Biology 202
2002 First Paper
On Serendip

Pick's disease is a form of dementia characterized by a progressive and irreversible deterioration of social skills and changes in personality, along with impairment of intellect, memory, and language. In 1892 Arnold Pick, a German neurologist studied a patient who in his life had dementia and lost of speech. When the patient died, his brain shrunk, with the brain cells having died (atrophied) in the specific areas of the brain. In Pick’s disease, the frontal and temporal lobes of the brain are most affected. Changes occur in the cerebral cortex (which is how the frontal lobe is affected.) Pick's disease affects the temporal lobes of the brain in 25%, frontal lobes in 25% and both frontal and temporal lobes in 50% of cases (1). Damage to the frontal lobes leads to alterations in personality and behavior, changes in the way a person feels and expresses emotion, and loss of judgment. On a microscopic level, there is severe neuron damage in the cerebral cortex. The brain cells in these areas are found to be abnormal and swollen. These abnormal cells define Pick’s disease and are called Pick’s cells. Pick’s disease is often confused with Alzheimer’s disease where the degeneration generally affects mostly the temporal and the parietal lobes of the brain (2). When such typical cells are not seen on post-mortem examination but the same areas of the brain are affected by cell death the case may be described as Pick's syndrome (3).

In the early stages of Pick’s disease, unlike Alzheimer’s in its early stages, the patient can recognize people and places. Usually, an infected person is diagnosed with "probable Alzheimer’s", it is later discovered that the patient has Pick’s disease (2). There are three stages of the development of Pick’s disease. The first is usually psychological, behavior, and judgment problems. There may be a change in their social behavior. The second is the development of other symptoms i.e. lost of speech and obsessed behavior. The last is generalized dementia.

There are personality changes where the person may talk to strangers, become withdrawn, impatient or rude. The person may develop insensitivity to others. The person’s actions may seem childish to others (3). Another sign of Pick's disease is that the person often becomes quite obsessed during the early stages, insisting that things are very neat and in order, or constantly washing his/her hand, or observing the methods in which things are carried out. Mathematical skills are usually relatively well preserved in Pick’s disease patients.

The person may develop changes in their diet and crave certain types of foods. These symptoms are often accompanied by weight gain. The person may even become an alcoholic. The may have an overall compulsion to put things in their mouth. They usually develop short attention spans and can barely hold lengthy conversations. The person may have speech problems. Repetition is a common symptom especially in brief words and phrases. Towards the end of the disease, the patient usually becomes completely mute. Unfortunately, people with Pick's disease often suffer from significant lack of knowledge into the effects of their behavior.

There is very little known about the causes of Pick’s disease. Through research, it is known that Pick’s disease is not found in any particular age or race. Researchers have come out with different outcomes. Some researchers say that it affects women more than men while others suggest men are at a greater risk. Anyone can develop Pick's disease. It affects men and women alike. Although it typically affects people in their 50s and 60s it has been diagnosed in people from the ages of 20 to 80. The most severe cases of Pick's disease occur before the age of 60 years (3). Pick's disease is the cause of less than 10% of all dementias. A brain scan is necessary to help define Pick's disease by showing the degree and location of the degeneration in the brain. There is no cure and no effective treatment yet available. Information and risk factors for Pick's disease are less understood than for Alzheimer's disease. Some people with Pick's disease and frontal lobe dementia can live for a very long period of time, while others have a more rapid illness. Doctors can give probable diagnosis to the living patient through EEG’s to determine whether they have Pick’s disease or something like Alzheimer’s.

Research has not been conclusive as to whether or not the disease is genetic, but it does exist as an inherited disease in some families. The majority of case studies show that the patients affected have no family history of the disease.

The rate of progression varies enormously between people ranging from a duration from 2-15 years (2). The death is usually caused by infection. Medication can be used to treat some of the behavioral problems. Pick’s disease alone is a very mentally and physically draining disease but along with medication, it maybe almost impossible for patients to continue a normal life once they are diagnosed with the disease and begin treatment.

References

1)Frontal Lobe Dementia and Pick’s Disease

2)Pick’s Disease from Alzheimer’s Outreach

3)CANDID Fact Sheets

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