Pick’s Disease or Frontotemporal Dementia (FTD)

What is Pick's disease or frontotemporal dementia (FTD)?

Pick’s disease is a specific type of frontotemporal dementia (FTD) that causes an irreversible decline in a person’s functioning over a period of years. The disease was first described by Arnold Pick in 1892. Although it is commonly confused with the much more prevalent Alzheimer’s disease, Pick’s disease is a rare disorder that, instead of affecting many different parts of the brain, causes a slow shrinking of cells in specific parts of the brain.

Excess protein build-up causes the frontal and temporal lobes of the brain, which control speech and personality, to slowly atrophy. It is therefore classified as a frontotemporal dementia (FTD), otherwise known as frontal lobe dementia or frontotemporal lobar degeneration (FTLD).

As well as causing speech and behavioral changes, Pick's or FTD also creates memory problems similar to those experienced by people with Alzheimer’s disease, along with cognition and judgment problems. Pick's disease and other frontotemporal dementia account for up to 15 percent of all dementia cases.

While FTD is a less common form of dementia, it is a significant cause of dementia in people under the age of 65. There is currently no cure for Pick's or FTD, but by understanding the unique symptoms, you can better manage the disease and improve your quality of life.

Causes of Pick's or FTD

Like Huntington’s disease and Lewy Body dementia, Pick’s disease is the result of a build-up of protein in the affected areas of the brain. The accumulation of abnormal brain cells, known as Pick bodies or Pick cells, eventually leads to changes in character, socially inappropriate behavior, and poor decision making. The symptoms can then progress to severe impairment in intellect, memory, and speech.

Pick’s disease usually strikes adults between the ages of 40 and 60. It's slightly more common in women than in men, and in some cases, it runs in families. However, other risk factors, including the cause for the build-up of protein that results in the disease, are unknown.

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Signs and symptoms of Pick's disease or FTD

In contrast to Alzheimer’s disease, where memory loss is the predominant early sign, the first symptoms of Pick’s disease or FTD usually involve personality changes or a decline in basic functioning.

Pick’s disease can also occur at an earlier age than Alzheimer’s disease. While cases have been reported in people as young as 20 years of age, symptoms typically first appear between the age of 40 and 60. While the progression of symptoms is slow, symptoms do worsen over time as brain cells continue to degenerate.

The following symptoms are typical of patients with Pick’s disease. More severe symptoms tend to appear in later stages of the illness.

Behavioral symptoms

• Impulsivity and poor judgment.
• Extreme restlessness (early stages).
• Overeating or drinking to excess (when this was not previously a problem).
• Lack of attention to personal hygiene.
• Sexual exhibitionism or promiscuity.
• Withdrawal or decreased interest in activities of daily living.
• Decline in function at work and home.
• Repetitive or obsessive behavior.

Emotional symptoms

• Abrupt mood changes.
• Lack of warmth, concern, or empathy.
• Apathy.
• Rudeness, impatience, or aggression.
• Easily distracted; poor attention span.
• Unaware of the changes in behavior.

Language symptoms

• Loss of vocabulary.
• Trouble finding the right word.
• Difficulty speaking or understanding speech.
• Repeating words others say.
• Weak, uncoordinated speech sounds.
• Decrease in ability to read or write.
• Complete loss of speech.

Physical symptoms

• Increased muscle rigidity or stiffness.
• Difficulty moving about.
• Lack of coordination.
• General weakness.
• Memory loss.
• Urinary incontinence.

Diagnosis

Pick’s disease or FTD can only be conclusively determined by a brain biopsy, but there are ways to reach a probable diagnosis when symptoms set in. These involve:

• Careful symptomatic evaluation, including assessments of behavior and cognitive function.
• Magnetic resonance imaging (MRI) of the brain.
• Electroencephalogram (EEGs).
• Positron emission tomography (PET) scan.
• Computerized tomography (CT) scan.
• Blood work.
• Lumbar puncture (also known as a spinal tap).

These techniques can help ascertain whether the condition is likely to be Pick’s disease or a related disorder such as Alzheimer’s disease. Although these dementias may be similar, there are clear symptoms that set them apart.

[Read: Alzheimer’s Disease: Signs, Symptoms, Causes, and Stages]

If at least three of the following five distinguishing characteristics are present in the early stages, the diagnosis is likely to be Pick’s rather than Alzheimer’s. Also, as compared with Alzheimer’s disease, obvious mental impairment and memory loss occur later in Pick’s disease patients than in Alzheimer’s patients.

Once diagnosed, patients and caregivers can use practical self-help strategies and professional support to treat the symptoms of the disease.

Treatment and management

While Pick’s and other types of frontotemporal dementia can shorten life on average to about six to eight years, some people do live for as long as 20 years with the disease.

Since there is currently no cure for Pick’s disease, treatment is usually similar to treatment for Alzheimer’s: symptom management that is aimed at maximizing quality of life. This may include medications to manage particular symptoms, regular supervision, and assistance.

