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Pick’s Disease
Running head: PICK’S DISEASE
Pick’s Disease
in APA Style
Mary Beth Moody
Floyd E. Kellam High School
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Pick’s Disease
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Abstract
This research paper is about Pick’s Disease, which is a form of frontotemporal dementia.
It was documented in 1882 by neurologist Arnold Pick. It is a progressive dementia, and mainly
affects people between the ages of forty and sixty. The disease affects the frontal and temporal
lobes of the brain, as is found on brain scans such as an EEG. It focuses on many different
facades of the subject, including its history, symptoms, causes, means of diagnosis, means of
treatment, how to manage it, and its affect on the brain.
Pick’s Disease
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Pick’s Disease is a frontotemporal dementia documented in the late nineteenth century of
Arnold Pick. Pick’s Disease is a very rare form of dementia, as most people only know of one
type of dementia; Alzheimer’s. By affecting two lobes in the brain, Pick’s Disease can affect the
entire bodies functioning, and will drastically alter a patient’s lifestyle. Although almost every
case of Pick’s Disease occurs in middle age to elderly people, there are still rare incidents where
Pick’s Disease is diagnosed to somebody younger than the typical age range of dementia.
Frontotemporal dementia originates in the brain, and is a result of brain deterioration.
Pick’s Disease was documented by Arnold Pick of Czechoslovakia in 1892. He
discovered the disease after performing an autopsy on a patient who exhibited signs of dementia
and speech loss. Arnold Pick stated that the dementia is most prominent in the frontal and
temporal lobes, and is a result of brain cell destruction. It has obtained many other names, such
as frontotemporal dementia, semantic dementia, lobar sclerosis, focal cerebral atrophy, primary
progressive aphasia, and circumscribed brain atrophy (Pick's Disease: Frontal Lobe Dementia,
2008).
Pick’s Disease is a progressive dementia, which makes it more difficult to have consistent
symptoms. Some symptoms can include personality and socio-behavioral changes, an inability
to plan and organize, and inappropriate social behavior. It is also characterized by obsessive
behavior, hypochondria, a sleep pattern change, loss of muscle control, rigidity, and a speech
loss (Pick's Disease: Frontal Lobe Dementia, 2008). The Diagnostic and Statistical Manual of
Mental Disorders defines the symptoms as “changes in personality, deterioration of social skills,
emotional blunting, behavioral disinhibition, and prominent language abnormalities” (First,
1994). University student Alisa Alexander writes that:
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“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” (Alexander, 2002).
In one case study, a 56 year old man diagnosed with Pick’s Disease eventually progressed to the
state where he could only continually repeat six phrases. In another case study, a police officer
had a slow deterioration over twelve years. It started with a hesitant speech, and then progressed
to where he could no longer perform the simplest tasks without error. Eventually he got to the
point where he could no longer add 3+2 or write his own name. Soon after that, the man became
mute and progressed into a vegetative state (Penington, 1998).
The behavior of a patient with Pick’s Disease changes in a different way for every
patient. Sometimes the patient exhibits impulsiveness, or an obsessive/compulsiveness. They
might want something extremely neat, or they might eat only one type of food. They can also
become more aggressive, and become rude or impatient. A patient with frontotemporal dementia
(FTD) might also become more promiscuous and have an increase in sexual exhibitionism.
Emotionally, a patient with FTD could become extremely abrupt and insensitive. The patient
may lose their sense of warmth and capacity for empathy (Rose & Russell, 2008).
One of the main signs of Pick’s Disease is the loss or depreciation of speech ability. A
victim of FTD will experience a reduction in vocabulary size and may have issues such as having
difficulty finding a word. They have a hard time understanding speech or composing a sentence,
which exhibits aphasia (“inability to use or understand language (spoken or written) because of a
brain lesion” (Miller, 2006)). A patient with Pick’s Disease will be affected physically as well.
They show problems with muscle rigidity, and have difficulty with movement and coordination
(Rose & Russell, 2008).
