How To Spot Pick's Disease (Frontotemporal Dementia)

Pick’s disease is one of three dementias classed as frontotemporal dementias; they are all associated with shrinking temporal and frontal anterior lobes of the brain. The other two frontotemporal dementias are semantic dementia and primary progressive aphasia. All three dementias have some genetic causes, for they often run in families. Pick’s disease can also be sporadic, which means it can have no known cause.

The symptoms of Pick’s disease fall into two broad categories: difficulties with language and behavioral changes. Unlike other dementias, such as Alzheimer’s disease, memory is not affected until the disease has become quite advanced. The patient’s spatial awareness also remains intact. Get to know some of the major warning signs of Pick's disease now.

Lack Of Social Tact

The frontal lobe of the brain, which is located behind the forehead, helps control an individual’s impulses and behavior. As Pick’s disease shrinks and otherwise damages this part of the brain, the patient gradually develops a lack of social tact. They can become completely uninhibited in their behavior as they lose their sense of what is and is not inappropriate. They can become far more sexually demonstrative than they should be.

Similarly, they can start saying mean or rude things to others, as they no longer have a filter. Individuals with Pick’s disease generally begin showing symptoms in middle age. Consequently, Dr. Katherine Rankin, a professor of neurology at the University of California, San Francisco, urges individuals over forty years old to see a neurologist if they start experiencing behavioral or personality changes.

Neglect Of Personal Hygiene

Pick’s disease is also associated with a growing lack of self-awareness. The patient thus becomes less concerned with the impression they make on others, which leads to a lack of interest in their appearance. That lack of interest often results in a neglect of personal hygiene. In addition, as their dementia worsens, the patient loses their functional abilities, so they can no longer recall the steps involved in getting dressed or brushing one’s teeth.

They may not even understand the point of such activities. Many caregivers find helping a patient with Pick’s disease take care of their hygiene among the more difficult aspects of their care. Some caregivers use a 'monkey-see-monkey-do' approach and show the patient how to brush their teeth or wash their hair.

Lack Of Empathy

As Pick’s disease worsens, the patient loses the ability to see things from another person’s point of view, resulting in a lack of empathy. Consequently, even somebody who was once known for their kindness can no longer respond appropriately to another person’s distress. Similarly, they lose the ability to read common social cues. Pick’s disease damages a brain pathway called the ventral salience network that helps individuals read emotional information and decide on the best way to respond to it. Damage to the ventral salience pathway causes individuals to lose the ability to correctly interpret somebody else’s emotions and thus empathize with them. It also impairs a patient’s ability to detect sarcasm or insincerity.

Agitation

Agitation and mood swings are among the symptoms associated with Pick’s disease. There is so far no cure for Pick’s disease, but doctors can provide medications for some of the symptoms like agitation or compulsive behavior. Pick’s disease can be difficult to diagnose, for some of its symptoms are similar to those of other dementias. There are some differences that doctors can and should look for. For example, Pick’s disease doesn’t affect memory until its later stages.

Second, the patients are generally younger; the average age of onset is fifty-four. While there is currently no single diagnostic test, doctors can use imaging tests like magnetic resonance imaging (MRIs) to examine the patient’s brain. They can also test the patient’s speech and writing capabilities, and they can interview the patient’s relatives about their behavior. The doctor can also take a medical history and perform physical and neurological examinations.

Compulsive Behavior

Patients with Pick’s disease often also develop obsessive-compulsive disorder (OCD). In addition to compulsive behavior, OCD is also characterized by repetitive and unwanted thoughts and feelings. Obsessive-compulsive disorder can persist throughout a patient’s life, or it can appear at a relatively late age. Researchers have found links between the latter type and dementia. For example, scientists at the 2016 American Academy of Neurology Annual Meeting reported sixty-five percent of patients with frontotemporal dementia had developed obsessive-compulsive disorder or some symptoms of it before developing dementia.

They also reported patients who had developed OCD relatively late in life were more likely to develop a type of dementia than individuals who developed it at an early age. Obsessive-compulsive disorder is also often linked to anxiety, and many dementia patients feel anxious and out of control. Their obsessive rituals may also help them remember given tasks in self-care.

