Differences Between Pick Disease and Alzheimer Disease in Clinical Appearance and Rate of Cognitive Decline

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Abstract
IN 1892, Arnold Pick, a professor of psychiatry at the University of Prague, provided the first description of the clinical and gross pathological features of a dementing illness that now bears his name. Pick observed a 71-year-old man with a history of dementia lasting 3 years. The associated features included prominent aphasia with many paraphasic errors. The autopsy disclosed prominent atrophy of the frontal and temporal lobes.1 Pick subsequently described other cases of dementia with cerebral atrophy localized to the temporal lobes2 and to the parietal and frontal lobes.3 Neither Pick nor his pathologist collaborator Chiari commented on the histological nature of the atrophy they observed, but several years later, Alzheimer described the histological characteristics of the disease as "spongy cortical wasting, ballooned cells, and argentophilic globes in neuronal cytoplasm."4(p383) Neurofibrillary tangles and senile plaques were notably absent. Gans5 and Onari and Spatz6 proposed the name Pick disease (PcD) for this neuropathological entity. According to a new proposed classification of focal cortical atrophies, PcD is now considered a subtype of a broad category of frontotemporal degeneration (FTD).7,8