Pick's disease

Alzheimer's disease

 [altz´hi-merz]

irreversible dementia characterized by intellectual deterioration, disorganization of the personality, and functional disabilities in carrying out activities of daily living. The official name is now dementia of the alzheimer type. It is categorized as either presenile (early onset) or senile (late onset) depending on whether or not it begins by the age of 65, and is subcategorized on the basis of accompanying features, including delirium, delusions, depressed mood, behavioral disturbances, or none (uncomplicated).

Diagnosis is tentatively made on the basis of the symptoms presented and their progression over a period of time. Confirmation of the diagnosis of Alzheimer's disease can be made only by postmortem examination of brain tissue. The defining characteristics noted on autopsy are neurofibrillary tangles in the cytoplasm of neurons, neuritic plaques or deposits resulting from degeneration in the neural processes, and granulovacuolar degeneration in the neurons.

Etiology. The cause or causes of Alzheimer's disease are under investigation. Postmortem studies have revealed below normal levels of choline acetyltransferase; altered levels of the neurotransmitters acetylcholine, somatostatin, substance P, and norepinephrine; and higher than normal deposits of aluminum in cerebral tissue. It is hypothesized that there is no single cause of the disease. Age is the most important risk factor. Many researchers believe that genetics plays a role. apolipoprotein e is also being actively studied as having a possible role.

Symptoms. Alzheimer's disease can progress slowly over a period of ten to fifteen years or it can become steadily worse in a matter of only a few years. In the early stages there are forgetfulness, especially of recent events, inability to learn or remember new information, impaired concentration, and deterioration in personal hygiene. Later as symptoms worsen, memory, language, and motor functions become increasingly impaired and the patient becomes more intellectually and physically disabled.

Perseveration, or continuous repetition of words or gestures, is characteristic of Alzheimer's disease in its later stages. Personality changes, incontinence, voracious appetite, and a compulsion to put everything in the mouth are other manifestations of the disease.

Treatment. At present there is no cure for Alzheimer's disease; therapies are aimed at relieving symptoms and managing behavior problems. There has been limited success in the use of drugs. tacrine, donepezil, rivastigmine, or galantamine may slow progression of symptoms in the early stages. Research in this area is ongoing.

Patient Care. As cognitive and psychomotor functions become more impaired, the impact on family members or other caregivers becomes more profound. They will need continued guidance and support as physical care of the patient escalates from a part-time to a full-time responsibility. In the early stages the patient may be able to handle basic self-care functions and can live in the community and take care of personal financial and marketing chores with minimal help. However, the forgetfulness that accompanies Alzheimer's disease places the patient at a safety risk because of the tendency to wander and get lost. Later, assistance with activities of daily living such as eating, grooming, and toileting will be required. Eventually the patient will be unable to handle the most basic tasks of personal care, and all motor abilities and forms of communication will be lost.

Family members and other caregivers encounter emotional outbursts and progressive intellectual and physical deterioration that make the tasks of care even more challenging. Part-time or full-time help in the home usually is needed to give some respite to caregivers. They will also need guidance in the management of incontinence and help in coping with role reversals and their own feelings about the loss they have suffered and the burden of care that they bear. Eventually, it may be necessary to institutionalize the person with Alzheimer's disease. This can bring on feelings of guilt and a sense of failure on the part of the caregiver.

Educational materials and information on clinical trials are available from the Alzheimer's Disease Education and Referral Center (ADEAR) by writing them at P.O. Box 8250, Silver Spring MD 20807-8250, calling them at 1-800-272-3900, or consulting their web site at http://www.alzheimer.org.

Pick's disease ¹

(pĭks) or

Pick disease

(pĭk)

n.

A form of frontotemporal dementia characterized by the presence of Pick bodies in the nerve cells of the brain.

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Pick's disease ²

(pĭks)

n.

Chronic constrictive pericarditis with ascites and enlargement of the liver. No longer in clinical use.

Pick's disease¹

Etymology: Arnold Pick, Czech neurologist, 1851-1924

a form of dementia that may occur in middle age. This disorder mainly affects the frontal and temporal lobes of the brain and characteristically produces slow disintegration of intellect, personality, and emotions and degeneration of cognitive abilities. See also dementia.

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Pick's disease²

Etymology: Friedel Pick, Czech physician, 1867-1926

constrictive inflammation of the mediastinum and pericardium, leading to chronic venous congestion and cirrhosis. Also called Pick's syndrome.

Pick's disease

Aphasia-agnosia-apraxia syndrome, Arnold Pick disease, Circumscribed brain atrophy, Lobar sclerosis Neurology A form of dementia characterized by a slowly progressive deterioration of social skills and changes in personality leading to impairment of intellect, memory, and language. See Presenile dementia. Cf Alzheimer's disease.

Pick's disease

Chronic constrictive PERICARDITIS. (Friedel Pick, 1867–1926, Polish ENT specialist).

Pick's disease,

n.pr See disease, Niemann-Pick.

Patient discussion about Pick's disease

Q. Can a low back pain start from picking up something from the oven? My mother has a low back pain. It started five days ago while she picked up a cake from the oven. the pain is always there, it bugs her while she sleeps and it excruciate while she is doing her regular physical activity. What can it be? should we go to our GP? Is there anything we can do to ease the pain except Tylenol? Just for the record my mom is 69 years old, and she has tuberculosis and a heart disease.

A. This is a case where your mom should have an examination by a professional. A chiropractor would be the specialist to deal with back pain and can make any appropriate referrals if necessary.

Q. I have a low back pain that radiates to my leg when i pick up stuff. Is it a disc herniation? I am a 43 years old bank teller. During the past 5 months I've suffered from a low back pain. The pain is not very strong, but it gets much worse while doing physical activity. When i walk or lift heavy things the pain is even stronger, and it radiates to my left leg. Can it be signs for disc herniation?

A. It's possible that you have a nerve impingement from a disc herniation, but not necessarily so. What you need to know is that even if you have a herniated disc, the question is what would the recommended treatment be?
90% or more of herniated discs resolve without surgical treatment within 6 months. MRI imaging is generally only indicated if one is considering surgery; in other words, your pain and neurological status is such that surgery is clinically indicated. Then, an MRI may be helpful for the surgeon. If surgery is not indicated based on clinical/symptoms, then it probably is unwise to get an MRI. They often show abnormalities that are simply 'red herrings' and often prompt people to proceed with surgery that really is not needed. Beware!