Pick's disease

Alternative names:

aphasia-agnosia-apraxia syndrome; Arnold Pick's disease; cerebral atrophy; circumscribed brain atrophy; lobar sclerosis; presenile dementia

Treatment:

There is no proven effective treatment for Pick's disease. Monitoring and assistance with care may be required depending on symptoms exhibited and progression of the disorder.

Progressive care of personal needs may be required. Eventually, there may be a need for 24-hour care and monitoring at home or in an institutionalized care setting to provide a safe environment and meet the individual's physiological needs.

Discontinuation or change in medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. This may include medications such as anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.

Disorders that contribute to confusion should be treated as appropriate. These may include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often gives great improvement in mental function.

Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others.

Sensory function should be evaluated and augmented as needed by the use of hearing-aids, glasses, cataract surgery, and so on.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Formal psychotherapy treatment is seldom effective, because it may overload limited cognitive resources. Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation. Family counseling may help in coping with the changes required for home care.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person. In some communities, there may be access to support groups (such as the Alzheimer's - support group, elder care - support group, or others).

Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with Pick's disease.

Expectations (prognosis):

The probable outcome is poor. The disorder progresses steadily and rapidly. Total disability occurs early. Commonly, Pick's disease results in death within 2 to 10 years, usually from infection and occasionally from general failure of body systems.

Complications:

• loss of ability to care for self or perform normal activities
• progressive loss of ability to function
• loss of ability to interact with others
• infection
• reduced life span
• abuse by an over-stressed caregiver
• side effects of medications used to treat the disorder

Calling your health care provider:

Call your health care provider if symptoms of Pick's disease develop.

Call your health care provider or go to the emergency room if acute deterioration in mental function occurs (this symptom may indicate development of another disorder).