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 patients are hypersexual, and some, like a small child, may place anything they pick up in their mouths.
Gluttonous eating occurs in some cases.
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.