From: hounddog23x@gmail.com   
      
   Eating More Carbs May Signal Frontotemporal Dementia   
   Pauline Anderson   
   December 22, 2014   
       
   If older patients are suddenly craving sweets, gaining weight, and developing   
   swallowing difficulties, consider a diagnosis of frontotemporal dementia   
   (FTD), a new study suggests.   
      
   Results show that patients with certain types of FTD eat significantly more   
   carbohydrates and sugar than healthy controls or those with Alzheimer's   
   disease (AD), and that these changes don't appear to be explained by being   
   hungrier.   
      
   Patients presenting with such eating behaviors should raise a red flag, study   
   author Olivier Piguet, PhD, associate professor, University of New South   
   Wales, and Principal Research Fellow, Neuroscience Research, Australia, told   
   Medscape Medical News.   
      
   "Someone in their 50s or early 60s showing these changes in eating preferences   
   and the amount of food that they eat would certainly indicate that something   
   might be going on in their brain that needs exploring further."   
      
   The study, published in the December issue of JAMA Neurology, is the first to   
   quantify abnormal eating behaviors in patients with FTD, said Dr Piguet.   
      
   Eating Disturbance   
      
   "Changes in eating behavior are part of the criteria for the diagnosis of   
   behavior variant FTD, but no one has really looked at exactly what that   
   means," said Dr Piguet. "This study is really the first one to try to measure   
   what it means when we say    
   these patients have an eating disturbance."   
      
   The analysis included 75 patients with dementia: 21 with personality or   
   behavioral disturbance (behavioral variant FTD [bvFTD]), 26 with language   
   disturbances (semantic dementia or SD), and 28 with AD, as well as 18 age- and   
   education-matched healthy    
   controls.   
      
   Caregivers completed the Appetite and Eating Habits Questionnaire (APEHQ),   
   which includes 34 questions examining changes in eating behaviors with regard   
   to swallowing, appetite, eating habits, food preferences, and other oral   
   behaviors (eg, eating    
   objects such as cigarette butts). For each question, researchers calculated a   
   composite score that included frequency and severity and derived an overall   
   score for each domain.   
      
   Investigators found the bvFTD group had significantly higher scores than the   
   AD group for all 5 APEHQ domains: swallowing (P = .003), appetite change (P =   
   .007), eating habits (P = .001), food preferences (P = .001), and other oral   
   behaviors (P = .009).   
      
   Caregivers also completed the Cambridge Behavioral Inventory, which includes   
   four questions related to eating behaviors: sweet preference, eating the same   
   foods, changes in appetite, and table manners.   
      
   The table manners item was included because of anecdotal evidence that   
   patients with behavioral disturbances lose this etiquette. "Caregivers will   
   report that 'my husband is stealing food from someone else's plate' or piling   
   up food on their plate," said    
   Dr Piguet.   
      
   There were significantly greater changes related to sweet preference (P <   
   .001), eating the same foods (P = .001), and table manners (P = .007) in the   
   bvFTD group compared with the AD group.   
      
   Some of the findings were unexpected.   
      
   "The finding that the behavior variant patients changed their preferences in   
   terms of the foods they like and their tendency to focus more on sweet foods   
   confirms something we knew already, although we were able to quantify that,"   
   commented Dr Piguet. "   
   But we also found that this tendency to prefer sweet foods was also present in   
   the group with semantic dementia, which was surprising."   
      
   Although patients with semantic dementia increased their carbohydrate intake   
   to some degree, the increase among those with bvFTD was "more prominent," said   
   Dr Piguet, "again confirming anecdotal evidence that we were able to measure   
   with the    
   questionnaire."   
      
   Caregivers also measured patients' level of hunger and satiety using a visual   
   analogue scale before and after meals during a 24-hour period (with higher   
   scores indicating more hunger). The bvFTD group had a significantly higher   
   overall hunger-satiety    
   index score than the semantic dementia (P = .02) and AD (P = .03) groups, but   
   not the control group (P = .38).   
      
   These results suggest that "these patients don't eat because they feel full,"   
   but simply because "the food is there and they eat it," said Dr Piguet.   
      
   Weight Concerns   
      
   The bvFTD and SD groups had significantly greater waist circumference compared   
   with the control group, and the bvFTD group had significantly greater waist   
   circumference compared with those with AD.   
      
   These patients, said Dr. Piguet, are "getting into the danger zone" with body   
   mass indexes "hovering around the 30 mark, which raises concerns about their   
   general health, their cardiovascular health and risks for related illnesses   
   such as diabetes."   
      
   An earlier paper by the same research group found atrophy in the hypothalamus   
   -- the area of the brain that plays a central role in eating regulation -- in   
   patients with FTD, said Dr Piguet. "The brain is receiving incorrect messages   
   from the periphery    
   in terms of hunger and satiety and is then responding to these messages in an   
   incorrect manner."   
      
   The changes, he added, can lead to disordered behavior when it comes to   
   eating. "These patients tend to want to eat the food that they have in front   
   of them; they have difficulty in inhibiting or stopping their eating."   
      
   In FTD, atrophy predominantly affects the frontal lobes and temporal brain   
   areas; in AD, in contrast, other brain regions are affected. "You rarely see   
   these behavior changes in patients with AD," noted Dr Piguet.   
      
   Reached for comment on these findings, Ronald Petersen, MD, PhD, director,   
   Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota,   
   said the study results illustrate disinhibition on the part of patients with   
   bvFTD.   
      
   "Foods that are sweet are very attractive to most of us, and people with bvFTD   
   lack the ability to deny themselves the pleasure," said Dr Petersen. "They   
   can't reason that this type of excessive ingestion of sweets will lead to   
   weight gain and other    
   health consequences."   
      
   These patients, he added, lack the ability to foresee the consequences and act   
   impulsively. "This is due to frontal lobe dysfunction since that part of the   
   brain is involved in our ability to judge the consequences of behavior."   
      
      
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