DEDICATION

I dedicate this book to my three daughters, Paula, Peggy and Pam, who have always encouraged their mother to "go for it" in any endeavor that I have embarked upon. To my sister Ernestine, who was more than a sister during the growing up years, being also caregiver to us all. And to the women of all generations who find themselves for one reason or another in the struggle of providing and supporting a family alone, fighting prejuidice, hardship and other life uncertainties while still making a difference both in their family and the world. God bless you all.

CHAPTER 1

Julia Ann was born July 5, 1910 in Jackson County Arkansas to Walter and Mary Lou Anner Rebecca Bradley Block. She was welcomed into the world by an older brother, William Alexander Block.

Life was very hectic for all the family, living on a farm where everyday was a struggle to grow enough food, harvest enough cotton to eke out a living for the family. Life for the other families who worked as share croppers for the big land baron was no different.

It seemed everyone born in the south was destined to have three names, families would name their children for friends and relatives whether it made snese or not. Julia's father Walter, however was different. He was called Babe until he was four years old, when his mother told him he had to have a Christian name. He told her he wanted to be called Walter and that was that. No middle name. No relative to be remembered. Just Walter.

Life continued in the way hard times of the early part of the 20th century. Julia Ann started school in a one room school house when she was 5 years old. During the winter, her dad would drive nails in their shoes so they could stay together and be able to walk the two miles to school. Julia Ann loved school and would cry when she had to stay home and care for smaller children while the harvest was gathered. By the time she was ten years of age, she was caring for five smaller siblings and cousins and cooking dinner for the family and field hands. The burden of work was great but she always wanted to help her mother (whom she called Mommy until the day she died). At the age of ten, Julia Ann had a stroke. The doctor told her mother she must have bedrest for a long period of time, but after two weeks, times being as they were and everyone having to pull their weight around the farm, Julia was back doing thee same thing, caring for the children, cooking, cleaning, etc. Life went and and Julia got in what schooling she could. She finished the eighth grade. She was so excited because a cousin had agreed to let her stay with her in town and go to high school...she would only need to furnish her books and clothing. "Mommy" was at first agreeable to this arrangement, even though it was thought not necessary for girls to have higher education because they were expected to marry, raised children, keep house and help in the fields.

Julia was ready to leave the house with such high hopes for higher learning. When her cousin came for her, her mother made the statement that set Julia Ann on a path of determination and a goal of seeking knowledge for the rest of her life, :You're not going." Hardly believing her ears, Julia fought back the tears. She was going to be denied her one chance for education. Her mother told her she was needed at home more than she needed an education.

 Being the dutiful daughter, she unpacked her few clothes and returned to the never ending task of caring for the children, cooking for the family and hired hands, and cleaning...like all good girls were raised to do. But the desire to learn still burned like a molten ember that was forever being fanned to burn brightly for the rest of her days. She thirsted for knowledge and adventure.

During the 1920s, times were still hard for everyone...especially living in rural Arkansas. Each week Julia Ann would take a list from each family in the community for the groceries and supplies needed from town. She would put the kids she cared for in the Model T truck and head for Newport to fill the orders (which was a full day's activity).

One particular day, she was doing what had to be done to start the truck: jack up the back wheel, run to the front and crank the truck. When it started, she ran to remove the jack from the back wheel, jumped into the driver's seat and hoped it didn't "die" before she could get in. That was the "system." But today, the truck started, jumped off the jack, knocked Julia down, skinned her leg and took of on its own...the kids giggling and having a great time. It only stopped when it ran  into a pile of stumps which were to be burned. Julia was furious, skinned knee and all.  And to make matters worse, her step dad Shelby was standing on the porch laughing his head off at the spectacle. (Julia told family members years later, if she'd had a weapon she'd have used it on her step father. She always laughed when she told that story)!  She got into the truck after getting everyone out and helping push the truck off the stump pile and headed for town to complete her task of securing the necessities of life to survive.

