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The spectrum of imaging and neuropsychological findings in Pick's disease

Departments of Neurology and Psychology, University of Minnesota, Minneapolis, MN (D.S. Knopman, K.J. Christensen, L.J. Schut, and T. Ngo)
Geriatric Research, Education and Clinical Center, Minneapolis VA Hospital, Minneapolis, MN (K.J. Christensen and L.J. Schut)
Department of Surgery, Section of Neurosurgery, Dartmouth Medical School, Hanover, NH (R.E. Harbaugh and T. Reeder)
Departments of Psychiatry and Neurology, Ramsey Clinic/St. Paul-Ramsey Medical Center and University of Minnesota, Minneapolis, MN. (W. Frey, II)

To seek improved methods for the diagnosis of Pick's disease, we reviewed imaging studies of four women and two men (ages 48 to 65 years at onset) and psychometric testing of three of them with autopsy or biopsy-proved Pick's. The presence of Pick bodies was required for the diagnosis. Seven patients with biopsy-proved Alzheimer's disease served as a comparison group. In the Pick's patients, CT in five of six showed marked frontal pole or temporal pole atrophy, which clearly differed from the pattern of cerebral atrophy seen in the Alzheimer's patients. Psychometric testing showed performance patterns that tended to differ from those of the Alzheimer's patients in that recent memory was relatively preserved despite marked impairment of executive functions. The distinctive psychometric pattern in the Pick's patients was evanescent, however. Thus, there were imaging and psychometric findings of potential diagnostic value for Pick's disease, but, for different reasons, they were imperfect.

Address correspondence and reprint requests to Dr. Knopman, Department of Neurology, Box 295, University of Minnesota Hospitals, Minneapolis, MN 55455.

Dr. Harbaugh's work was supported in part by NIMH grant # R01 MH40505 and the American Health Assistance Foundation. The St. Paul-Ramsey Brain Bank is supported by Alzheimer's Disease Research, a program of the American Health Association Foundation, the State of Minnesota, and the Ramsey Foundation.

Presented in part at the fortieth annual meeting of the American Academy of Neurology, Cincinnati, OH, April 1988.

Received July 14, 1988. Accepted for publication in final form September 1, 1988.

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