Dietary Changes, Compulsions and Sexual Behavior in Frontotemporal Degeneration

Abstract

The occurrence of weight gain, sweet and carbohydrate craving, hyposexuality, and compulsions in frontal lobe dementia (FLD) compared to Alzheimer’s disease (AD) was evaluated. FLD is a progressive dementia with a high rate of misdiagnosis and therefore better diagnostic criteria for FLD are needed. Fourteen patients meeting research criteria for AD were compared to 14 with suspected FLD. All had cerebral perfusion measured with xenon-133 and imaged with HMPAO using brain-dedicated SPECT. The FLD group showed frontotemporal and AD posterior temporoparietal hypoperfusion. The primary caregivers were queried regarding weight gain, sweet/carbohydrate preference, sexual drive, and compulsions. Differences were compared with Fisher''s exact test. The following was found in FLD versus AD: Weight gain in FLD patients amounted to 64% (AD 7%), carbohydrate craving was 79% (vs. 0%) and compulsive behavior 64% (vs. 14%). The differences for these symptoms were statistically significant, whereas for the symptoms increased sexual drive (8 vs. 8%) and reduced sexual drive (54 vs. 23%) no significant difference could be found. In FLD the first symptoms were often dietary changes or hyposexuality. Compulsions were more bizarre and severely disabling in FLD than in AD. Dietary changes, hyposexuality, and disabling compulsions are prominent early symptoms in FLD but not AD. The cause of these symptoms may be due to both frontal and subcortical serotonin loss and dysfunction of the anterior temporal lobes.

Neural correlates of viewing photographs of one’s own body and another woman’s body in anorexia and bulimia nervosa: an fMRI study

“…53,54 Interestingly, previous research showed that frontotemporal dementia is associated with changes in eating behaviour including alterations in appetite, food preferences and eating habits (e.g., overeating). 55,56 In spite of the generally higher reactivity of the amygdala in individuals with depression 22 and enhanced amygdala activity in participants with AN when looking at the other woman's body in the present study, we found no differences in amygdala activity between participants with and without depression in the eating-disordered group when either viewing one's own or the other woman's body. Furthermore, in contrast to our hypotheses, we did not find any group difference in the extrastriate body area, 17 either when looking at photographs of one's own body or the other woman's body.…”

Characterizing Sexual Behavior in Frontotemporal Dementia

“…This difference may be due to the fact that these studies used retrospective case note review looking for documentation of hypersexual behavior and did not look for evidence of hyposexual behavior. It is notable that the one previous study which included caregiver interviews also found hyposexual behavior in the majority of bvFTD patients [13]. It may be that the emergence of aberrant and disinhibited sexual behaviors are more salient and disruptive to the caregiver in everyday life and thus overshadow the presence of hyposexual behaviors.…”

“…As mentioned, one previous study has alluded to the presence of hyposexual behavior in FTD, with 54% of FTD caregivers reporting hyposexual behavior versus 23% in AD patients, and suggested that this may represent one of the first presenting symptoms of FTD [13]. Other studies have reported the rate of sexual changes in AD between 60-80% [28,29] without changes in expression of affection [14].…”

“…Perhaps surprisingly, there has been little examination of sexual function in bvFTD, other than isolated reports [8][9][10] and series [11,12] using retrospective case note analyses, documenting hypersexuality and aberrant behaviors in a proportion of cases. One previous study that used a carer survey suggested that hyposexuality may be the dominant behavioral change [13]. Despite this, the limited evidence to date has led to the conclusion that hypersexuality and aberrant behavior is a common behavioral manifestation of bvFTD.…”

Funcionalidade e desempenho cognitivo na demência frontotemporal variante comportamental

“…Miller et al (1995), em estudo que envolveu uma avaliação neuropsicológica ampla, destacaram que os sintomas mais prevalentes no grupo com DFTvc quando comparados ao grupo com DA foram perda de autoconsciência, hiperoralidade, comportamentos estereotipados e perseverantes, redução progressiva da fala, e preservação de orientação espacial. subgrupos da DLFT, a maior sobrecarga emocional esteve associada aos cuidadores de pacientes com DFTvc, em virtude dos distúrbios de comportamento e personalidade, medidos por meio da escala NPI.…”