Binge eating is associated with right orbitofrontal-insular-striatal atrophy in frontotemporal dementia

Neurology. 2007 Oct 2;69(14):1424-33. doi: 10.1212/01.wnl.0000277461.06713.23.

Abstract

Background: Neurophysiologic studies on human and nonhuman primates implicate an orbitofrontal-insular-striatal circuit in high-level regulation of feeding. However, the role of these areas in determining feeding disturbances in neurologic patients remains uncertain.

Objective and methods: To determine brain structures critical for control of eating behavior, we performed a prospective, laboratory-based, free-feeding study of 18 healthy control subjects and 32 patients with neurodegenerative disease. MR voxel-based morphometry (VBM) was used to identify regions of significant atrophy in patients who overate compared with those who did not.

Results: Despite normal taste recognition, 6 of 32 patients compulsively binged, consuming large quantities of food after reporting appropriate satiety. All six patients who overate were clinically diagnosed with frontotemporal dementia (FTD), a disorder previously associated with disordered eating, while the nonovereaters were diagnosed with FTD, semantic dementia, progressive aphasia, progressive supranuclear palsy, and Alzheimer disease. VBM revealed that binge-eating patients had significantly greater atrophy in the right ventral insula, striatum, and orbitofrontal cortex.

Conclusion: Binge eating can occur despite reported satiety and is associated with damage to a right-sided orbitofrontal-insular-striatal circuit in humans. These findings support a model in which ventral insular and orbitofrontal cortices serve as higher-order gustatory regions and cooperate with the striatum to guide appropriate feeding responses.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Appetite / physiology
  • Atrophy / etiology
  • Atrophy / pathology*
  • Atrophy / physiopathology
  • Brain / pathology*
  • Brain / physiopathology
  • Bulimia Nervosa / etiology
  • Bulimia Nervosa / pathology*
  • Bulimia Nervosa / physiopathology
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology
  • Corpus Striatum / pathology
  • Corpus Striatum / physiopathology
  • Dementia / complications
  • Dementia / pathology*
  • Dementia / psychology
  • Feeding Behavior / physiology
  • Female
  • Functional Laterality / physiology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Mental Disorders / etiology
  • Mental Disorders / pathology
  • Mental Disorders / physiopathology
  • Middle Aged
  • Neural Pathways / pathology*
  • Neural Pathways / physiopathology
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Prefrontal Cortex / pathology
  • Prefrontal Cortex / physiopathology
  • Reward
  • Satiety Response