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Is Pick’s disease terminal??

Pick's disease, also referred to as Pick disease or PiD, is a rare neurodegenerative disorder in which the brain cells gradually degenerate. It belongs to the subgroup of frontotemporal dementia and is distinguished by dementia and aphasia (a disorder that affects a person’s ability to communicate) symptoms [1].


What causes pick’s disease and how to identify it?


Pick’s disease

Pick's disease is brought on by modifications to the neurons in specific regions of the brain. Pick bodies or Pick cells, which are silver, spherical aggregations accumulate in the neurons, in this disease. They are basically tau proteins, which are present normally in the brain, but people with Pick's disease have abnormally high or different levels.


Currently, it is unknown where the abnormalities in the tau protein came from. The research on this topic is unclear, but a number of genes have been linked to the accumulation of the protein [1].


What are the symptoms of this disease and how to identify it?


Pick’s disease can affect adults of any age, but cases in people as young as 20 years have been documented. However, it typically manifests in patients between the ages of 40 to 60 years. The disease is accompanied by a variety of symptoms, such as:

  • Behavioral changes: withdrawal behavior and compulsive nature which is inappropriate

  • Emotional changes: erratic behavior, boredom, and lack of empathy.

  • Language changes: aphasia, disorganized speech, and difficulty in writing.

  • Neurological changes: challenges with decision-making and difficult tasks.

It can be challenging to distinguish Pick's disease from Alzheimer's disease in the early stages of the illness. Memory loss, which starts earlier in Alzheimer’s disease but progresses slower in Pick's disease, is the main difference between the two diseases [2].


Detection of pick’s disease


A thorough medical history should be taken at first, along with details about any family members who have had Pick's disease. The most crucial elements to be taken into account for the identification of this disease are the presentation of the symptoms and signs. This helps in distinguishing it from other conditions such as Alzheimer's disease, which has comparable symptoms, similar to this disease.


For the diagnosis of Pick's disease, the following examinations might be necessary:

  • A neuropsychological evaluation

  • Brain MRI (magnetic resonance imaging)

  • Electroencephalogram (EEG)

  • Psychological test

  • Brain and spinal fluid analysis(CSF)

  • Computed tomography (CT) scan of the head

  • Tests of cognitive function

However, definitive confirmation of this disease will be done only by the histopathological examination of the biopsy specimen which identifies the presence of Pick bodies [3].


What is the treatment for pick’s disease?


Pick's disease does not have a known cure, but there are treatments to control the symptoms. Patients frequently display agitated and aggressive behavior, which can be challenging for caregivers to manage. Sometimes behavior modification (counseling the patient to adopt good behavior) will reduce this aggressive behavior to a certain extent. However, to control aggressive behavior, pharmacological intervention with antidepressants is also required. Selective serotonin reuptake inhibitors (SSRI) like fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram have been shown in studies to be effective in treating a range of Pick’s disease symptoms.


It is also very important to note that frequently stopping or altering the medication regimen is not advised because it can exacerbate symptoms and increase confusion. The treatment varies from patient to patient depending upon their needs. Many of the patients require round-the-clock care in a day which will aid them in managing the symptoms of the disease and also to monitor the progression of the disease [4].


Living with pick’s disease!


Pick's disease has no known treatment to date. Although medications can reduce the symptoms to a certain extent, they cannot stop the disease progression. The disease advances gradually but sometimes it typically gets worse over time. Some people with this condition can survive for about 10 years. So prevention of this disease by identifying the genes involved in the pathogenesis is gaining attention in recent times.


References


1. M. M. Pippin and V. Gupta, “Pick Disease,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2022. Accessed: Dec. 30, 2022. Available: http://www.ncbi.nlm.nih.gov/books/NBK562226/

2. “Pick’s disease: Symptoms, causes, treatment, and more,” Mar. 23, 2022. https://www.medicalnewstoday.com/articles/picks-disease (accessed Jan. 02, 2023).

3. “Pick’s Disease - an overview | Science Direct Topics.” https://www.sciencedirect.com/topics/medicine-and-dentistry/picks-disease (accessed Jan. 11, 2023).

4. R. M. Tsai and A. L. Boxer, “Treatment of Frontotemporal Dementia,” Curr Treat Options Neurol, vol. 16, no. 11, p. 319, Nov. 2014, doi: 10.1007/s11940-014-0319-0.

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