Dementias is a type of neurodegenerative disease in which different mental capacities are progressively lost, with the whole person progressively deteriorating as the disease progresses. The best known of these diseases is Alzheimer’s , although there are many others.

Within this group of disorders, another neurodegenerative disease that has characteristics very similar to those of Alzheimer’s is known as Pick’s disease . Let’s see what its characteristics are.

Pick’s disease: main features

Pick’s disease is a neurodegenerative disorder that causes the progressive deterioration of the mental capacities of those who suffer it due to neuronal death. Thus, it causes a frontotemporal type of dementia, initiating cellular destruction in the frontal lobe to gradually expand to the temporal lobe.

This disease is a relatively common form of frontotemporal dementia, with about 25% of it estimated to be due to Pick’s disease. The symptoms usually start between 40 and 50 years of age , and has the peculiarity that it is a disease that does not have more prevalence as age increases (unlike Alzheimer’s).

Like most other dementias, Pick’s disease is a disease that causes progressive and irreversible deterioration without periods of remission and culminates in the death of the individual. It has a course of about 5 to 15 years between the onset of symptoms and the death or demise of the subject.

Symptoms

The presentation of the symptoms of Pick’s disease sometimes causes it to be confused with rare forms of Alzheimer’s, but has characteristics that allow it to be distinguished from this and other dementias .

The main symptoms of dementia caused by this disease are the following.

1. Personality changes

One of the first symptoms to be noticed in Pick’s disease is the presence of sudden changes in the patient’s personality . These changes usually refer to an increase in behavioural disinhibition, greater aggressiveness and impulsiveness and even an increase in socialization. The opposite may also occur, with abulia and apathy.

2. Altered mood

Like personality, mood can also be altered from the early stages of the disease. Emotional lability, irritability, nervousness or conversely emotional dullness can often be seen.

3. Executive functions

Considering that the alteration starts in the frontal area, it is easy to associate this disease with the presence of alterations in the executive functions. Decision making, risk assessment, planning and maintenance or change of action are complicated. It is common to observe the existence of perseverance and even obsessive characteristics. Especially marked is the lack of impulse control .

4. Socialization

It is also common for the patient’s social relationships to deteriorate. Although initially in some cases a approach to others may be facilitated by reducing the level of inhibition , in the long run social bonds and skills deteriorate. It is also frequent that the weakening of self-control leads to hypersexuality, performing practices such as masturbation in public.

5. Memory

In its frontal and temporal expansion, Pick’s disease gradually generates memory disorders both antegrade and retrograde. These alterations occur later than in other dementias such as Alzheimer’s, with which it is sometimes confused.

6. Language

Pick’s disease often causes language changes in the patient over time. It is common for speech, as well as reading and writing, to slow down and become less fluent. Anomie, perseveration and repetition of words and echolalia are also frequent. Also the pragmatic use of language both in its verbal and paraverbal aspects and its adaptation to the rules and concrete situations often present alterations.

Its causes

Pick’s disease is a problem of unknown origin. However, people with Pick’s disease have been found to have alterations in the tau protein encoding genes .

Tau protein appears in excess in the brain, within the complexes known as Pick bodies. These cells cause damage to the neurons in the frontal and temporal areas culminating in progressive atrophy of the brain lobes . The presence of abalone neurons is also observed.

The fact that genetic mutations have been found in the genes that develop this protein indicates that the disease is influenced by genetics, and in fact can be transmitted to the offspring .

Treatment of Pick’s disease

Dementia caused by Pick’s disease has no treatment that can reverse its effects. Thus, Pick’s disease has no proper curative treatment at present . However, it is possible to slow down the deterioration caused by the progression of the disease and help those affected to have a better quality of life.

On a psychological level, the use of occupational therapy and neurostimulation is fundamental in order to keep the patient mentally active. It is also useful to use compensatory mechanisms with regard to the skills that are lost, such as the use of an agenda to control the things that must be done and that the memory deficits have less effect on their daily life.

Psychoeducation, counselling and psychological support for both the patient and his/her environment is also essential, since we are facing a complicated situation in which the existence of information regarding what is happening to the individual is fundamental to understanding his/her situation.

At the pharmacological level, different psychoactive drugs such as antidepressants or even some antipsychotics can be used to control the symptoms.

Bibliographic references:

  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Román, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.