Julia's Granny Block (her dad's mother), lived with them and was always telling them stories of her earlier married life to the grandfather Nicholas. She was a fiesty and sometimes mean woman. She liked Julias brother Willie but didn't like Julia, stating that she looked too much like on of Anner's sisters...which, in those days, meant you were liked or disliked by whom you looked like. Granny would allow Willie to come into her room and feed him candy while Julia stood at the door and sobbed. Later, Willie would come out and announce to all the kids what flavors he had.

Granny Block did have some "wild" stories. She and Nicholas set up housekeeping in a little house among the trees and raised a handful of children. During their married lives, Nicholas would, as many men in the community did at the time, frequent the local "road house" (with the reputation that went with it). One fateful night, Granny Block had had enough of being alone with the kids and surmising where Nicholas was, she reached for the pistol, walked to the "road house" and ordered Nicholas to "Come out, blast ya!" He refused, she insisted so she told him she was going to start blasting through the door if he didn't "show" himself. So the other men (probably not wanting to be identified) made Nicholas leave and Granny (all five feet of her) marched him the long way home with the gun nestled in the middle of his back. Theirs was a very tumultuous union. She also told of the time they got into an argument at the supper table and she threw a fork and it stuck in Nick's nose. They then proceeded to break all the dishes by throwing them at each other until they had none left. They then had to go to town the next day and buy dishes before another meal could be eaten.

They separated for a long time, people didn't divorce much in those days. But then Nicholas got really ill and asked Granny to come and take care of him. She relented and did just that and she stayed with Grandpa Nicholas until his death some years later. Although great turbulence during their married life, there was enough love and companionship to bridge the gap in the end.

CHAPTER 2

Entertainment on the farm in the 20s and 30s was what people made it. They would get together as families do, brothers, sisters, aunts, uncles, cousins and lots of friends. All lived fairly close and a part of the community, when a minister was circuit riding through, they would go to church and some Sundays, have dinner on the grounds. Plenty of fried chicken, potato salad (Arkansas style) watermelon in season and crazy games the kids played...lots of "boys aggravating the girls". The young boys would chase the girls with frogs and other "creepy" things to scare them. The older boys being very shy for the most part trying to put three words together to say to the girls and being brave enough to hold her hand sometimes. These activitites were few and far between given the hard work load all of them had...including the children.

They would also go house to house (the grown ups) sometimes for a good old fashioned "hoedown" (dance). It was a good time for all until the one time at Julia's house (who was hosting the dance that night) two brothers showed up (known by all but not liked by many) with a little too much "store bought and homemade spirits and decided to pick a fight with Julia's brother Willie. (All the furniture and rug ( if they had one) had been moved or rolled up against the walls. They both jumped on Willie. That was the wrong thing to do. Mother Anner grabbed one of the brothers by the back of his collar and threw him across the room. He landed on the bed, bounced off and ended up behind it on the floor. The she used her fist to land a good lick across the nose of the other brother. They decided they had better rethink the idea of beating on Willie when "Miss Anner" was his mother. Julia developed the same fighting spirit when it came to protecting her children.

Time went on and more babies were born, more hired hands to eed and cook for and Julia was busy doing for the family and at times working in the fields also. Summertime was harvestime for a good part of the garden produce, jars had to be washed, in the #3 galvanized wash tub, then rinsed, sterilized by boiling in hot water on the wood stove. Then everyone including the children had a hand in preparing the food needed for the winter. These were the days before refrigeration or cooling of any kind had reached rural areas and farms, so nothing was left to chance. There were all kinds of beans and peas to preserve, tomatoes, juice and sauces. Homemade hominy, cabbage was made and stored in large crock jars to ferment a couple of weeks to make sauerkraut. Whatever could be preserved would be including meats...Anner would fry the meat or pickle some of it then put in jars or pressure it in a large pressure cooker that built pressure to different pound amounts depending on the need. IT was hot, hard work but a fried sausage patty on a cold winter morning sure tasted good. There were a lot of mouths to feed and anyone was down on their luck, they knew they could get food or a meal at the "Block" home of "Mrs. Anner."

