Picks Disease: Symptoms, Types, Causes and Treatment

Pick’s disease, a subtype of frontotemporal dementia (FTD), is a rare and complex neurodegenerative disorder that primarily affects the frontal and temporal lobes of the brain. Unlike more common forms of dementia such as Alzheimer’s disease, Pick’s disease often presents with striking personality changes, behavioral symptoms, and language difficulties. This article provides a comprehensive overview of Pick’s disease, synthesizing up-to-date research evidence to explore its symptoms, types, causes, and treatment options.

Symptoms of Picks Disease

Understanding the symptoms of Pick’s disease is crucial for early identification and effective management. Symptoms often start subtly, with changes in personality or behavior long before memory loss becomes evident. Because the disease targets specific regions of the brain, the symptom profile can be quite distinct from other dementias.

Symptom	Description	Typical Onset	Source(s)
Behavior	Personality change, disinhibition	Early stage	1 2 5
Language	Speech and comprehension difficulties	Early to middle	3 5
Memory	Impaired recall, especially recent events	Middle stage	1 2 5
Movement	Rare, but possible (e.g. parkinsonism)	Late/atypical	5 3

Table 1: Key Symptoms

Behavioral Changes

Pick’s disease often begins with dramatic alterations in personality and social conduct. These may include inappropriate social behavior, impulsivity, apathy, or lack of empathy. Family members frequently notice a loss of social graces, reduced inhibitions, compulsive behaviors, or emotional blunting. Disinhibition—doing or saying socially inappropriate things—can be especially prominent and distressing 1 2 5.

Language and Communication Difficulties

Language impairment is a hallmark of Pick’s disease, often manifesting as difficulty finding words, reduced speech output, or trouble understanding complex sentences. Some patients develop primary progressive aphasia—a condition where language skills deteriorate while other cognitive functions remain relatively spared in the early stages 3 5.

Memory Impairment

Although memory loss can occur, it tends to emerge later in the disease course compared to Alzheimer’s disease. Early on, memory for recent events may be relatively preserved, but as the disease progresses, recall becomes increasingly affected 1 2 5.

Movement and Atypical Presentations

While primarily a cognitive and behavioral disorder, Pick’s disease can rarely involve movement symptoms such as parkinsonism or corticobasal syndrome. These cases are less common, but highlight the clinical variability of the disease 5 3.

Types of Picks Disease

Pick’s disease is not a one-size-fits-all diagnosis. Researchers have identified several clinical and pathological variants, each with unique features and progression. Understanding these types helps in tailoring diagnosis and care.

Type	Main Features	Typical Age of Onset	Source(s)
bvFTD	Behavioral, personality changes	50s-60s	5 3
PPA	Progressive language impairment	50s	5 3
CBS	Movement + cognitive symptoms	50s-60s	5
Pathological	Pick bodies, tau inclusions	Variable	1 2 4

Table 2: Types of Pick’s Disease

Behavioral Variant Frontotemporal Dementia (bvFTD)

This is the most common clinical presentation of Pick’s disease. Individuals with bvFTD primarily experience changes in behavior and personality, rather than memory loss. They may act impulsively, neglect social norms, or develop compulsive habits. Emotional withdrawal and lack of initiative are also frequent 5 3.

Primary Progressive Aphasia (PPA)

In this variant, language difficulties—such as trouble speaking, understanding, or finding words—are the initial and most prominent symptoms. Memory and reasoning skills are often preserved early on. PPA may appear earlier than the behavioral variant, with onset sometimes in the early 50s 5 3.

Corticobasal Syndrome (CBS)

A minority of Pick’s disease patients develop movement-related symptoms alongside cognitive changes, a condition known as corticobasal syndrome. This includes muscle stiffness, limb apraxia (inability to perform purposeful movements), and sometimes parkinsonism 5.

Pathological Subtypes

Pick’s disease is defined pathologically by the presence of Pick bodies (spherical, tau-rich inclusions within neurons) and Pick cells (ballooned neurons), as well as localized brain atrophy. Constantinidis’ classification describes three pathological types: Type A (classic Pick’s disease), Type B (corticobasal degeneration), and Type C (dementia lacking distinctive histology) 1 4.

