Exams and Tests

The only way to confirm the diagnosis of Pick disease is to look at the brain directly and to identify Pick bodies and swollen neurons. This is possible only if the brain is biopsied. This means taking a small sample of brain tissue for testing. This is done by a neurosurgeon, a surgeon who specializes in operating on the brain. The sample is examined under a microscope by a pathologist, a doctor who specializes in diagnosing diseases by looking at tissues in this way. The brain can also be examined in this way at autopsy, after a person’s death.

Biopsy offers a definite diagnosis while the person is still alive, and many people and their families are choosing to undergo this procedure. Without biopsy, the diagnosis in a living person is usually made on the basis of symptoms and ruling out other conditions. This is done by a combination of medical interview, physical and mental examinations, lab tests, imaging studies, and other tests. A doctor should discuss the potential risks and benefits of each approach with the patient and family.

The medical interview involves detailed questions about the symptoms and how they have changed over time. Your health care provider will also ask about medical and mental problems now and in the past, family medical problems, medications taken now and in the past, work and travel history, habits, and lifestyle.

A detailed physical examination is done to rule out medical problems that might cause dementia. The examination should include a mental status evaluation. This involves answering the examiner’s questions and following simple directions. In some cases, the health care provider will conduct neuropsychological testing or refer the person to a psychologist for such testing.

At any point in this process, your primary care provider may refer you to a specialist in brain disorders (neurologist or psychiatrist).

Neuropsychological testing

Neuropsychological testing is the most accurate method of pinpointing and documenting a person’s cognitive problems and strengths.

• This can help give a more accurate diagnosis of the problems and thus can help in treatment planning.
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• The testing involves answering questions and performing tasks that have been carefully prepared for this purpose. The test is given by a neurologist, psychologist, or other specially trained professional.
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• It addresses the individual’s appearance, mood, anxiety level, and experience of delusions or hallucinations.
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• It assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions.
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• Reasoning, abstract thinking, and problem solving also are tested.

Lab tests

These include blood tests to rule out infections, blood disorders, chemical abnormalities, hormonal disorders, and liver or kidney problems that could cause dementia symptoms.

Imaging studies

Brain scans cannot detect Pick disease specifically, but they can detect atrophy and other abnormalities in the frontal and temporal lobes. The scan also helps rule out other conditions that can cause dementia.

• MRI or CT scan of the brain
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• Single-photon emission computed tomography (SPECT) or positron-emission tomography (PET) scan: This scans are used in certain cases when the diagnosis is doubtful. They are especially good at detecting abnormal brain function. SPECT and PET scans are available only at some large medical centers.

Other tests

Any of these tests may be ordered as part of the evaluation of dementia.

• Electroencephalography (EEG) is a measurement of the electrical activity of the brain. It can be useful in some cases to rule out other conditions.
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• Spinal tap (lumbar puncture) is a method of obtaining a sample of cerebrospinal fluid. This may be done to rule out certain other brain conditions that can cause dementia.