Mother Anner also did midwifing during these early days and continued to do so into the late 40s and early 50s. One year she delivered 52 babies...an average of one per week. If they needed help, she was there. During her tenure as a midwife only two babies died and those due to disease. She very seldom got paid and if she did, it could be a couple of chickens, a pig or whatever the people had to give. Mostly it was a thank you and Anner was content to know she had brought another life into the world successfully. There were good times, bad times, and often harsh times but always the family loved and cared for each other to the best of their abilities. Always extended family members were present, it may be step children, cousins, friends, who for whatever reason  had no place else to go. So they stayed in the home of Julia and her family.

Julia met Robert Raymond Henderson and they wre married in 1928. Julia was 18 years old which by Arkansas standareds was old. She was now in her own home but the challenges were the same. The work still hard. Robert was a day laborer and share cropper, so money was nearly non-existent. But they were happy. There were all kinds of people moving in and out of the area. And one in particular, a woman with a somewhat colorful reputation decided she didn't want her five year old daughter Minnie anymore. She was going away and wanted to give Minnie to Julia and Robert so being the compassionate woman she was, Julia took her in and loved and cared for her until she married at the early age of 16. By then the Henderson family was growing: Celia, Ernestine, Alexander and later Mary Lou and Willistine. Celia only lived to be fourteen months old. Life expectancy of children in those days wasn't very long. And for as long as Julia lived, the hold in her heart for the child she lost never completely healed.

About ten years into her marriage, Julia realized Robert had become very ill. Loss of memory, inflammatory rheumatism had troubled him in earlier years, but this illness was something different. Strange behavior...never hostility, Robert was always a kind, sweet, loving man, who loved his family. He was admitted to a rehabilitation hospital in Little Rock for the mentally disturbed where he spent years being treated in and out of the facility. This was while World War 2 was taking its toll on everyone and the best doctors and equipment were shipped to the war effort. Treatment for Robert was not very effective...and that was not all the troubles that Julia had to encounter. People can be so cruel, even when they are loving and close family friends and relatives. She found herself having to protect and defend her children from the ignorance and hurtfulness of people who were saying that Robert was insane and his children would be also. So little was known at the time about "mental illness", counseling and rehabilitation. People do not tolerate what they do not understand. And in their ignorance and misunderstanding they can intentionally or unintentionally cause a moutain of hurt to others. They are to be pitied more than blamed for just stating what had been brought on by generations of intolerance  that only God can remedy.

It was a sad and heartbreaking time to see Robert fall deeper and deeper into the abyss of not remembering the ones he had loved the most and in 1946 at the age of 38 years, Robert passed away, leaving Julia alone to raise her four children amid the turmoil of prejudice and suspicion that surrounded alleged "mental illness" she knew she would see Robert again in heaven where no one's hateful, hurtful words would cause such grief. All would be well. Then. She also knew she was now on her own to make a living and raise her family with only an eight grade education in a world that had just not recognized the worth of a woman in the workplace. World war 2 was a fine example of this. She knew that the God of her youth would guide her now into the unknown territory of forging ahead to sustain her family which was never an easy task in the rural 1940s.

CHAPTER 3

Julia decided she could better provide for her family by moving to Newport which was a small town of a few thousand and very close to the airbase. She found work in a dry cleaning business working for $15 per week, 10 hours per day. Living inE.Newport she had to walk a couple of miles each way to work since bus transportation was almost non-existent at the time. There was no money to buy a ticket anyway.

