PICK

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PICKS DISEASE
By Erin Barbee
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What is Picks Disease? Picks 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.
Picks 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.
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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.

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Difference between Alzheimers and Picks
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.
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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 Picks Disease is still
  unknown therefore it is difficult to diagnose.

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Picks 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 Picks, 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.

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Treatment

• -There is no proven effective treatment for
  Picks 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.

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Interventions
Speech Therapy During the early stages of
Picks speech therapy can help the individual to
maintain speech for as long as possible. Occupat
ional 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.
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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 Alzheimers, the
process of Picks disease cannot be slowed.
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CONCLUSION!
Because Picks 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. Picks is often
confused with Alzheimers disease and the only
way to distinguish between the two is through an
autopsy. Interventions for Picks disease are
somewhat not helpful because the disease
progresses on its normal path. Only pain
intervention is extremely helpful during the
later stages of Picks. 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 Picks because
they can communicate their needs and it benefits
the caregiver because they are not left to fully
speak on behalf of the individual.
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References

• Helping Guide and Aging Issues.
  www.helpguide.org. May 3, 2006
• Kertesz, Andrew, Munoz, David G. Picks Disease
  and Pick Complex. March 1999. Northern
  California.
• Office of Communications and Public Liaison.
  www.ninds.nih.gov/disorders/picks/picks.htm.
  April 28,2006
• Picks Support Group. www.pdsg.org.uk. May 1,2006