PICK’S DISEASE

A rare degenerative disease of the brain, first described in 1892 by the Czech psychiatrist Arnold Pick (1867-1926).The disease occurs between the ages of forty-five and fifty and affects more women than men. For reasons unknown, the higher associative areas of the cortex, starting in the frontal and temporal lobes, begin to atrophy, as if in premature senility, and the mechanisms of speech and thinking are increasingly affected.The onset of the disorder is gradual, and the earliest symptoms are usually difficulty in thinking and concentrating, memory defect, indifference, and inability to deal with new situations. One of the outstanding symptoms is inability to generalize and deal with abstractions. As the atrophy spreads to different brain areas, the patient becomes increasingly bewildered, either refuses to talk or talks in a rambling manner, and gradually loses the ability to read, write, and name objects (alexia, agraphia, nominal aphasia). Finally, extreme mental and physical deterioration sets in: Speech practically disappears, paralyses and contractures of the arms and legs occur, incontinence develops, and the patient becomes so debilitated that he has to be confined to bed. He does not usually survive more than four to six years after the onset of the disease.It is sometimes difficult to distinguish Pick’s disease from Alzheimer’s disease, since the age of the patient and many of the symptoms are similar. In Pick’s disease, however, there is more apathy and indifference and less agitation, anxiety and activity than in Alzheimer’s. Memory defect occurs later in Pick’s, and delusions, hallucinations, and confabulation rarely occur. Some investigations indicate that Pick’s disease tends to run in families and is based on defective genes. There are no preventive measures, and treatment is limited to routine medical and custodial care.