Causes of Picks Disease

The exact causes of Pick’s disease are still being unraveled, but advances in neuropathology and genetics have shed light on its origins. Both hereditary and sporadic cases are recognized.

Factor	Explanation	Evidence	Source(s)
Genetics	Familial patterns, autosomal dominant	Multi-generational	2 8 9 7
Tau Protein	Abnormal tau aggregation (Pick bodies)	Pathological hallmark	1 2 4
Other Path	Coexistent Alzheimer’s, Lewy body	Mixed pathologies	5
Unknown	Many cases remain idiopathic	Ongoing research	1 2

Table 3: Causes of Pick’s Disease

Genetic Susceptibility

Multiple studies have confirmed that Pick’s disease can run in families, sometimes following an autosomal dominant inheritance pattern. Large families with several affected generations have been documented, suggesting a strong genetic component in some cases. However, no single causative gene has been universally identified for classic Pick’s disease, and sporadic (non-inherited) cases are also common 2 8 9 7.

Abnormal Tau Protein Accumulation

The defining feature of Pick’s disease is the presence of Pick bodies—spherical inclusions composed primarily of abnormally aggregated tau protein within neurons. These tau deposits disrupt normal cellular function and lead to nerve cell loss, especially in the frontal and temporal lobes 1 2 4. Notably, the tau protein involved in Pick’s disease is structurally distinct from that seen in Alzheimer’s disease 1.

Coexisting Pathologies

Recent research has shown that many patients with Pick’s disease also have evidence of other neurodegenerative processes, such as Alzheimer’s pathology or Lewy bodies. This overlap complicates diagnosis and suggests that multiple disease processes can coexist in the same brain 5.

Other and Unknown Causes

Despite advances, many cases of Pick’s disease arise without any known familial or genetic risk factors. Environmental, metabolic, or yet-undiscovered biological triggers may play a role, but research is ongoing 1 2.

Treatment of Picks Disease

Managing Pick’s disease remains challenging due to its progressive nature and the lack of disease-modifying treatments. However, several strategies can help optimize quality of life and address specific symptoms.

Approach	Purpose	Example/Details	Source(s)
Symptom Mgmt	Control behavior, mood, language	Medications, therapy	5 2
Supportive	Maximize daily function, safety	Multidisciplinary care	2 5
No Cure	No disease-modifying therapy	Research ongoing	2 5 1
Research	Experimental interventions	Tau-targeted drugs (in trials)	1

Table 4: Treatment Strategies

Symptomatic Management

There is currently no cure for Pick’s disease, nor are there any medications that can slow or halt its progression. Treatment focuses on alleviating symptoms and maximizing the patient’s quality of life. This may include:

• Medications: Antidepressants or antipsychotics may be used cautiously to manage mood swings, agitation, or psychotic symptoms. No drugs have been shown to specifically target the underlying disease mechanism 5 2.
• Speech and Language Therapy: For patients with language difficulties, therapy can help maintain communication skills for as long as possible 2 5.
• Behavioral Interventions: Structured routines, environmental modifications, and behavioral strategies can help manage impulsivity and inappropriate behavior.

Multidisciplinary and Supportive Care

A team approach is essential. Occupational therapists, social workers, and caregivers play key roles in supporting daily function and ensuring safety. Education of family members helps manage expectations and provides crucial emotional support 2 5.

Current Research and Future Directions

Research continues into disease-modifying therapies, including tau-targeted drugs and immunotherapies. However, these are still in experimental stages and not yet available for clinical use 1. Participation in clinical trials may be an option for some patients.

Conclusion

Pick’s disease is a rare but impactful form of dementia, marked by pronounced behavioral and language changes, a range of clinical variants, and complex underlying biology. While treatments remain supportive, ongoing research offers hope for future breakthroughs.

Key Points:

• Pick’s disease presents primarily with behavioral and language symptoms, making it distinct from other dementias like Alzheimer’s.
• There are several clinical and pathological subtypes, most notably bvFTD and PPA.
• Causes include genetic susceptibility and abnormal tau protein accumulation, but many cases remain sporadic.
• No cure exists, but multidisciplinary care can greatly improve quality of life.
• Continued research into disease mechanisms and treatments is ongoing.

Understanding Pick’s disease requires a nuanced and compassionate approach—one that blends up-to-date science with human-centered care for patients and families alike.