From the Guidelines
Early signs of Pick's disease often manifest as changes in personality and behavior, including inappropriate social behavior, lack of inhibition, apathy, emotional blunting, and loss of empathy for others, which can appear before significant memory problems develop. These symptoms are a result of the progressive degeneration of the frontal and temporal lobes of the brain, areas responsible for personality, behavior regulation, and language processing 1. According to the Alzheimer's Association clinical practice guideline, individuals with Pick's disease may exhibit a progressive dysexecutive and/or behavioral syndrome, characterized by changes in executive function, judgment, problem-solving, and reasoning, with or without apathy or changes in personality or social or emotional behavior 1.
Some key early signs include:
- Inappropriate social behavior
- Lack of inhibition
- Apathy
- Emotional blunting
- Loss of empathy for others
- Language difficulties, such as struggling to find words, reduced speech, or simplified language patterns
- Compulsive or ritualistic behaviors
- Changes in eating habits, particularly a preference for sweet foods
- Decreased personal hygiene
It's essential to note that memory often remains relatively preserved in the early stages of Pick's disease, unlike in Alzheimer's disease 1. The disease typically affects people between ages 40-60, earlier than most forms of dementia. If these symptoms appear, prompt medical evaluation is crucial as early diagnosis can help with symptom management and family planning, even though there is currently no cure for the condition.
From the Research
Early Signs of Pick's Disease
The early signs of Pick's disease can be subtle and may resemble those of other conditions, making diagnosis challenging. Some common early signs include:
- Personality changes, such as apathy, disinterest, and disinhibition 2
- Behavioral changes, including social misconduct, stereotypy, and compulsive behavior 3, 2
- Language changes, such as word-finding difficulty, impaired comprehension of nominal terms, and palilalia 3, 2
- Memory deficits, although these may be less severe than visuospatial and apraxic disorders 4
- Emotional changes, such as anxiety and depression 5
Specific Symptoms
Some specific symptoms that may be observed in the early stages of Pick's disease include:
- Restlessness and irritability 3
- Wandering and attempting to open doors or engage in other repetitive behaviors 3
- Eating large amounts of food or exhibiting other changes in appetite 3
- Loss of verbal skills and problem-solving abilities 5
- Kluver-Bucy syndrome, characterized by hyperorality, hypersexuality, and placidity 6
Diagnostic Challenges
Diagnosing Pick's disease can be difficult, as the early signs may be similar to those of other conditions, such as Alzheimer's disease or depression 5, 3. A differential diagnosis may require several years, and a magnetic resonance imaging (MRI) scan may be necessary to show atrophied portions of the frontal and temporal lobes 5.