Assessment of Eating Behavior Disturbance and Associated Neural Networks in Frontotemporal Dementia
Open accessAbstract
IMPORTANCE: Abnormal eating behaviors are common in patients with frontotemporal dementia (FTD), yet their exact prevalence, severity, and underlying biological mechanisms are not understood. OBJECTIVE: To define the severity of abnormal eating behavior and sucrose preference and their neural correlates in patients with behavioral variant FTD (bvFTD) and semantic dementia. DESIGN, SETTING, AND PARTICIPANTS: Forty-nine patients with dementia (19 with bvFTD, 15 with semantic dementia, and 15 with Alzheimer disease) were recruited, and their eating behavior was compared with that of 25 healthy controls. The study was conducted from November 1, 2013, through May 31, 2015, and data analyzed from June 1 to August 31, 2015. MAIN OUTCOMES AND MEASURES: Patients participated in an ad libitum breakfast test meal, and their total caloric intake and food preferences were measured. Changes in eating behavior were also measured using the Appetite and Eating Habits Questionnaire (APEHQ) and the Cambridge Behavioral Inventory (CBI). Sucrose preference was tested by measuring liking ratings of 3 desserts of varying sucrose content (A: 26%, B: 39%, C: 60%). Voxel-based morphometry analysis of whole-brain 3-T high-resolution brain magnetic resonance imaging was used to determine the gray matter density changes across groups and their relations to eating behaviors. RESULTS: Mean (SD) ages of patients in all 4 groups ranged from 62 (8.3) to 66 (8.4) years. At the ad libitum breakfast test meal, all patients with bvFTD had increased total caloric intake (mean, 1344 calories) compared with the Alzheimer disease (mean, 710 calories), semantic dementia (mean, 573 calories), and control groups (mean, 603 calories) (P < .001). Patients with bvFTD and semantic dementia had a strong sucrose preference compared with the other groups. Increased caloric intake correlated with atrophy in discrete neural networks that differed between patients with bvFTD and semantic dementia but included the cingulate cortices, thalami, and cerebellum in patients with bvFTD, with the addition of the orbitofrontal cortices and nucleus accumbens in patients with semantic dementia. A distributed network of neural correlates was associated with sucrose preference in patients with FTD. CONCLUSIONS AND RELEVANCE: Marked hyperphagia is restricted to bvFTD, present in all patients with this diagnosis, and supports its diagnostic value. Differing neural networks control eating behavior in patients with bvFTD and semantic dementia and are likely responsible for the differences seen, with a similar network controlling sucrose preference. These networks share structures that control cognitive-reward, autonomic, neuroendocrine, and visual modulation of eating behavior. Delineating the neural networks involved in mediating these changes in eating behavior may enable treatment of these features in patients with complex medical needs and aid in our understanding of structures that control eating behavior in patients with FTD and healthy individuals.
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Abnormal eating behaviours such as increased appetite and increased intake of sugar and carbohydrates are universal in FTLD patients and correlate with atrophy in discrete neural networks, suggesting dietary restriction may exert a positive effect.
“abnormal eating behaviours, such as increased appetite and increased intake of sugar and carbohydrates, are universal in FTLD patients and correlate with atrophy in discrete neural networks,498,499 suggesting that dietary restriction may exert a positive effect.”
From Antiageing strategy for neurodegenerative diseases: from mechanisms to clinical advances (2025) · cites this paper as [499]
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Anhedonia in Semantic Dementia—Exploring Right Hemispheric Contributions to the Loss of Pleasure
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“preference changes observed in bvFTD, where there is a marked preference for carbohydrates and sweets often accompanied by a profound gain in weight (Ahmed et al., 2016; Aiello, Silani, & Rumiati, 2016; Piguet, 2011).”
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Regional brain abnormalities in behavioral variant frontotemporal dementia: a meta-analysisPreprint
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- Authors
- Ahmed, R. M., Irish, M., Henning, E., Dermody, N., Bartley, L., Kiernan, M. C., Piguet, O., Farooqi, S., & Hodges, J. R.
- Affiliations
- The University of Sydney (AU)
- UNSW Sydney (AU)
- University of Cambridge (GB)
- Neuroscience Research Australia (AU)
- University of Cambridge Metabolic Research Laboratories and National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust–Medical Research Council Institute of Metabolic Science, Cambridge, United Kingdom
- Corresponding author
- Ahmed, Rebekah M.
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2016-03-01
- Volume
- 73
- Issue
- 3
- Pages
- 282
- ISSN
- 2168-6149 (ISSN-L)
- OpenAlex
- W2262227503
- Cited by
- 110
- References
- 55
- Citations by year
- 2026: 4 · 2025: 17 · 2024: 10 · 2023: 6 · 2022: 7 · 2021: 20 · 2020: 11 · 2019: 12 · 2018: 11 · 2017: 7 · 2016: 5
- FWCI
- 10.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Neurology (publishedVersion)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (acceptedVersion)
- Apollo
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Keywords
- frontotemporal dementia, behavioral variant frontotemporal dementia, semantic dementia, abnormal eating behavior, energy intake, sucrose preference, neural correlates, gray matter atrophy, cingulate cortex, thalamus, cerebellum, orbitofrontal cortex, nucleus accumbens, appetite, Alzheimer's disease, behavioral symptoms of dementia, voxel-based morphometry
- MeSH terms
- Aged, Alzheimer Disease, Feeding and Eating Disorders, Atrophy, Brain, Female, Humans, Male, Middle Aged, Nerve Net, Frontotemporal Dementia
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