Dementia Due to Pick’s Disease

Dementia Due to Pick’s Disease

Pick’s disease is a rare form of progressive dementia clinically indistinguishable from Alzheimer’s disease. It is about one-fifth as common as AD. Pick’s disease occurs in the sixth and seventh decades of life and has a duration that varies from 2 to 15 years. It has a strong familial tendency, but definite genetic pattern has not been established. ACh levels are reduced.

The pathology of Pick’s disease involves prominent changes (e.g., sclerosis, atrophy) in the frontal and temporal lobes (Figure 32.7). The parietal and occipital lobes are spared. Alzheimer himself noted the argentophilic (staining silver) in-traneuronal inclusion in Pick’s bodies.

The clinical features of Pick’s disease are quite similar to those of Alzheimer’s disease, and since neither condition is curable, an elaborate differential diagnosis is unnecessary. Because of parietal sparing, such features as apraxia and agno-sia are less common in Pick’s disease, and visual–spatial ability, often impaired in Alzheimer’s disease, is preserved (Kaufman, 1990b). Given the prominent changes in the frontal lobe, disin-hibited behavior, loss of social constraints and lack of concern about appearance and matters of personal hygiene occur rela-tively early in Pick’s disease. Such speech disorders as echola-lia and logorrhea are common, and patients with Pick’s disease are more likely to develop Klüver–Bucy syndrome (orality, hyperphagia, hypersexuality, placidity) indicative of damage to the temporal lobes. Significant memory impairment may occur relatively late in the course, and eventually the patient becomes listless, mute, and ultimately decerebrate and coma-tose. Like Alzheimer’s disease, the treatment of Pick’s disease is symptomatic.