Definition
Picks disease is called frontotemporal dementia, similar to Alzheimer’s disease, which only affects certain brain areas.
Dementia is also called a major neurocognitive disorder.
It affects the part of the brain which controls emotions, behavior, personality, and language.
Causes
People with Picks disease have abnormal substances like Tangles, Pick cells and tau proteins inside nerve cells in the damaged areas of the brain. The exact cause for abnormal substances is unknown. Many different abnormal genes are present and can be passed down through families.
FTD is rare as it can occur in 20 years but usually begins between ages 40 and 60.
Symptoms
The disease worsens and affects the brain’s tissues and causes them to shrink. Behavior changes, speech difficulty, and problems thinking.
A doctor can differentiate FTD from Alzheimer’s disease from early personality changes.
The changes in behavior continue to get worse and are more often the most disturbing symptoms of the disease. Some persons have difficulty with decision-making, complex tasks, or language(trouble finding or understanding words or writing)
There are variations of FTD seen with other nervous system problems, such as:
- Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig disease)
- Primary progressive aphasia
- Progressive supranuclear palsy
General symptoms include:
BEHAVIORAL CHANGES:
- Not able to keep a job
- Compulsive behaviors
- Impulsive or inappropriate behavior
- Inability to function or interact in social or personal situations
- Problems with personal hygiene
- Repetitive behavior
- Withdrawal from social interaction
EMOTIONAL CHANGES
- Abrupt mood changes
- Decreased interest in daily living activities
- Failure to recognize changes in behavior
- Failure to show emotional warmth, concern, empathy, sympathy
- Inappropriate mood
- Not caring about events or the environment
LANGUAGE CHANGES
- Cannot speak (mutism)
- Decreased ability to read or write
- Difficulty finding a word
- Difficulty speaking or understanding speech (aphasia)
- Repeating anything spoken to them (echolalia)
- Shrinking vocabulary
- Weak, uncoordinated speech sounds
NERVOUS SYSTEM PROBLEMS
- Increased muscle tone (rigidity)
- Memory loss that gets worse
- Movement/coordination difficulties (apraxia)
- Weakness
OTHER PROBLEMS
- Urinary incontinence
Exams and Tests
The healthcare provider will ask about the medical history and symptoms.
Tests may be ordered to help rule out other causes of dementia, including dementia due to metabolic causes. FTD is diagnosed based on symptoms and results of tests, including:
- Assessment of the mind and behavior (neuropsychological assessment)
- Brain MRI
- Electroencephalogram (EEG)
- Examination of the brain and nervous system (neurological exam)
- Examination of the fluid around the central nervous system (cerebrospinal fluid) after a lumbar puncture
- Head CT scan
- Tests of sensation, thinking, reasoning (cognitive function), and motor function
- Newer methods that test brain metabolism or protein deposits may better allow for more accurate diagnosis in the future
- Positron emission tomography (PET) scan of the brain
A brain biopsy is the only test that can confirm the diagnosis, although usually never recommended.
Treatment
There is no specific treatment for FTD. Medicines may help manage mood swings.
Sometimes, people with FTD take the same medicines to treat other types of
dementia.
In some cases, stopping or changing medicines that worsen confusion or are unnecessary can improve thinking and other mental functions. Medicines include:
- Analgesics
- Anticholinergics
- Central nervous system depressants
- Cimetidine
- Lidocaine
It is essential to treat any disorders that can confuse. These include:
- Anemia
- Decreased oxygen (hypoxia) level
- Heart failure
- High carbon dioxide level
- Infections
- Kidney failure
- Liver failure
- Nutritional disorders
- Thyroid disorders
- Mood disorders, such as depression
Medicines may be needed to control aggressive, dangerous, or agitated behaviors.
Behavior modification can help some people control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (when it is safe to do so).
Talk therapy (psychotherapist) does not always work. This is because it can cause further confusion or disorientation.
Reality orientation, reinforcing environmental and other cues, may help reduce disorientation.
Depending on the symptoms and severity of the disease, monitoring and help with personal hygiene and self-care may be needed. Eventually, there may be a need for 24-hour care and monitoring at home or in a particular facility. Family counseling can help the person cope with the changes needed for home care.
Care may include:
- Adult protective services
- Community resources
- Homemakers
- Visiting nurses or aides
- Volunteer services
People with FTD and their families may need legal advice early in the disorder. Advanced care directives, power of attorney, and other legal actions can make it easier to make decisions regarding the care of a person with FTD.
Support Groups
You can ease the stress of FTD by joining a support group. Sharing everyday experiences and problems with others can help you not feel alone.
Outlook (Prognosis)
The disorder quickly and steadily becomes worse. The person becomes disabled early in the course of the disease.
FTD commonly causes death within 8 to 10 years, usually from infection or sometimes because body systems fail.
Prevention
Unknown
Written by
Dr. Nikita Pawar
MBBS PGDCR
Dr. Nikita Pawar, MBBS PGDCR General Practitioner, and Post Graduate in Clinical Research & Pharmacovigilance from Mumbai.
I do my general clinical practice with the corporate company and online consultations. Received appreciation for working as Best Doctor in Audit at Pan India Level. Affiliated with Checkup Magazine as a writer on various subjects. I have my own unique articles page on Facebook. I have won many awards for medical excellence and my writing.