Depression-Like Symptoms

A specific study was done to better understand the nature of the symptoms of depression in the early stages of Pick’s disease and how it affects a patient’s rapidly changing neurology. The patients surveyed for this study were originally treated for major depressive disorders before being clinically diagnosed with Pick’s disease. Majority of the patients displayed signs of depression associated with Pick’s disease such as social isolation and withdrawal, slowing down of thought processes and a reduction in physical movements by the patient, agitation, hastily making decisions, and anxiety. Only a few of the patients displayed melancholia and physical symptoms such as insomnia and loss of appetite.

Besides the study, Pick’s disease and depression have many of the same symptoms such as difficulty concentrating and making decisions, memory loss, irritability, restlessness, and a loss of interest in daily life. Considering many of the symptoms of both conditions tend to cross paths, diagnosing Pick’s disease or depression in an older individual can be tricky for doctors, and numerous tests may take place for a proper diagnosis.

Language & Speech Issues

Unfortunately, one of the most common and noticeable symptoms of Pick’s disease is the patient will begin to experience language and speech issues as the disease progresses. Depending on the type of frontotemporal dementia the patient has, their ability to verbalize and comprehend language can become incredibly challenging as the temporal lobes in the brain begin to change.

Some signs of speech and language difficulties include a loss of vocabulary, speaking slowly, trouble finding the right words to use when speaking or writing, unable to name objects, difficulty speaking or understanding speech, and repeating words others say. They will also have weak and uncoordinated speech sounds and a decrease in the overall ability to read or write properly. Once Pick’s disease has progressed to later stages, some patients may even completely lose their ability to speak.

Physical Signs To Be Aware Of

Similar to speech and language difficulties, some types of frontotemporal dementia can cause mobility issues similar to those observed with Parkinson’s disease. Some of the physical challenges a patient with Pick’s disease may experience include increased muscle rigidity or stiffness, general weakness throughout their body, a lack of coordination, difficulty moving around in general, and urinary incontinence. More symptoms include muscle weakness, balance issues, tremors, and muscle spasms as well.

Some patients even experience a shift in their physical appearance, especially their weight, as due to memory loss, may forget to eat meals throughout the day, therefore losing weight. On the flip side, some patients with Pick’s disease can begin to experience constant hunger pangs and feel hungry all the time, possibly developing an unhealthy ‘sweet tooth’ and eating more sugar and processed foods than before, resulting in weight gain.

Neurological Changes

Similar to Alzheimer’s and other neurological conditions, one of the first and predominant symptoms of Pick’s is advanced memory loss. Unfortunately, the patient may begin to forget family and friends, places, things, and memories they have had their whole life. Similar to the previous symptoms, there are numerous behavioral and emotional changes the patient will experience. Behavioral signs include impulsivity and poor judgment, restlessness, overeating or drinking, repetitive or obsessive behavior (OCD), decreased interest in daily activities, lack of personal hygiene, sexual exhibitionism or promiscuity, inability to plan things, and a decline in function at work and home.

Neurological Changes: Emotional Signs

Emotional signs of Pick’s disease include abrupt mood changes, apathy, a lack of empathy or concern for others, rudeness, impatience, aggression, easily distracted with a poor attention span, and individuals are often unaware of these changes in their behavior. Specifically, a patient’s sudden and frequent mood changes will be one of the most noticeable emotional signs of the disorder, as a person with frontotemporal dementia might be sad and depressed one moment, then joyous and euphoric not long after. Many of them have erratic and unpredictable mood changes that occur due to the progressive changes in the brain.

The Distinguishing Features Of Pick’s Disease

When it comes to looking for signs and diagnosing Pick’s disease, doctors will generally look for a few distinct behavioral, emotional, and physical signs. These signs include if the individual is showing classic symptoms of Pick’s disease before the age of sixty-five, personality changes, a lack of inhibition, they tend to roam around more often, and a loss of normal controls such as they’ve become more gluttonous and hypersexual. With these major changes taking place, it is essential for the affected individual’s loved ones to remember that these difficult behaviors are not done with malice or out of ill-will, but are all signs of a progressively changing brain, as many of these patients are unaware and are unable to control these problematic behaviors.