 Home was a converted garage of two small rooms with a concrete floor with cracks which allowed roaches and waterbugs to play at night. But Ernestine, the oldest child was the caregiver and took over the home while Julia worked. It's furnishings were sparse, two beds and a cot, a couch and chair and an old radio that was the family's lifeline to the outside world. Kitchen was a stove, table and chairs and an old sink with a cold water spigot. The outhouse was just that (out) which was hardly ever emptied and when this happened Mary Lou and Willistine would go to the landlady's to use her indoor facilities but she didn't like it very much telling them she didn't like trash in her house. This hurt deeply both Mary Lou and Willistine and aded more fuel to the fire that Willistine wrestled with most of her life. Feelings that made her feel like she was afflicted with the same affliction as her father. It only made Mary Lou feel more insecure but more determined that she WAS NOT afflicted like her father. It put a desire in her heart to get as much education to learn about "insanity" and see why everyone treated her father as they did.

Julia made the little house a home of love and caring even though it was of a very humble presence. We were loved and it was loved by her family. Work was very hard. Standing on her feet for 10 hours daily and a dry cleaning press on concrete floors. After several months Julia became very ill, she had always been a very thin person but it had never stopped her from her appointed tasks.  The children had a hard time fitting in to the "city school" once again the old prejudice arose. Not about mental illness but in the fact the children were very shabbily dressed because there was no money for the extra clothes. It took everything for food, rent and utilitites even though Julia had gotten a raise, she was making $18 per week. Mary Lou was having a difficult time. Being very introverted and easily intimidated...having no self esteem but she had a kind and loving teacher named Mrs. Nance who took her under her wing and helped her. Julia was determined that her children should and would do better in life than she had been allowed to do. She knew God would help her accomplish this, and she in turn would never give up trying to further her education. Not by book learning alone but living life in whatever situation she found herself in.

The city was a difficult, alien world to a woman having to make a living for her family, but Julia always took time to help someone else in need. She always said, "We may not have much but we can share what we have." Most families were struggling to make a living also during the depression. Many people walked by her house and if they stopped she fave them food such as she had and offered the screened porch for shelter to the moether and small children. The father and older boys would camp in the woods nearby. Julias family never was never prosperous in material things, but they were prosperous in a mothers love and never really went hungry. She always asked the Lord for provision when there would be nothing in the house to eat, and this was quite often...especially living in the city having no garden to provide food. The Lord always made a way and food would arrive maybe at the eleventh hour but God never failed to provide.

Julia didn't recover from her illness sufficiently to return to the drycleaning job so she packed up her family and moved to the country into a tiny town for a while and worked in a grocery/drygoods/post office store for 35 cents an hour. This started another chapter in her life and her quest for knowledge. She was very good working with the books and charge tickets in the store and dealing with the people. Most everyone had a running tab at the "we sell everything" store and she gained a new spirit and independence and enjoyed working there for quite a long time.


She had rented a three room house for $5 per month. No inside plumbing whatsoever. Heated by woodstove but the family was happy there. During our stay there her oldest daughter Ernestine was married and moved away so the kids were on their own before and after school. The girls stayed with Grandma Anner during the summer while Julia worked. She also taught herself to play piano, organ and violin (in the country it was called a "fiddle.") She enjoyed this very much and she and the children would sing hymns and when other families came for a meal, Julia would retire to the living room and play her fiddle while the others ate. It was a happy yet hard time for her.

After a few years in "town" Julia was given the oportunity to move to a farm to care for a number of cattle in return for a place to live and have a beef to butcher and raise chickens, hogs and a garden to sustain her family. Everyone was excited about this except her son Alexander. He didn't want to leave "town" but he was old enough to join the Armed Services so he did just that and at 17 years of age joined the navy. So Julia was left with Mary Lou who was 12 and Willistine who was 9. So the three musketeers moved to the farm which was owned by a kindly old gentleman who was very good to all of them and cared for them but for easons only known to him, marriage was never part of the package. Even tho he and Julia loved each other and he was the father image that Mary Lou and Willistine had never had since their father passed away at such an early age.

