Classification / type of disease:
- Uncharacteristic impulsive behaviour
- Easily distractible
- Lack of personal hygiene (stops bathing, brushing teeth, combing hair, etc without prompting from wife)
- Appears unkempt/dishevelled
- Uncharacteristically rude to friends and family
- Eats with fingers occasionally
- No focal neurological signs/symptoms.
- Prominent grasp and snout reflex.
- To differentiate between Alzheimer’s disease and Pick’s disease =
- All six isoforms of tau proteins are expressed in alzheimers.
- The presence of neurofibrillary tangles that are a hallmark of Alzheimer’s can be stained with antibodies to basic fibroblast growth factor, amyloid P, and heparan sulfate glycosaminoglycan.
- In Pick’s disease, a personality change occurs prior to any form of memory loss, unlike Alzheimer’s, where memory loss typically presents first.
- This is used clinically to determine whether patient is suffering from Alzheimer’s or Pick’s.
- Blood and urine tests:
- Dementia screen which should include B12, TFTs, ANF and TPHA (if appropriate).
- Genetic tests for Huntington’s disease may be indicated.
- Further tests may include cerebrospinal fluid (CSF) examination via LP (for chronic meningitis and HIV-related disease) and, if inattention is prominent, exclusion of Lyme disease (Lyme serology) and metastatic carcinoma may be necessary.
- Brain biopsy in exceptional circumstances
Imaging may be necessary:
- Structural scans = CT or more preferred - MRI
- Functional scans = PET
Aetiology: Pick’s disease causes progressive destruction of nerve cells in the brain and causes tau proteins in neurons to accumulate into silver-staining, spherical aggregations known as “Pick bodies” (aka balloon cells) that are a defining characteristic of the disease
- Cerebrovascular disease
- HIV-related disease such as AIDS Dementia Complex
- Huntington’s Disease
- Herpes simplex encephalitis
- Tertiary neurosyphilis
- Lyme disease
- Multiple sclerosis
- Prion-related diseases
- Stopping drugs which may be exacerbating memory problems or confusion (anticholinergics, CNS drugs).
- Treatment of symptoms of depression.
- Considering thiamine/vitamins.
- Help with social planning / support
Prognosis: 6 year median survival after onset