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Psycology » Psychiatry and psychotherapy » Late-onset psychosis » Pick's disease

ContentPsychosis later age:
- Presenile (involution) psychoses atrophic brain diseases: - Senile dementia of Alzheimer's type - Alzheimer's Disease - Pick's disease - Parkinson's disease and Huntington's chorea borderline disorders in later life

A. The peak in 1892 described cases of senile dementia with increased atrophic process, mainly in the frontal and temporal lobes. These observations then led Alzheimer A., ​​E. Altman, X. Lipman and others (1892-1908).

The assumption that the described A. Peak cases are independent in relation to nosological form, first expressed X. Richter (1918). Confirmation of Pick's disease nosology independence was held in the 20-ies of XX century postmortem studies, which revealed a number of significant morphological features of this disease, namely essentially local atrophic changes in contrast to the typical histological changes in Alzheimer's disease. X. Spatz (1926) identifies the following morphological characteristics:

limited atrophic changes, mainly in the frontal and temporal lobes, in their "core areas";

Loss of all the elements of the nervous tissue, especially in the upper layers of the cortex;

absence or slight degree of vascular changes;

no signs of inflammation and senile plaques or neurofibrillary changes in Alzheimer's;

frequent finding of globular argentophile intracellular formations and swollen cells;

atrophic changes, often passing on the subcortical region.

Later gained recognition extended X. Spatz (1938), the concept of belonging to Pick's disease so called system atrophy. Atrophic process is usually split into separate areas of the brain unevenly begins in typical segments called centers wrinkling, atrophy (VA Giljarovsky, 1932).

Clinic. Debut at age 45 - 50 years. In the early stages of Pick's disease for a relatively long time coming to the fore deep personality changes and signs of easing the most difficult types of intellectual activity. An initial manifestation of dementia less concern "instrumental" functions ("preconditions") intelligence - memory, memory, attention, perceptual knowledge. At the beginning of dementia little affected automated forms of intellectual activity (eg, count). Because of these features of dementia with little or no limited patients' ability to navigate in their usual or even new simple setting. Affected the most differentiated and complex personal relationships and attitudes; primarily marked change in the character of patients. Yet along with this gradually declining productivity and flexibility of thinking, the ability to comprehension and critical evaluation of new, more complex situations, to judgments and consistent conclusions, generalizations, other mental operations. Unlike Alzheimer's disease, Pick's disease cases in the process of developing dementia intelligence affected as if the "top" in a characteristic sequence - from the more complex, subtle and differentiated forms of intellectual activity to a more simple and automated.

Personality changes appear quite typical signs. In one embodiment, disinhibition prevails to release drives expressed geperseksualnostyu that can lead to delinquency. Patients gradually developing disappearance marked sense of distance, stroke, shame, old moral principles, the prevalence of inadequate euphoria, sometimes expansive or impulsivity along with a sharp decline of criticism. Such a pattern of personal changes in the presence of dementia is usually defined as psevdoparalitichesky symptom, which are observed in the structure of gross violations of conceptual thinking (impaired ability to synthesize, inability to explain proverbs and determine the difference and similarity). Feature is the absence of the clinical picture with the disorders of memory and orientation.

Another option is determined by the prevalence of personality disorders apathy, lethargy, aspontannost, buildup of indifference, inaction, emotional staling. In parallel there is scarcity of speech, thinking and motor functions.

Celebrated the particularities of personality disorders on the preferential localization of primary atrophic process: primary atrophy centers are located either on the protuberances of the frontal lobes (lethargy, apathy, inactivity) or in frontal and orbitelnyh all zones or "basal neocortex" (disinhibition, euphoria, carelessness, psevdoparalitichesky syndrome ). History of these patients can learn that they have reduced the effectiveness of the work, they are less productive, carelessly and negligently starting to take its responsibilities, start business without showing any concern in this regard, become sleepy, lethargic, apathetic, or, conversely, excitable, mindless fun, activities, but ridiculous, foolish, insensitive, selfish, callous. Such behaviors may cause others the impression that patients reduced the memory that they are "forgetful", "scattered". Indeed, patients with active attention instability, reduced. The directed study of memory in such cases detected relative safety of its reserves. Patients better remember the simple facts related primarily to themselves, to the events that are not relevant to them, they are of interest, as a rule, do not show. Often intact and stock previously acquired knowledge, but interest is usually lost. In many cases, Pick's disease refers to "the apparent loss of memory."

Pretty long the consciousness or feeling time sequence (hronognoziya), patients know that recently, which may be in the near future. Such a possibility is known as "anticipate" future features of these patients suffering from Alzheimer's disease. With an increase of progression become more visible manifestations of dementia, reduced intellectual performance and the level of intellectual activity, and finally affects all kinds of memory.

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