Treatment should also include emotional and substantive support for the caregiver. If you or a loved one has Pick’s disease, the following may help control symptoms.

Sensory function aids. Eyeglasses or hearing aids can bolster failing senses.

Behavior modification. Systems that reward positive behaviors can help reinforce appropriate behavior when symptoms set in. Creating a calm and soothing caregiving environment can also help a dementia patient feel safe and less anxious, often reducing problem behavior.

Professional therapy. Speech therapy and/or occupational therapy can improve communication and movement.

Medication to control behaviors that can be dangerous to oneself or others. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may offer some relief from apathy and depression and help reduce food cravings, loss of impulse control and compulsive activity.

[Read: Alzheimer’s and Dementia Behavior Management]

Treatment of other disorders that can cause or worsen symptoms of confusion, such as anemia, thyroid disorders, and kidney or liver disease.

Stopping or changing medications that may worsen confusion, such as paracetamol, NSAIDS, and anticholergenics used to treat COPD.

Self-help tips

Being diagnosed with a terminal disease can be an overwhelming experience, especially when it involves any form of dementia. Focusing on the positive aspects might seem like an exercise in futility, and yet, there can be unexpected bright spots for patients with Pick's disease.

For instance, at the University of California/San Francisco Medical Center's Memory and Aging Center, doctors discovered a small group of frontotemporal dementia patients who developed new creative skills in music and art. The artistic talents emerged when the brain cell loss occurred predominantly in the left frontal lobe, which controls functions such as language.

As the ability to communicate through words declined, these patients' brains somehow accessed other realms of self-expression. So exploring and encouraging the development of latent skills is one way in which Pick's disease patients can maintain their quality of life and possibly slow the progress of mental deterioration.

[Read: Preventing Alzheimer’s Disease and Dementia—or Slowing its Progress]

Other ways you can cope with a diagnosis of FTD include:

Becoming informed. Learn as much as you can about Pick’s disease and frontotemporal dementia. The more you know, the more control you’ll feel and the better prepared you’ll be to manage symptoms.

Reducing stress. Stress and anxiety can make exacerbate many dementia symptoms and increase behavior problems. Experiment with different relaxation techniques such as music therapy, meditation, and deep breathing exercises. Pet therapy, involving visits from specially trained animals, can also help to relieve stress and improve mood.

Treating depression. Depression can be common among those diagnosed with frontotemporal dementia. Treating depression can make it easier to handle the other challenges of the disease.

Exercising can help relieve stress and boost your mood. Any type of physical activity, even regular walks, can be beneficial, so find the activities that appeal to you.Some research seems to indicate that an active lifestyle might slow cognitive decline, even in people who are genetically at risk of FTD.

Maintaining social activity. Reaching out to family and friends for emotional support can help you avoid isolation. Joining a support group for patients with dementia and talking to other people facing similar challenges can help with feelings of isolation and depression and provide a wealth of coping tips. You may also want to talk to a therapist, counselor, or clergyman.

Seeking out mental stimulation. Playing cards or word games such as Scrabble, or completing crossword and Sudoku puzzles can exercise your brain and may help slow cognitive decline in people with Pick’s or FTD.

Caring for someone with Pick's disease or FTD

Caring for someone with dementia can be a life-changing experience. People with Pick’s disease or FTD will eventually need daily or around-the-clock caretaking. Taking this on can be a huge responsibility.

You may feel alone, and the kind of daily challenges you face can be tough on your physical and mental health. One of the most important ways that you, as a caregiver, can help the patient with FTD is to make sure you also take care of yourself.

Seek help. Reach out to other family members, friends, or volunteer organizations to help with the daily burden of caregiving or to arrange respite care. Caregivers who take regular time away not only provide better care, they also find more satisfaction in their caretaking roles.

Schedule regular exercise. Exercise releases endorphins that make you feel happy. If you can’t block out an hour away at a time, try ten-minute sessions sprinkled over the course of the day.

Stay socially active. Stay connected to friends and family and welcome the support they give you. This will lighten the load of caretaking.

Talk to others in similar situations. Caring for someone with dementia can be very hard work—both physically and emotionally. Joining a support group can provide a welcome opportunity to speak frankly about your experiences with other caregivers. See below for links to FTD support groups in your area.

Learn how to manage stress. Caregiving for a loved one with dementia can be one of the most stressful tasks you’ll undertake in life. Relaxation techniques such as deep breathing, meditation, rhythmic exercise, or yoga can help reduce stress and boost your mood and energy levels.

Research and clinical trials

While there is currently no cure for Pick’s disease or FTD, organizations such as the National Institute of Neurological Disorders and Stroke (NINDS) in the U.S., and other branches of the National Institutes of Health, conduct regular research related to frontotemporal dementia.

Ongoing research, including clinical trials for new medications, aims to help us understand more about the causes, diagnosis, treatment, and possible prevention of Pick's disease and other FTDs. Going forward, new therapies may be able to target specific genes that cause brain degradation. Wearable or mobile tech could also be used to monitor treatment effects.