Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Central Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia.
Ann Clin Transl Neurol. 2021 Jun;8(6):1318-1329. doi: 10.1002/acn3.51369. Epub 2021 May 11.
Alterations in eating behaviour are one of the diagnostic features of behavioural variant frontotemporal dementia (bvFTD). It is hypothesised that underlying brain network disturbances and atrophy to key structures may affect macronutrient preference in bvFTD. We aimed to establish whether a preference for dietary fat exists in bvFTD, its association with cognitive symptoms and the underlying neural mechanisms driving these changes.
Using a test meal paradigm, adapted from the obesity literature, with variable fat content (low 20%, medium 40% and high 60%), preference for fat in 20 bvFTD was compared to 16 Alzheimer's disease (AD) and 13 control participants. MRI brain scans were analysed to determine the neural correlates of fat preference.
Behavioural variant FTD patients preferred the high-fat meal compared to both AD (U = 61.5; p = 0.001) and controls (U = 41.5; p = 0.001), with 85% of bvFTD participants consistently rating the high-fat content meal as their preferred option. This increased preference for the high-fat meal was associated with total behavioural change (Cambridge Behavioural Inventory: r = 0.462; p = 0.001), as well as overall functional decline (Frontotemporal Dementia Rating Scale: r = -0.420; p = 0.03). A preference for high-fat content in bvFTD was associated with atrophy in an extended brain network including frontopolar, anterior cingulate, insular cortices, putamen and amygdala extending into lateral temporal, posteromedial parietal and occipital cortices.
Increased preference for fat content is associated with many of the canonical features of bvFTD. These findings offer new insights into markers of disease progression and pathogenesis, providing potential treatment targets.
饮食行为的改变是行为变异额颞叶痴呆（bvFTD）的诊断特征之一。据推测，大脑网络的潜在紊乱和关键结构的萎缩可能会影响 bvFTD 对宏量营养素的偏好。我们旨在确定 bvFTD 是否存在对膳食脂肪的偏好，以及这种偏好与认知症状的关联，以及驱动这些变化的潜在神经机制。
使用一种源自肥胖文献的测试餐范式，具有不同的脂肪含量（低 20%、中 40%和高 60%），将 20 名 bvFTD 患者与 16 名阿尔茨海默病（AD）患者和 13 名对照组参与者的脂肪偏好进行比较。对 MRI 脑部扫描进行分析，以确定脂肪偏好的神经相关性。
与 AD（U=61.5；p=0.001）和对照组（U=41.5；p=0.001）相比，行为变异 FTD 患者更喜欢高脂肪餐，85%的 bvFTD 参与者一致将高脂肪含量的餐评为首选。这种对高脂肪餐的偏好增加与整体行为变化（剑桥行为量表：r=0.462；p=0.001）以及整体功能下降（额颞叶痴呆评定量表：r=-0.420；p=0.03）有关。 bvFTD 中对高脂肪含量的偏好与包括额极、前扣带、岛叶皮质、壳核和杏仁核在内的扩展大脑网络的萎缩有关，并延伸到外侧颞叶、后内侧顶叶和枕叶皮质。
对脂肪含量的偏好增加与 bvFTD 的许多典型特征有关。这些发现为疾病进展和发病机制的标志物提供了新的见解，为潜在的治疗靶点提供了依据。
