From: deputydog23x@gmail.com   
      
   J Neurol Neurosurg Psychiatry 2002;73:371-376 doi:10.1136/jnnp.73.4.371   
   Paper   
      
   Changes in appetite, food preference, and eating habits in frontotemporal   
   dementia and Alzheimer’s disease   
      
      
    Authors   
   Abstract   
      
   Background: Despite numerous reports of changes in satiety, food preference,   
   and eating habits in patients with frontotemporal dementia, there have been   
   few systematic studies.   
   Objectives: To investigate the frequency of changes in eating behaviours and   
   the sequence of development of eating behaviours in frontotemporal dementia   
   and Alzheimer’s disease, using a caregiver questionnaire.   
   Methods: Three groups of patients were studied: frontal variant frontotemporal   
   dementia (fv-FTD) (n = 23), semantic dementia (n = 25), and Alzheimer’s   
   disease (n = 43). Level of education and dementia severity was similar in the   
   three groups. The    
   questionnaire consisted of 36 questions investigating five domains: swallowing   
   problems, appetite change, food preference, eating habits, and other oral   
   behaviours.   
   Results: The frequencies of symptoms in all five domains, except swallowing   
   problems, were higher in fv-FTD than in Alzheimer’s disease, and changes in   
   food preference and eating habits were greater in semantic dementia than in   
   Alzheimer’s disease.    
   In semantic dementia, the developmental pattern was very clear: a change in   
   food preference developed initially, followed by appetite increase and altered   
   eating habits, other oral behaviours, and finally swallowing problems. In   
   fv-FTD, the first symptom    
   was altered eating habits or appetite increase. In Alzheimer’s disease, the   
   pattern was not clear although swallowing problems developed in relatively   
   early stages.   
   Conclusions: Change in eating behaviour was significantly more common in both   
   of the frontotemporal dementia groups than in Alzheimer’s disease. It is   
   likely that the changing in eating behaviours reflects the involvement of a   
   common network in both    
   variants of frontotemporal dementia—namely, the ventral (orbitobasal)   
   frontal lobe, temporal pole, and amygdala.   
   Alzheimer’s disease appetite frontotemporal dementia orbitofrontal cortex   
   See Editorial Commentary, page 358   
   Frontotemporal dementia is the term currently favoured to describe progressive   
   focal atrophy involving frontal or anterior temporal lobes or both, in   
   association with a spectrum of non-Alzheimer pathologies.1,2 Patients with   
   frontotemporal dementia may    
   present with predominantly frontal involvement (so called frontal variant   
   frontotemporal dementia or fv-FTD). A wide range of behavioural changes has   
   been reported in fv-FTD, including loss of insight, disinhibition,   
   impulsivity, apathy, poor self care,    
   mood changes, mental rigidity, and stereotypic behaviour.3–6 Recent studies   
   have highlighted the high prevalence of alterations in food preference,   
   appetite, and eating behaviours in fv-FTD.5,7 Patients with the temporal   
   variant of frontotemporal    
   dementia, often referred to as semantic dementia in view of the predominance   
   of anomia and impaired comprehension, also show changes in behaviour,   
   including alterations in appetite and food preference similar to those seen in   
   fv-FTD.5 In Alzheimer’s    
   disease, by contrast, changes in eating habits are said to be less common,   
   with the exception of anorexia,8,9 although the results of studies have been   
   contradictory.10   
   Despite numerous reports of these changes in satiety, food preference, and   
   eating habits in patients with frontotemporal dementia, there have been very   
   few systematic studies comparing frontotemporal dementia subgroups, or   
   contrasting Alzheimer’s    
   disease and frontotemporal dementia. The study of such changes has both   
   practical and theoretical relevance. From a clinical point of view, it is   
   important to distinguish Alzheimer’s disease from frontotemporal dementia,   
   particularly with the advent of    
   disease modifying treatments.11 From a theoretical standpoint, the brain   
   mechanisms underlying appetite control and food preference are poorly   
   understood.   
   In this study we used a newly created caregiver questionnaire to examine the   
   changing in eating behaviours in frontotemporal dementia and Alzheimer’s   
   disease. The three main aims were: to investigate the frequency of changing in   
   eating behaviours in    
   frontotemporal dementia and Alzheimer’s disease; to investigate the sequence   
   of development of eating behaviours in frontotemporal dementia and   
   Alzheimer’s disease; and to establish whether the subtypes of frontotemporal   
   dementia are characterized by    
   different eating behavioural changes.   
   METHODS   
      
   This study was conducted after obtaining informed consent from all subjects or   
   their caregiver.   
   Patients   
   Patients were identified through the memory and cognitive disorders clinic at   
   Addenbrooke’s Hospital, Cambridge, England, where they were seen by a senior   
   neurologist (JRH), a senior psychiatrist, and clinical neuropsychologist. All   
   patients underwent    
   a standard psychiatric evaluation to exclude major functional psychiatric   
   disorders such as depression, mania, and schizophrenia. Patients were assessed   
   with a comprehensive neuropsychological test battery,12 including the   
   mini-mental state examination (   
   MMSE)13 and clinical dementia rating (CDR).14 All patients underwent computed   
   tomography or magnetic resonance imaging (MRI), together with the usual   
   battery of screening blood tests to exclude treatable causes of dementia.   
   Patients with a history of    
   significant head trauma and alcoholism were also excluded.   
   Three groups of patients were involved in the study: fv-FTD (n = 23), semantic   
   dementia (n = 25), and Alzheimer’s disease (n = 43). All except six (four   
   with frontotemporal dementia, one with semantic dementia, and one with   
   Alzheimer’s disease) were    
   living at home. Those who were institutionalised had a spouse or relative who   
   still maintained close contact and was therefore able to complete the   
   questionnaire. The demographic characteristics of fv-FTD, semantic dementia,   
   and Alzheimer’s disease    
   group are summarised in table 1. All patients in the fv-FTD and semantic   
   dementia groups fulfilled the recent consensus criteria for frontotemporal   
   lobar degeneration, which recognises the subtypes of frontotemporal dementia   
   (termed here fv-FTD),    
   semantic dementia, and progressive non-fluent aphasia.15   
   View this table:   
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   Table 1   
   Demographic variables of the three patient groups   
      
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