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It is not easy to be able to define who is at a high risk for getting frontotemporal dementia
because it is so diverse. The disease is not found in any particular race, and it affects men and
women alike (Alexander, 2002). Other researchers have found that it is slightly more common
in women than men, though (Rose & Russell, 2008). The range of age of those affected with
lobar sclerosis differs greatly between researchers as well, but the Diagnostic and Statistical
Manual of Mental Disorders sets the range from the ages of fifty to sixty years (First, 1994). It
has been looked at as a hereditary disease, and forty percent of cases of Pick’s Disease are
thought to be hereditary (Rose & Russell, 2008). It is thought that approximately seven million
Americans are afflicted with frontotemporal dementias, but only about five percent are
diagnosed with Pick’s Disease (Rose & Russell, 2008).
Not all cases are put definitely at the ages of fifty to sixty. In one case of Pick’s Disease,
a young woman is diagnosed at the age of twenty-seven. She was evaluated as an extrovert as a
child, but at age twenty-seven, she became withdrawn. Her productivity in the workplace
declined, and she was eventually fired from her job as a secretary. She then started having
incontinency of urine, couldn’t perform daily activities, fell often, and couldn’t perform simple
tasks such as using silverware. Her appetite changed, and she suddenly was a voracious eater.
She was admitted for testing after such changes, and findings were generally normal after brain
scans such as an electroencephalogram. Only a few areas showed abnormal signals in the
cerebral cortex, but those abnormalities were still unclear. Two months later, Pick bodies were
found in testing in the cytoplasm of small and medium-size cortical neurons. Such ideas have
been concluded about the presence of this kind of dementia in someone so young:
“The terminological confusion of Pick disease makes the analysis of
age at onset reported in the published literature very difficult. The use
of the terms Pick disease and Pick complex to describe a clinical
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syndrome of frontotemporal deficits with focal atrophy encompasses a
variety of different diseases defined by their histological features., Some
early ages at onset, for example, that described by Mowadat et al, were
clinical diagnoses without histological confirmation. Pick disease needs
to be considered in the differential diagnosis of behavioral and cognitive
decline in young adults” (Rossor, 1999).
The most major part of any mental disorder is how the brain is affected by the disease.
Pick’s Disease occurs in the frontal and temporal lobes. The brain experiences cell degeneration,
and in Pick’s Disease, that degeneration is most prominent in the thalamus, corpus striatum, and
the subcortex. The thalamus is the part of the brain that processes information. The corpus
striatum is the part of the brain that is involved with movement control, and the subcortex is “the
nerve cells below the cerebral cortex or surface of the brain that control neurological functions”
(Pick's Disease: Frontal Lobe Dementia, 2008). The degeneration in the corpus striatum is what
primarily affects the body’s ability to move. In this form of dementia, the body moves more
rigidly, an obvious result of deterioration of the corpus striatum. Alexander (2002), assesses that
“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” (Alexander, 2002).
Pick’s Disease is caused by the damage of five different types of nerve cells in a patient.
Two out of those five nerve cells contain abnormal deposits of tau proteins (Pick's Disease:
Frontal Lobe Dementia, 2008). Tau proteins are “Microtubule-associated proteins that are
mainly expressed in neurons” and “Aggregation of specific sets of tau proteins in filamentous
inclusions is the common feature of intraneuronal and glial fibrillar lesions in numerous
neurodegenerative disorders” (Tau Proteins, 2009). The accumulation of tangles of these
proteins in the frontotemporal lobes of the brain is one of the major causes of FTD. It is has also
been proved that the inheritance of tau proteins puts a patient at an increased risk for Pick’s
Disease (Pick's Disease: Frontal Lobe Dementia, 2008).
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Another cause for Pick’s Disease is the presence of abnormalities in the nerve cells of the
brain called Pick bodies. This is what distinguishes a frontal lobe dementia from other types of
dementia. These Pick bodies are “fibrous tangles of tau proteins.” These tangles are different
from those of the neurofibrillary tangles consistent with Alzheimer’s (Pick's Disease: Frontal
Lobe Dementia, 2008). Pick bodies are also abnormally swollen (Alexander, 2002). Pick bodies
lead to the changes in character common in Pick’s Disease (Rose & Russell, 2008).
