What is Pick’s disease?

Pick’s disease is a rare condition that causes progressive and irreversible dementia. This disease is one of many types of dementias known as frontotemporal dementia (FTD). Frontotemporal dementia is the result of a brain condition known as frontotemporal lobar degeneration (FTLD). If you have dementia, your brain doesn’t function normally. As a result, you may have difficulty with language, behavior, thinking, judgment, and memory. Like patients with other types of dementia, you may experience drastic personality changes.

Many other conditions can cause dementia, including Alzheimer’s disease. While Alzheimer’s disease can affect many different parts of your brain, Pick’s disease only affects certain areas. Pick’s disease is a type of FTD because it affects the frontal and temporal lobes of your brain. Your brain’s frontal lobe controls important facets of everyday life. These include planning, judgment, emotional control, behavior, inhibition, executive function, and multitasking. Your temporal lobe mainly affects language, along with emotional response and behavior.

If you have Pick’s disease, your symptoms will get progressively worse over time. Many of the symptoms can make social interaction difficult. For example, behavioral changes may make it hard to conduct yourself in a socially acceptable manner. Behavior and personality changes are the most significant early symptoms in Pick’s disease.

You may experience behavioral and emotional symptoms, such as:

  • abrupt mood changes
  • compulsive or inappropriate behavior
  • depression-like symptoms, such as disinterest in daily activities
  • withdrawal from social interaction
  • difficulty keeping a job
  • poor social skills
  • poor personal hygiene
  • repetitive behavior

You may also experience language and neurological changes, such as:

  • reduced writing or reading skills
  • echoing, or repeating what’s been said to you
  • inability to speak, difficulty speaking, or trouble understanding speech
  • shrinking vocabulary
  • accelerated memory loss
  • physical weakness

The early onset of personality changes in Pick’s disease can help your doctor differentiate it from Alzheimer’s disease. Pick’s disease can also occur at an earlier age than Alzheimer’s. Cases have been reported in people as young as 20 years old. More commonly, symptoms begin in people between the ages of 40 and 60. About 60 percent of people with frontotemporal dementia are between 45 and 64 years old.

Pick’s disease, along with other FTDs, is caused by abnormal amounts or types of nerve cell proteins, called tau. These proteins are found in all of your nerve cells. If you have Pick’s disease, they often accumulate into spherical clumps, known as Pick bodies or Pick cells. When they accumulate in the nerve cells of your brain’s frontal and temporal lobe, they cause the cells to die. This causes your brain tissue to shrink, leading to the symptoms of dementia.

Scientists don’t yet know what causes these abnormal proteins to form. But geneticists have found abnormal genes linked to Pick’s disease and other FTDs. They’ve also documented the occurrence of the disease in related family members.

There’s no single diagnostic test that your doctor can use to learn if you have Pick’s disease. They will use your medical history, special imaging tests, and other tools to develop a diagnosis.

For example, your doctor may:

  • take a complete medical history
  • ask you to complete speech and writing tests
  • conduct interviews with your family members to learn about your behavior
  • conduct a physical examination and detailed neurologic examination
  • use MRI, CT, or PET scans to examine your brain tissue

Imaging tests can help your doctor see the shape of your brain and changes that may be occurring. These tests can also help your doctor rule out other conditions that can cause symptoms of dementia, such as brain tumors or stroke.

Your doctor may order blood tests to rule out other possible causes of dementia. For example, thyroid hormone deficiency (hypothyroidism), vitamin B-12 deficiency, and syphilis are common causes of dementia in older adults.

There are no known treatments that effectively slow the progression of Pick’s disease. Your doctor can prescribe treatments to help ease some of your symptoms. For example, they may prescribe antidepressant and antipsychotic medications to help treat emotional and behavioral changes.

Your doctor may also test for and treat other problems that could worsen your symptoms. For example, they may check and treat you for:

  • depression and other mood disorders
  • anemia, which can cause fatigue, headaches, moodiness, and difficulty concentrating
  • nutritional disorders
  • thyroid disorders
  • decreased oxygen levels
  • kidney or liver failure
  • heart failure

The outlook for people with Pick’s disease is poor. According to the University of California, symptoms usually progress over the course of 8–10 years. After the initial onset of your symptoms, it may take a couple of years to get a diagnosis. As a result, the average time span between diagnosis and death is around five years.

In advanced stages of the disease, you will need 24-hour care. You may develop trouble completing basic tasks, such as moving, controlling your bladder, and even swallowing. Death usually occurs from complications of Pick’s disease and the behavioral changes it causes. For example, common causes of death include lung, urinary tract, and skin infections.

Ask your doctor for more information about your specific condition and long-term outlook.