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Pick's disease differs from Alzheimer's disease in several ways. First, the two diseases produce different abnormalities in the cells of the brain. Pick's disease is marked by "Pick bodies", rounded, microscopic structures found within affected cells. Neurons swell, taking on a "ballooned" appearance. Neither of these changes appears in Alzheimer's disease, and the pathology of Alzheimer's disease (plaques and tangles) is not found in Pick's disease. Secondly, Pick's disease is usually sharply confined to the front parts of the brain, particularly the frontal and anterior temporal lobes. This contrasts with Alzheimer's disease, which is more widely distributed. The two diseases also produce different neurochemical changes in the brain.

These basic differences between Alzheimer's disease and Pick's disease mean that the two tend to produce somewhat different symptoms. In contrast to Alzheimer's disease, in which early memory loss predominates, the first symptoms of Pick's disease are often personality change, and a decline in function at work and home. Personality change may take the form of apathy and indifference toward customary interests, or of disregard for social decorum and for the feelings of others. Poor social judgement, inappropriate sexual advances, or a coarse and jocular demeanor may be seen. Function declines because the patient simply does very little, or displays confusion and poor judgement. Patients may not be highly forgetful. Often times the patient performs well when directed to do something, but cannot undertake the very same thing independently. What is lost is the ability to initiate, organize, and follow through on even very simple plans and familiar activities.

As the illness advances, difficulties with language become common. Patients become unusually quiet, and when they do speak it may be slowly, in brief sentences. They may labor to make the sounds of words and their speech may sound distorted. Some become extremely apathetic -- they may sit for hours doing nothing at all unless prompted to do so by another, while others become extraordinarily restless, and may pace unceasingly. Some patients are hypersexual, and some, like a small child, may place anything they pick up in their mouths. Gluttonous eating occurs in some cases. Attention span is poor; patients seem to be distracted instantly by anything that they hear or see. Later in the disease, patients usually become mute. Restlessness gives way to profound apathy and the patient may not respond at all to the surrounding world. Eventually, they enter a terminal vegetative state.

Pick's disease usually begins after age 40 and is less common after age 60. It is a disease that invariably worsens. The average course is about 5 years, but it ranges from 2-15 years. It is rare, accounting for between 1% and 5% of dementia.