PICK’S DISEASE By: Erin Barbee

What is Pick’s Disease? Pick’s Disease can be defined as: “A progressive dementia commencing in middle life (usually between 50 and 60 years) characterized by slowly progressing changes in character and social deterioration leading to impairment of intellect, memory and language”. Pick’s disease is thought to be due to a build up in the brain of an abnormal form of the protein Tau. This is a relatively rare form of dementia. The first description of the disease was published in 1892 by Arnold Pick. Until recently it was thought that Pick's disease could not be distinguished from Alzheimer's disease during life. Consequently, it has been little studied, and much less is known about it than about Alzheimer's disease.

Frequency: In the US: Of individuals with dementia, 10-15% have clinical characteristics suggestive of Pick disease. Pick disease is the third most common neurodegenerative cortical dementia after Alzheimer disease and diffuse Lewy body disease and the fourth most common if nonneurodegenerative (vascular) dementia is included. After death, only approximately 5-7% of people meeting clinical criteria for the diagnosis of Pick disease meet strict neuropathologic criteria for the diagnosis. In some clinical settings, most patients with autopsy-confirmed Pick disease have been diagnosed during life as having Alzheimer disease or another neurodegenerative illness.

Difference between Alzheimer’s and Pick’s Pick's disease differs from Alzheimer's disease in several ways. First, the two diseases produce different abnormalities in the cells of the brain. Pick's disease is marked by "Pick bodies", rounded, microscopic structures found within affected cells. Neurons swell, taking on a "ballooned" appearance. Neither of these changes appears in Alzheimer's disease, and the markers of Alzheimer's disease (plaques and tangles) is not found in Pick's disease. Secondly, Pick's disease is usually sharply confined to the front parts of the brain, particularly the frontal and anterior temporal lobes. This contrasts with Alzheimer's disease, which is more widely distributed. The two diseases also produce different neurochemical changes in the brain.

Symptoms Loss of intellectual abilities: Affected individuals may exhibit confusion and general lack of concern about their surroundings. Loss of retentive memory. The ability to initiate, organize and follow through on very simple plans and familiar activities is lost. Attention span is poor. In many cases, individuals become unusually quiet but when they do choose to speak it is often times in slowly and in brief sentences. The exact cause of Pick’s Disease is still unknown therefore it is difficult to diagnose.

Pick’s and Communication -Naming is often an early problem as well as misuse of verbs. Loss of facial expression can cause caregivers and family a lot of sadness, it is amazing how much we depend on other ways of communicating apart from just words. Lack of emotion and becoming self centered also cause a break down in communication. Inappropriate use of words can cause distress as well as loss of inhibitions. Loss of communication affects the person with Pick’s, the spouse or caregiver, all friends and family as well as strangers. -Echolalia Occurs: This is when someone repeats the speech of somebody else in an involuntary and meaningless way. People with echolalia may repeat a word, phrase, or entire sentences. For example, if somebody said to a person with echolalia, "It sure is a very nice day today," he or she would respond, "It sure is a very nice day today." In echolalia, the tone and accent of the speaker is repeated as well. Think of echolalia as being like something a parrot does, in terms of speech repetition. Echolalia is sometimes accompanied by echopraxia, in which the person involuntarily repeats the behavior of another person.

Treatment - There is no proven effective treatment for Pick’s disease. Monitoring and assistance with self-care may be required depending on the severity of the disorder. - Aggressive, agitated, or dangerous behaviors could require medication. Anti-depressants have been shown to improve some symptoms. - Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others.

Interventions ~Speech Therapy: During the early stages of Pick’s speech therapy can help the individual to maintain speech for as long as possible. ~Occupational Therapy: This helps the individual to function normally in the everyday activities within their given occupation. ~Behavior Modification: This may improve the day-to-day functioning of the individual and may improve autonomy.

Intervention Continued Formal psychotherapy treatment is seldom effective, because it may overload limited cognitive resources. Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation. Family counseling may help in coping with the changes required for home care. Unlike Alzheimer’s, the process of Pick’s disease cannot be slowed.

CONCLUSION! Because Pick’s Disease is so rare the research that could benefit those suffering with it is quite limited. While many researchers believe that there will one day be a drug that could ultimately slow the progression of the disease none have been found thus far. Pick’s is often confused with Alzheimer’s disease and the only way to distinguish between the two is through an autopsy. Interventions for Pick’s disease are somewhat not helpful because the disease progresses on it’s normal path. Only pain intervention is extremely helpful during the later stages of Pick’s. Though interventions may not be helpful it is still important to emphasize that communication of any kind is important until the person is simply not capable. Communication can benefit the individual with Pick’s because they can communicate their needs and it benefits the caregiver because they are not left to fully speak on behalf of the individual.

References Helping Guide and Aging Issues. May 3, 2006www.helpguide.org Kertesz, Andrew, Munoz, David G. Pick’s Disease and Pick Complex. March Northern California. Office of Communications and Public Liaison. April 28, April 28,2006 Pick’s Support Group. May 1,2006www.pdsg.org.uk