Frontal Lobe Dementia

This is the illness my uncle Charley has. He is only 39 years old.

FRONTAL LOBE DEMENTIA AND PICK'S DISEASE

Like Alzheimer's disease, Pick's disease and frontal lobe dementias cause a progressive and irreversible decline in a person's abilities over a number of years. Frontal lobe dementia and Pick's disease are the cause of less than 10 per cent of all dementias and may usually be distinguished from Alzheimer's disease early in the course of the illness.

Arnold Pick first described Pick's disease in a 71-year-old man in 1892. Pick's disease affects the temporal lobes of the brain in 25 per cent of cases, frontal lobes in 25 per cent and both frontal and temporal lobes in 50 per cent. Frontal lobe dementia affects the frontal lobes initially. Damage to the frontal lobes leads to alterations in personality and behaviour, changes in the way a person feels and expresses emotion, and loss of judgement.

Who can get the disease?
Anybody can get the disease, although there may be geographical differences in the incidence of Pick's disease. Some studies suggest the disease to be more common in women while others suggest a greater risk in men. The most severe cases of Pick's disease occur before the age of 60 years. The highest incidence is between 50 and 60, but people may develop the disease earlier or up to 80 years.

What is the cause?
As with Alzheimer's disease, in most cases, the cause cannot yet be determined. However, there are strong genetic components in certain families. When there is a genetic element, it is autosomal dominant, (on average, half of the children of an affected parent will develop the disease, but half will not) but is clearly modified by a number of environmental factors as yet to be discovered. The genetic component has been variously described as affecting 20 to 50 per cent of people with Pick's disease.

Diagnosis
Although Pick's disease can only be conclusively diagnosed after a person's death by a post mortem examination of the brain, there are several techniques, such as brain scans and EEGs, which can be used during the person's lifetime to give a probable diagnosis. These techniques can help in determining whether the dementia is likely to be Pick's disease or a closely related disorder, for example, Alzheimer's disease.

Prognosis and treatment
As yet, there is no cure for Pick's disease and neither can the progression be slowed down with any medication treatment. Probably because Pick's disease is much less common than Alzheimer's disease, there is less research into Pick's, and there are currently no drug trials taking place in relation to treating Pick's disease.

The course of Pick's disease is an inevitable progressive deterioration. From the onset of the disease, life expectancy is 2-15 years, with an average of 6-12 years. Death is usually caused by infection.

Some of the symptoms of the disease can be treated effectively. For example, certain medications can reduce some of the behavioural problems. Also knowing more about the disease and why the person is behaving as they are can in itself be an effective means of helping people to cope with the disease.