents with speech problems, with changes to behavior following. Unlike Alzheimer’s disease, it rarely affects a person’s memory.
There is no known treatment for Pick’s disease, but medications can treat some of the symptoms, including depression, agitation, and irritability.