Psychology and Psychiatry

Pick's disease

Pick's disease is a rare, chronic and progressive CNS disease characterized by atrophy of the temporal, as well as frontal lobes of the cerebral cortex with an increase in dementia. The disease begins in 50-60 years, although there are later or earlier manifestations. Women tend to get sick more often than men.

A. Peak in 1892 gave a description of cases of senile dementia, aggravated by the atrophic process mainly in the temporal and frontal lobes. Similar studies were conducted by A. Alzheimer, X. Lipman, E. Altman. Statements that the cases of the disease described by A. Pick represent an independent form were first noted by X. Richter. The confirmation of this nosological independence of the disease was the pathological studies that showed a number of morphological features of this particular pathology.

Morphological features include the following signs: the limited nature of atrophic changes in the frontal and temporal lobes; insignificant degree or absence of vascular changes; loss of elements of the nervous tissue in the upper layers of the cortex gol. brain; the absence of all signs of the inflammatory process, as well as senile plaques or alzheimer's changes in neurofibrils; atrophic changes, passing into the subcortical region; the frequent presence of spherical argentophilic intracellular formations, as well as swollen cells.

The atrophic process is unevenly distributed in some parts of the brain, starting in typical areas called wrinkling and atrophy centers.

Pick's disease causes

The causes of Pick's disease have not yet been established. At the moment, identified only factors that increase the risk of its development. The main risk factor is hereditary predisposition. If blood relatives in old age had different types of dementia, then it is necessary to be very careful and wary of their condition.

One of the causes of Pick's disease is intoxication of the body. Prolonged exposure to the body of chemicals increases the chance of developing the disease. Anesthesia also refers to the causes of Pick's disease, since it is very difficult for the nervous system to tolerate. Head injuries and mental illness are also a provoking factor for the disease.

Pick disease symptoms

Pick's disease at an early stage is characterized by profound personality changes and signs of a weakening of all types of intellectual activity. The initial manifestations of the disease slightly affect the prerequisites of the intellect: memorization, memory, attention, sensory knowledge. This disease has several options for the course.

Pick's disease in the first version is little concerned with automated forms of intellectual activity. According to the increase of the symptoms of the disease, the abilities of the patients do not change by orientation in the usual or in the uncomplicated new environment. The disease affects differentiated as well as complex personal attitudes and relationships. There is a change in the nature of patients, in parallel, productivity decreases, as well as the flexibility of thinking and the ability to critically evaluate new, complex situations, the ability to comprehend, to make consistent conclusions, generalizations or other mental operations is lost.

Pick's disease, in contrast to Alzheimer's disease, is marked by the development of mental dementia. The intellect of the disease is affected from above. Personality changes in the disease are marked by typical symptoms. With the course of the disease, increased sexual desire prevails, disinhibition with the release of the instincts, which provokes offenses. In patients, a developing disappearance of a sense of tact, distance, shame, as well as former moral attitudes appears. Patients tend to predominance of inadequate euphoria, impulsivity and expansiveness along with a decrease in criticism.

This picture of personality change is characterized by a pseudo-paralytic symptom complex with gross violations in conceptual thinking, namely, the ability to generalize, to determine the difference and similarity, the inability to explain proverbs. A feature of the clinic is the lack of memory disorders and orientation.

Pick's disease in another variant of the course is characterized by a predominance of lethargy, apathy, aspiration, inaction, an increase in indifference, as well as emotional hysteria. In parallel with this comes the impoverishment of speech, motor functions, thinking. Often there is a dependence on the characteristics of personality disorders and localization of the initial atrophic process, affecting the convex frontal lobes. As a result, the patient appears lethargy, apathy, inactivity, disinhibition, carelessness, euphoria, pseudoparalytic syndrome. From the history of such patients it is known that their performance decreases, negligence and negligence appear in the performance of their duties, they trigger matters, lack of initiative, lethargy, indifference or excitability, as well as senseless gaiety accompanied by foolishness and tactlessness, selfishness, callousness.

These behavioral features give the impression that patients have memory loss, they are forgetful, absent-minded. Active attention in patients with reduced and unstable. A directional study of memory reveals the relative safety of its reserves. Patients can memorize simple facts that concern themselves, and they do not show interest to events that do not apply to them. The stock of previously acquired knowledge is also noted intact, but interest in them is usually lost.

Many cases of Pick's disease indicate apparent loss of memory. Patients for a long time retain a sense of the sequence of time and consciousness. Patients know what will happen soon and what has happened recently. This ability to anticipate the future distinguishes patients from Alzheimer's patients. The increase in progression is marked by noticeable manifestations of dementia, a decrease in intellectual efficiency and level of intellectual activity, and the defeat of all types of memory. As a result, deep dementia develops, marked by impoverishment of mental activity, as well as activity. Frequent stereotypes, which monotonously repeat on a pattern, are characteristic of behavior. This is more noticeable in speech with repetitive phrases, words.

Pick's disease diagnosis

Patients with suspected illness are examined by a psychiatrist. The doctor assesses the current state through a conversation, a general superficial examination. Preliminary examination reveals the inadequacy of actions, as well as a violation of social behavior.

To assess the state of the brain, the following methods are recommended: CT scan (computed tomography), electroencephalography, MRI (magnetic resonance imaging).

Computed tomography makes it possible to obtain high-precision layered images of the brain, as well as to identify the degree of progression of the process and the most affected part of the brain.

Electroencephalography allows you to catch the minimum electrical impulses that occur in the brain. All pulse data is displayed on a sheet of paper as a set of curves. With Pick's disease, we have thinned cortex, and therefore much less process occurs in it, as the electroencephalogram shows.

MRI (magnetic resonance imaging) has the same diagnostic significance as computed tomography.

When diagnosing it is important to differentiate Pick's disease from other diseases (Alzheimer's disease, brain cancer, Huntington's chorea, diffuse atherosclerosis).

Pick disease treatment

Cholinesterase inhibitors are used in treatment. These are drugs such as Amiridin, Rivastigmine (Exelon), Reminyl (Galantamine), Aricept, and Gliatilin. These drugs for Pick's disease normalize the condition of patients at an early stage of the disease.

A good effect exists from the use of long-term (about 6 months) NMDA blockers (Akatinolmemantin), as well as nootropic drugs (Fenotropil, Aminalon, Nootropil) and Cerebrolysin. Relief of productive psychotic symptoms is accomplished by mild neuroleptics — Teralen, Teraligen, Klopiksol, Chlorprothixen.

Patients with Pick's disease need constant psychological support. Patients are recommended to participate in special trainings that slow down the progression of the disease. The forecast for the future is unfavorable. Six years after the onset of the disease, complete moral as well as mental disintegration of the personality sets in, insanity and cachexia set in. Ill for society becomes completely lost. The patient needs compulsory permanent care or placement in a specialized psychiatric hospital.