UNTREATABLE CAUSES OF DEMENTIA: PICK’S DISEASE

This condition was described in 1892, before Alzheimer’s disease, but appears to occur much less frequently. Like Alzheimer’s disease it is a chronic degenerative condition of the brain. In the majority of cases it appears as if there is an inherited tendency and it strikes particularly in late middle age. It is said to affect women a little more frequently than men.

The most striking feature of this condition is the way in which the degeneration and wasting of the brain tissue appears to be confined to two lobes in particular, the frontal and temporal lobes. Sometimes the left hemisphere appears to be more affected than the right and the disease also seems to start at the front end of these lobes. When one examines the brain under the microscope there is a considerable degree of nerve cell loss and also an increase in the numbers of the non-nerve cell population, the glia, in the outer layers of the brain — the cortex. Some of the neurones are distorted in a particular fashion; the nerve cell bodies appear to be distended by some abnormal material that has collected within the cell.

The symptoms that a patient shows reflect the site at which the damage occurs. Abnormalities of the frontal lobe often result in deterioration in personality and disorders of mood. These changes make it quite clear that something is amiss, especially as they usually occur in a younger person. Unlike some of the other illnesses that cause dementia, in the early stages of the disease memory function and the ability to use language are less affected in proportion to the personality and mood changes. In many instances therefore it is possible to suspect the diagnosis after questioning a relative or close friend and examining the person concerned. A brain scan may then show that the atrophy has particularly affected the frontal and temporal lobes and this makes the diagnosis almost certain. In most of the other dementias memory function is affected first and is usually one of the aspects of mental function that is affected most.

The condition is not always easy to spot, however, and can sometimes mimic the commoner illnesses such as Alzheimer’s disease. Alzheimer’s sufferers may be caught shoplifting because they have absentmindedly put an article in their bag, forgetting that they ought to pay for it. Rather than having forgotten, Pick’s sufferers may well have felt that they should not be expected to pay or perhaps just wanted to see if they could get away with not doing so.

As the disease progresses it becomes more and more difficult to distinguish from other conditions like Alzheimer’s. Often the diagnosis is only made when the brain is examined after the person has died. Most people with Pick’s disease live for five or six years after the diagnosis has been made, sometimes a little longer.

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