Julia worked the farm for several years, the whole family pitching in to do the work. But it was very hard work and her health again started to fail. She had just lost her mother Anner, and she knew her mothers house was for sale after her stepfather decided he would no longer live there, so the old gentleman farmer bought the house or Julia and her two girls and they moved to another small town called Grubbs. Not much of a town but several close relatives lived there and Willistine enrolledi n school and life was tolerable. Mary Lous was working but the work available was not steady so she decided she woulde move to Illinois to stay with her older sister Ernestine. Julia tried to talk her out of it, not wanting the 3 musketeers to break apart, but she finally relented and wished her well. Mary Lou found work and also the man she would marry, produce three daughters and 33 years of love and happiness before death parted them.

Willistine graduated from high school and went to Memphis to attend business college so Julia had to make a decision at this time and not wanting her last child to go out into the world alone, she decided to sell her home and moved with Willistine. After  graduating from business college, Willistine met a man from Mississippi and they were soon married. This left Julia all alone in a big city for the first time in her life and she was frightened to death. She was now a woman in her 50s with no formal education and only limited means. She found herself not knowing what to do, she moved back to Arkanses to be near her sisters and brother and existed on whatever work she could get, helping out families when needed.

She met a man whom she had known as a young lady. He offered (she thought) security and a home so without means to have either she agreed to marry him. This turned out to be a disaster and they were soon divorced. Still feeling frightened with no means of support and her health and age against her, she met another man. She had known both he and his now deceased wife, so they were married and he wanted someone like his first wife to wait on him and Julia being the independent person had no liking for this so ater a few months...maybe a year, Julia found herself divorced again and on her own. Again. Once more she was back into a pattern of finding work when she could, visiting children and family, helping when new babies came along, doing what she could to make a living.

Years went by and Julia met a man who was several years her junio and fell in love with him and he cared for her also. They were married and were happy for several years but the age gap and interfering friends and family eventually drove  a wedge so wide they could not bridge it, and eventually they too divorced. Now alone again and still with no home, Julia found herself again by searching for roots in her family and coming totally back to the God of her younger life who had never left her when she lost her way. She was always helping people, staying with children, adults, whoever needed her and growing strong in her reslove, love and dependence on the Lord. However, there came a time when Julia felt the need to be near her older girls and to seek out a better, easier way of life than the country atmosphere afforded her.

CHAPTER 4

Julia moved to Illinois and became a God-send to her daughter Mary Lou in taking care of a new baby girl, Pamela, who became the joy of her life. She did this for several years, and when Mary Lou and her husband Ken moved further east, she had gotten an apartment of her own when Pam started school. She moved to the small town also and stayed in a mobile home on her older daughter's property. Julia had also sometime before received news of her son Alexander. He had been afflicted with the same disease as his father and his father's brothers and sisters. Needless to say, Julia and the daughters were heartbroken but they knew their strength lay in the Lord. After five years of illness and having to be put in a nursing home, the Lord was merciful and took Alexander home without too much pain. While Julia was sad at losing her son, she knew he would never have to face the indignity of people saying behind his back that he was insane. Which was still a very hurtful image in her mind.

But life went on. After the creek by her home flooded for the last time, Julia decided to move into an apartment in town and she did. She made friends very easily and was soon very active at the Senior Center and everyone knew she was a farm girl at heart and would bring extra produce to her for preserving which she shared with anyone in need. She traveled by bus thousands of miles in her lifetime and never came away from a trip without one or 2 pen pals with which to correspond. This was her way of witnessing for the Lord as she didn't have a vehicle and witness she did to everyone she met. She was always trying new things, would ride roller coasters with the grand kids, grew giant sunflowers that produced so many seeds she is in the Guinness book of World Records.

