Skip to main content
SpringerLink
Log in

Frontal lobe degeneration of non-Alzheimer type and Pick's atrophy: Lumping or splitting?

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

We report six cases of presenile (five) and senile (one) progressive dementia with a mild-to-marked frontal or frontotemporal atrophy and ventricular dilation (Frontal Lobe Degeneration [FLD]). The most prominent microscopic features were layer-dependet neuronal depletion of the cortex, spongiosis, and cortical and subcortical gliosis. Five cases showed additional degeneration of the S. nigra, and two also had motor neuron disease. Despite the absence of Pick cells and bodies, such cases have many features in common with Pick atrophy. Because Pick cells and bodies are inconstantly occurring features in other-wise typical cases of Pick atrophy, they cannot be regarded as inevitable markers of the latter. In our opinion, cases with mild frontal or frontotemporal atrophy as described herein and by others match the grades 1 and 2 in terms of Schneider's classification of Pick atrophy [37]. As long as the etiology of both Pick atrophy and the socalled FLD is unknown, and we finally have to follow morphological criteria for classification, there is apparently no convincing reason to introduce a separate category, such as FLD or FTA, for the cases with moderate or mild frontal atrophy and dementia of frontal lobe type, which can be sufficiently classified with the Pick spectrum of lobar atrophy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bagh K von (1941) Über anatomische Befunde bei 30 Fällen von umschriebener Atrophie der Großhirnrinde (Picksche Krankheit). Vorl Mitt Arch Psychiatr 114: 68–70

    Google Scholar 

  2. Becker E (1935) Klinische und anatomische Beiträge zur Pickschen Krankheit. Mschr Psychiatr 92: 107–121

    Google Scholar 

  3. Bergmann M, Kuchelmeister K, Gullotta F, Schmidt KW, Gerhard L, Schröder R (1994) Different variants of non-Alzheimer degenerative dementia: a morphological study. Clin Neuropathol 13: 235

    Google Scholar 

  4. Boller F, Forette F, Khachaturian Z, Poncet M, Christen Y (1992) Heterogeneity of Alzheimer's disease. In: Christen Y (ed) Research and perspectives in Alzheimer's disease. Springer, Berlin Heidelberg New York

    Google Scholar 

  5. Braunmühl A von (1930) Picksche Krankheit. In: Bumke O, Spielmeyer W (eds) Handbuch der Geisteskrankheiten, Bd XI, Teil VII, Die Anatomie der Psychosen. Springer, Berlin Heidelberg New York, pp 673–715

    Google Scholar 

  6. Brun A (1987) Frontal lobe degeneration of non-Alzheimer type. I. Neuropathology. Arch. Gerontol Geriatr 6: 193–208

    Google Scholar 

  7. Brun A (1993) Frontal lobe degeneration of non-Alzheimer type revisited. Dementia 4: 126–131

    Google Scholar 

  8. Constantinidis J, Richard J, Tissot R (1974) Pick's disease: histological and clinical correlations. Eur Neurol 11: 208–217

    Google Scholar 

  9. Filley CM, Kleinschmidt-DeMasters BK, Gross KF (1994) Non-Alzheimer fronto-temporal degenerative dementia. Clin Neuropathol 13: 109–116

    Google Scholar 

  10. Förstl H, Baldwin B (1994) Pick und die fokalen Hirnatrophien. Fortschr Neurol Psychiatr 62: 345–355

    Google Scholar 

  11. Förstl H, Hentschel F, Besthorn C, Geiger-Kabisch C, Sattel H, Schreiter-Gasser U, Bayerl JR, Schmitz F, Schmitt HP (1994) Frontal und temporal beginnende Hirnatrophie. Nervenarzt 65: 611–618

    Google Scholar 

  12. Gans A (1992) Betrachtungen über Art und Ausbreitung des krankhaften Prozesses in einem Fall von Pickscher Atrophie des Stirnhirns. Z Ges Neurol Psychiatr 80: 10–28

    Google Scholar 

  13. Gustafson L (1987) Frontal lobe degeneration of non-Alzheimer type. II. Clinical picture and differential diagnosis. Arch Gerontol Geriatr 6: 209–223

    Google Scholar 

  14. Gustafson L (1993) Clinical picture of frontal lobe degeneration of non-Alzheimer type. Dementia 4: 143–148

    Google Scholar 

  15. Hirano A, Kurland LT, Krooth RS, Lessell S (1961a) Parkinsonism-dementia complex an endemic disease on the island of Guam. I. Clinical features. Brain 84: 642–661

    Google Scholar 

  16. Hirano A, Malamud N, Kurland LT (1961b) Parkinsonism-dementia complex, an endemic disease on the island of Guam. II. Pathological features. Brain 84: 662–679

    Google Scholar 

  17. Hulette CM, Crain BJ (1992) Lobar atrophy without Pick bodies. Clin Neuropathol 11: 151–157

    Google Scholar 

  18. Jakob H (1979) Die Picksche Krankheit. In: Hippius H, Janzarik W, Müller C (eds) Monographien aus dem Gesamtgebiete der Psychiatrie, Bd 23, Springer, Berlin Heidelberg New York

