Pick’s disease: clinicopathologic characterization of 21 cases

Parichita Choudhury, Eugene L. Scharf, Michael A. Paolini, Jonathan Graff-Radford, Eva C. Alden, Mary M. Machulda, David T. Jones, Julie A. Fields, Melissa E. Murray, Neill R. Graff-Radford, Eleni Constantopoulos, Ross R. Reichard, David S. Knopman, Joseph R. Duffy, Dennis W. Dickson, Joseph E. Parisi, Keith A. Josephs, Ronald C. Petersen, Bradley F. Boeve

Research output: Contribution to journalArticle

Abstract

Background: Pick’s disease (PiD) is a unique subtype of frontotemporal lobar degeneration characterized pathologically by aggregates of 3-Repeat tau. Few studies have examined the clinical variability and disease progression in PiD. We describe the clinical features, neuropsychological profiles and coexistent pathologies in 21 cases of autopsy-confirmed PiD. Methods: This study was a retrospective analysis of patients with Pick’s disease evaluated at Mayo Clinic, Rochester or Jacksonville (1995–2018), and identified through an existing database. Results: Twenty-one cases with sufficient clinical data were identified. Behavioral variant FTD (bvFTD; 12/21) was the most common phenotype, followed by primary progressive aphasia (PPA; 7/21), corticobasal syndrome (CBS; 1/21) and amnestic dementia (1/21). Median age at disease onset was 54 years, with PPA cases (median = 52 years) presenting earlier than bvFTD (median = 59). Median disease duration (onset–death) overall was 10 years and did not differ significantly between bvFTD (median = 9.5 years) and PPA (median = 13). Age at death was not significantly different in PPA (median = 66) compared to bvFTD (median = 68.5). A third of the cases (n = 7/21) demonstrated pure PiD pathology, while the remainder showed co-existent other pathologies including Alzheimer’s type (n = 6), cerebral amyloid angiopathy (n = 3), combined Alzheimer’s and amyloid angiopathy (n = 4), and Lewy body disease (n = 1). Conclusions: Our study shows that bvFTD and PPA are the most common clinical phenotypes associated with PiD, although rare presentations such as CBS were also seen. Coexisting non-Pick’s pathology was also present in many cases. Our study highlights the clinical and pathologic heterogeneity in PiD.

Original languageEnglish (US)
JournalJournal of Neurology
DOIs
StateAccepted/In press - 2020

Keywords

  • Frontotemporal dementia
  • Pick’s disease
  • Primary progressive aphasia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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