Behavioral and Psychological Symptoms and Frontotemporal Dementia (Pick's Disease)

Extract

Frontotemporal dementia, or Pick's disease, begins with personality and behavioral changes, in contrast to Alzheimer's disease (AD), which begins with memory deficits. Frontotemporal dementia is a term widely used for both the behavioral-personality component of frontal lobe dementia and for the disease itself (Brun et al., 1994). According to consensus criteria developed by the Manchester/Lund group (Brun et al., 1994), the core features of frontal lobe dementia or frontotemporal degeneration are disinhibition, loss of insight, apathy, disorganization, aspontaneity, indifference, lack of personal hygiene, mental rigidity, perseveration, hyperorality, and utilization behaviors. The clinical features of frontal lobe dementia often overlap with those of primary progressive aphasia, a condition characterized by language deficit in the first 2 years of the disease (Mesulam, 1987). Pick's original patient with lobar atrophy was also aphasic (Pick, 1892), and primary progressive aphasia has a course, eventual outcome, and pathology similar to that of frontal lobe dementia (Kertesz et al., 1994). In some patients with primary progressive aphasia, extrapyramidal symptoms similar to those that occur with corticobasal degeneration and motor neuron disease are superimposed.