    Google Scholar 

  19. Jellinger K, Bancher C (1994) Incidence of non-Alzheimer dementia in large consecutive autopsy series. Clin Neuropathol 13: 254

    Google Scholar 

  20. Knopman DS, Mastri AR, Frey WH, Sung JH, Rustan T (1990) Dementia lacking distinctive histologic features: a common non-Alzheimer degenerative dementia. Neurology 40: 251–256

    Google Scholar 

  21. Lüers Th, Spatz H (1957) Picksche Krankheit. In: Lubarsch O, Henke F, Rössle R, Scholz W (eds) Handbuch der speziellen pathologischen Anatomie und Histologie, Bd XIII/1A Springer Berlin Heidelberg New York, pp 614–715

    Google Scholar 

  22. Lynch T, Sano M, Marder KS, Bell KL, Foster NL, Defendini RF, Sima AAF, Keohane C, Nygaard TG, Falm S, Mayeux R, Rowland RL, Wilhelmsen KC (1994) Clinical characteristics of a family with chromosome 17-linked disinhibition-dementia-parkinsonism-amyotrophy complex. Neurology 44: 1878–1884

    Google Scholar 

  23. Mann DM, South PW (1993) The topographic distribution of brain atrophy in frontal lobe dementia. Acta Neuropathol 85: 334–340

    Google Scholar 

  24. Mesulam M-M (1982) Slowly progressive aphasia without generalized dementia. Ann Neurol 11: 592–598

    Google Scholar 

  25. Minauf M, Jellinger K (1969) Kombination von Amyotrophischer Lateralsklerose mit Pickscher Krankheit. Arch Psychiatr Nervenkrankh 212: 279–288

    Google Scholar 

  26. Neary D (1990) Dementia of frontal lobe type. J Am Geriat Soc 38: 71–72

    Google Scholar 

  27. Neary C (1991) Non-Alzheimer's disease forms of cerebral atrophy. J Neurol Neurosurg Psychiatry 53: 929–931

    Google Scholar 

  28. Neary D, Snowden JS, Northen B, Goulding P (1988) Dementia of frontal lobe type. J Neurol Neurosurg Psychiatry 51: 353–361

    Google Scholar 

  29. Neary D, Snowden JS, Mann DMA, Northen B, Goulding P, Macdermott N (1990) Frontal lobe dementia and motor neuron disease. J Neurol Neurosurg Psychiatry 53: 23–32

    Google Scholar 

  30. Neumann MA (1949) Pick's disease. J Neuropathol Exp Neurol 8: 255–282

    Google Scholar 

  31. Neumann MA, Cohn R (1967) Progressive subcortical gliosis. A rare form of presenile dementia. Brain 90: 405–418

    Google Scholar 

  32. Pick A (1892) Über die Beziehungen der senilen Hirnatrophie zur Aphasie. Prager Med Wschr 17: 165–167

    Google Scholar 

  33. Pick A (1901) Senile Hirnatrophie als Grundlage von Herderscheinungen. Wien Klin Wschr 14: 403–404

    Google Scholar 

  34. Pick A (1904) Zur Symptomatologie der linksseitigen Schläfenlappenatrophie. Mschr Psychiatr Neurol 16: 378–388

    Google Scholar 

  35. Pick A (1906) Über einen weiteren Symptomenkomplex im Rahmen der Dementia senilis, bedingt durch umschriebene stärkere Hirnatrophie (gemischte Apraxie). Mschr Psychiatr Neurol 19: 97–108

    Google Scholar 

  36. Schmitt HP, Emser W, Heimes Ch (1984) Familial occurrence of amyotrophic lateral sclerosis, parkinsonism, and dementia. Ann Neurol 16: 642–648

    Google Scholar 

  37. Schneider C (1927) Über Picksche Krankheit. Mschr Psychiatr 65: 230–275

    Google Scholar 

  38. Seitelberger F (1968) Allgemeine Neuropathologie der Alterns- und Aufbrauchskrankheiten des Gehirns. Verh Dtsch Ges Pathol 52: 32–61

    Google Scholar 

  39. Lund and Manchester Groups (1994) Clinical and neuropathological criteria for frontotemporal dementia. J Neurol Neurosurg Psychiatry 57: 416–418

    Google Scholar 

  40. Wechsler AF, Vesity MA, Rosenschein S, Fried J, Scheibel AB (1982) Pick's disease: a clinical computed tomographic and histologic study with Golgi impregnation observations. Arch Neurol 39: 287–290

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Neuropathologie, Universität Heidelberg, D-69198, Heidelberg, Germany

    H. P. Schmitt & Y. Yang

  2. Zentralinstitut für Seelische Gesundheit, D-68072, Mannheim

    H. Förstl

Authors
  1. H. P. Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Förstl
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

A part of this work has been sponsored by the German Research Foundation (DFG, SFB 258; project K2: Förstl-Beyreuther).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmitt, H.P., Yang, Y. & Förstl, H. Frontal lobe degeneration of non-Alzheimer type and Pick's atrophy: Lumping or splitting?. Eur Arch Psychiatry Clin Nuerosci 245, 299–305 (1995). https://doi.org/10.1007/BF02191871

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02191871

Key words

Search

Navigation