 She would make her own clothes and sew for others, quilted quilts, loved garage sales, read continuously anything and everything. She never stopped learning, and finding new adventures. Sometimes it may have been a simple thing but it was adventure to her. She won horse shoe throwing tournaments. It never occurred to her that she couldn't do what she set her mind to but through it all she kept on reaching out to people in anyway she could. Baking for church bake sales, hemming pants and shirts for her son in law, picking berries which recalls a funny incident: Julia was picking blackberries and she heard a humming noise and couldn't locate it until she glanced down at her overalls she had slipped on over her dress. She was covered with yellow jackets. She said her first thought was to run, but keeping a level head she quietly unsnapped the overalls and let them all gently to the ground and stepped out of them, then picked up her berries and ran. She would tackle anything, several of the places that she moved hand no outside toilet. she would take the saw, go to the woods, cut down and haul logs back, split them, build a 2 holer" toilet which was the basic for the family. She did this three times during the times she moved. Julia lived after the days of pioneering women, but in a sense when was as much a pioneer as they because he had to break new ground, combat prejudice, and struggle to make a decent living and home for her family. Julia continued to thrive and live among her family and friends or several years. Visiting her other children and helping anyone in need.

She may never have had much in worldly good but she was a very rich woman and a woman as her daughters has admired and tried to emulate all her life. She overcame obstacles that no ordinary person could have accomplished she spread the good news through her correspondence and her presence wherever she went, and left a legacy of love and warmth that is still felt by her family now into the fourth generation and her presence is still felt and so sorely missed.

Her ever inspiring spirit lives on in her grandchildren and her children, by world standards when was but a pin dot in the universe but in the memories of her friends and children she had a presence that was larger than the tallest oak and as deep as the depths of the ocean.

Julia always had stories to tell of moving days of which she became quite the expert after having moved 34 times in the 17 years of marriage to Robert who was part Cherokee Indian. He had a wandering spirit and wanted to move often, never more than 100 miles in any direction.

 She told of the many times of moving her flock of chickens, they were so used to it when they saw her coming with a coop they laid on their side and crossed their legs to be tied for transport. She lived in houses that had no ceiling and one day her son Alexander was climbing to the rafters looking for the bird eggs and she had just ordered him down and he jumped to the bed and as he got off a black snake fell on the bed also...he too had been looking for bird eggs. Never was a house painted...she lived in log houses with heat for the second floor coming off the stove pipe that ran from the first floor to the second then through the roof. Hunters always made their way to the Henderson house and at 4 a.m. in the morning Julia could be found making breakfast for whoever stopped by.

Later, Julia would learn to hunt ducks, geese and squirrels herself to help fill the larder for her family. She lived through two world wars, the time of ration stamps, saccharin, no coffee, doing without, riding buses as an only means of transportation and through it all good times and bad, she never lost her love for helping people or her sense of humor. She left a legacy of Christian love and compassion for all who knew her. She lives in the lives of her children, grandchildren, and great grandchildren who will keep her pioneering and need-to-know spirit both in learning and striving to new heights. Alive in whatever their undertaking and horizons they cross.

Julia Ann left this world for her heavenly home June 9, 1987 at 76 years of age. When the daughter were going through the few material things of her life, Mary Lou found her correspondence box which was an old stationary box and in it were 21 letters of "pen pals" she corresponded with on a regular basis. She could write a ten-twelve page letter with hardly any effort. So, taking pen in hand, Mary Lou set about the task of answering them and informing them of Julian's passing. She touched so many lives. A little part of Julia lives on in us all.

EPILOGUE

Any form of memory loss illness for so many years was very much misunderstood. It was learned over the years that all the men in the Henderson family had died before the age of 50...so whatever the disease afflicting the family was thought to only effect the male members of the family, although Robert's mother died when he was  4 and her sister Thima  at age 38. Life expectancies were not then what they are now. 

Some of the cousins started to inquire if any of the females of the family had experienced symptoms, (several other male cousins had died from the disease already) because another child, this time a female, was experiencing the same illness. This branch of the family lived in Michigan and from there it became an intense study by the University of Michigan to make a correct diagnosis.