A diagnostic test for Pick’s disease can include a physical exam, clinical assessment,
blood tests, neuro-psychology assessment, linguistic tests, or a CT or MRI scan (Pick's Disease:
Frontal Lobe Dementia, 2008). Although all of the above tests can be proctored, the only
conclusive way of determining the presence of Pick’s Disease is an autopsy of the brain. But
without an autopsy, an EEG is also an effective way of finding a diagnosis (Rose & Russell,
2008). After a diagnosis has been determined, the life expectancy range varies widely from two
to seventeen years, but averages at about eight years (Pick's Disease: Frontal Lobe Dementia,
2008). FTD is often misdiagnosed as depression in its early stages because of symptoms in the
early stages of the disease. It is also often misdiagnosed as Alzheimer’s disease, as they are very
similar (Rose & Russell, 2008).
Pick’s Disease is very similar to and is often mistaken as Alzheimer’s disease. But there
are some major differences that separate the two dementias. One big difference is what part of
the brain they affect. Pick’s is only located in the frontal and temporal lobes. Alzheimer’s on
the other hand can be located in various areas, including the posterior, temporal, parietal regions,
and the hippocampus. Another difference is that Pick’s Disease has a range of about fifty to
sixty while for Alzheimer’s it is extremely uncommon for there to be a diagnosis for a patient
under sixty-five. Another difference is the symptoms. With Pick’s, the initial symptoms are
Pick’s Disease
those of behavior and a change in lifestyle. Alzheimer’s initial symptoms are memory loss
(Pick's Disease: Frontal Lobe Dementia, 2008).
There is no cure for the actual dementia of Pick’s Disease, but researchers are searching
for a cure desperately. Current treatments for Pick’s include tranquilizers, antidepressants,
serotonin-based supplements, and behavioral therapy (Pick's Disease: Frontal Lobe Dementia,
2008). Even with medication though, it is near impossible to go back to living a normal life.
Medication is used primarily to treat the behavior symptoms (Alexander, 2002).
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Pick’s Disease
References
Alexander, A. (2002, February 27). Pick's Disease. Retrieved March 11, 2009, from
http://serendip.brynmawr.edu/bb/neuro/neuro02/web1/aalexander.html
First, M. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth
Edition (Text Revision). Arlington, VA: American Psychiatric Publishing.
Miller, G. (n.d.). WordNet Search - 3.0. Retrieved March 11, 2009, from
http://wordnet.princeton.edu/perl/webwn
Odawara, T. (2003). Alterations of muscarinic acetylcholine receptors in atypical Pick's disease
without Pick bodies. Journal of Neurology, Neurosurgery, & Psychiatry, 74(2), 965.
Penington, M. (1998, May 26). What Are The Symptoms of Picks Disease from Alzheimer's
Outreach. Retrieved March 11, 2009, from
http://www.zarcrom.com/users/alzheimers/odem/pk2.html
Pick's Disease: Frontal Lobe Dementia. (n.d.). Retrieved March 11, 2009, from
http://www.about-dementia.com/articles/about-dementia/dementia-causes/dementiapicks-disease.php
Rose, A., & Russell, D. (2008, November 20). Pick's Disease: Symptoms and Prognosis.
Retrieved March 11, 2009, from http://www.helpguide.org/elder/picks_disease.htm
Rossor, M. (n.d.). Arch Neurol -- A Case of Sporadic Pick Disease With Onset at 27 Years,
October 1999, Jacob et al. 56 (10): 1289. Retrieved March 11, 2009, from
http://archneur.ama-assn.org/cgi/content/full/56/10/1289
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Pick’s Disease
Tau proteins. (2009, March 6). Retrieved March 11, 2009, from
http://ghr.nlm.nih.gov/glossary=tauproteins
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