What EEG findings are characteristic of Pick disease?

Updated: Oct 09, 2019
  • Author: Eli S Neiman, DO, FACN; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Answer

Pick disease, which is a frontotemporal dementia, is much less common than AD. The age of onset is earlier than that of AD. The EEG is less abnormal than in AD, especially in the early stages. Posterior alpha rhythm is more preserved. Theta and delta are increased. Frequency analysis may demonstrate a difference at a time when simple visual reading may not pick up a clear abnormality. The major feature of Pick disease is a decline in judgment and insight with relative early preservation of memory.

Because EEG correlates poorly with the clinical symptoms, impressive EEG changes are not observed in this condition. Blood flow measurements correlate with thinking processes; Ingvar demonstrated these changes in 1977. [23] Stigsby demonstrated a decrease in anterior blood flow in patients with Pick disease. [6] Because the anterior cholinergic system is relatively preserved in Pick disease, the EEG changes are not prominent frontally.

Gemignani et al studied sleep in Pick disease with a longitudinal polysomnographic and fluorodeoxyglucose positron emission tomography (FDG-PET) study, [24] documenting sleep fragmentation, short rapid-eye-movement (REM) latency, and a severe reduction of slow wave sleep, with relatively preserved non-REM (NREM)-REM sleep cycles. PET scan revealed severe cerebral glucose metabolic reductions in the frontal and temporal areas.

Postmortem study showed severe neuronal loss, spongiosis, and gliosis most marked in cortical layers I, II, V, and VI. [24] In vivo, neurometabolic and postmortem neuropathologic data are consistent with and indicative of a severe dysfunction of intra- and transhemispheric regional connectivity and of corticothalamic circuits. These findings suggest that the decreased cortical and subcortical connectivity may have been the main pathophysiologic mechanism responsible for delta sleep reduction and the cognitive decline.


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