In the meantime, Alexander's children had become victim to the illness and Mike, the eldest had died. Then Chris was diagnosed while in the armed forces and was given a mental discharge because he couldn't remember what needed to be done. He was experiencing other symptoms as well. After all these years society still had not learned to be tolerant or understanding of so called "mental illness." Robin, the daughter was diagnosed and later died. Then Chris passed away and the only child left in Alexander's family was Rick. He lost his claim on life in 2002. So now, all of Alexander's children are gone due to this mysterious illness.  However, some good came from all of it for the children of the future.The study by the University of Michigan believed they had pinpointed the illness but there was no cure. None of the children of the three daughters of Robert had any symptoms of the disease and none of their children. Unfortunately, Alexander's five grandchildren have only a 50/50 chance of survival. Research is now being done on a priority basis so there may be hope for them. We pray to God it is soon. Chris's service benefits were restored to him before he passed away, and he was given an honorable discharge. Alexander's wife Blanch still lives in Newport near the grandchildren and her family. I'm thankful Julian Ann did not have to see the death of her grandchildren as it was a tremendous loss to us all but God is good and gives us strength to weather the storms of life...

 Another of Julia's daughters, Willistine lost her life not due to the disease that had devastated the family but from ALS (Lou Gehrig's disease) She fought a gallant fight leaving just the two sisters who carried on the principles and faith of their mother who had the resolve to carry on no matter what. 

If Julia were still here she would be urging her family froward to live their lives, love their families, reach out to others, live for God and never, never stop seeking knowledge and striving for all you can be...because you are "never too old to learn."

The disease spoken of was discovered to have been passed down through Robert's mother, who died at age 38. The name is Pick's Disease and is fatal to young adults. No one knows the cause.(see Appendix for more information)

Lizzie Mary Lou, the daughter who wrote this memoir, died of a massive heart attack on August 10, 2003. She died with her hair freshly done at the salon, her suitcase packed (she was to leave for a trip to the Dakotas with her oldest daughter) and her house clean, looking forward to another adventure.

Lizzie Mary Lou shares her final, eternal adventure with Ken, her husband, Julia Ann, her dad Robert, her brother Alexander, and all in the family who have gone before.

APPENDIX: PICKS DISEASE

What is Pick's Disease

Pick's disease is a relatively rare, degenerative brain illness that causes dementia. The first description of the disease was published in 1892 by Arnold Pick. Until recently it was thought that Pick's disease could not be distinguished from Alzheimer's disease during life. Consequently, it has been little studied, and much less is known about it than about Alzheimer's disease.

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.

The diagnosis of Pick's disease is difficult during life, because its symptoms are so variable and because they overlap so much with Alzheimer's disease. A CT or MRI scan may show a pattern of atrophy that suggests Pick's disease, and neuropsychological testing may be helpful. In our experience, the experimental brain scanning techniques with PET and SPECT can be revelatory. However, it is very hard to be certain even with an extensive evaluation; Alzheimer's disease can produce the symptoms described above, and Pick's disease may produce symptoms typical of Alzheimer's disease. In all cases, it is critical to obtain a good evaluation in order to rule out treatable conditions that can cause these symptoms.

Unfortunately, neither the cause nor cure for Pick's disease is known. A few studies suggest that Pick's disease may have a genetic component, but most family members are unaffected. Other risk factors are unknown. The treatment of the disease is essentially the same as that of Alzheimer's disease; supervision and assistance for the patient aimed at maximizing his or her quality of life, medications to manage particular symptoms, and emotional and substantive support for the caregiver. The Alzheimer's Association and its network of support groups are an excellent source of help in facing this difficult illness.

 
Bruce R. Reed, Ph.D., Chief Neuropsychologist
Northern California Alzheimer's Disease Center
3/95 - from the Alzheimer's Association