sailor girlWhat is Pick's Disease and Frontal Lobe Dementia?

This sheet tells you about two less common causes of dementia, Pick's Disease and Frontal Lobe Dementia, how they occur and what is likely to happen to someone who develops these conditions.

What is Pick's disease?

Pick's disease is a cause of dementia similar to Alzheimer's disease involving a progressive decline in a person's mental powers over a number of years. It occurs far less frequently than Alzheimer's disease, and usually starts to take effect between the ages of 40 and 65.    Damage to brain cells is more localised than in Alzheimer's disease, and usually begins in the front part of the brain or frontal lobe. The initial symptoms affect personality and behaviour more and memory rather less than those of Alzheimer's.    In later stages the person becomes totally dependent on others and the condition is very similar to late stage Alzheimer's.    After death Pick's disease can be distinguished from Alzheimer's because there are no 'senile plaques' and characteristic changes in affected areas, known as Pick's bodies and Pick's cells, are found.    The condition was first described by a German neurologist, Arnold Pick, in 1892.

What is frontal lobe dementia?

Frontal lobe dementia is the name given to any dementia caused by damage to this part of the brain. It includes Pick's disease but can also be caused by other diseases. They all have similar symptoms and prognoses.

What are the symptoms?

The frontal lobe of the brain is the part that governs our mood and behaviour. The person's mood and behaviour may become fixed and difficult to change, making them appear selfish and unfeeling. The affected person usually knows where they are, what day it is and does not have the sudden lapses of memory which are characteristic of Alzheimer's disease. Some people become withdrawn, while others lose their normal inhibitions and start talking to strangers. Others become aggressive. In many cases a person's normal sense of judgment seems to desert them. Because they lose their inhibitions and judgment some people exhibit sexual behaviour in public. The difference in symptoms between Alzheimer's disease and Pick's disease can be illustrated by thinking of different ways in which someone might walk out of a shop without paying.

In Alzheimer's disease this might happen because they become confused and forget they are holding a bag or forgot to pay.

In Pick's disease someone might know perfectly well they have the shopping but fail to see why they should be expected to pay for it. These behaviours can be very distressing for relatives and carers. They have a physical cause, and are not something that the person can usually control or contain. As the disease progresses language is affected. The person may become obsessional, repeating patterns of movement and behaviours like hand-washing, or repeating whatever is said to them. There is often an oral fixation, which can lead to people overeating and to putting objects other than food into the mouth. Some cases of Pick's disease also affect cells in the temporal lobe of the brain. When this happens memory is more likely to be affected, and the disease will more closely mimic Alzheimer's, with the addition of behavioural disorders. In the later stages the dementia is generalised. The person no longer recognises friends and family and may become totally dependent and need nursing care.

Is treatment possible?

A brain scan may help to 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. The risk factors for Pick's disease are less well 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.

Is Pick's disease genetic?

Most cases of Pick's disease are not inherited or passed on to children. There is a small number of Pick's disease families where the disease is passed on in the genes. In these cases, inheriting the gene means developing the disease, often as young as 40. Some other frontal lobe dementias have a stronger genetic link.

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