Three Profiles of Abnormal Eating Behaviors in Patients with Dementia

As a speech-language pathologist, I receive frequent nursing referrals when a resident with dementia stops eating, plays with their food, impulsively eats certain kinds of food, or demonstrates other undesired behaviors at meals.

Recently, I read a research article that provided insight into the incidence and prevalence of abnormal eating behaviors in dementia. In the study, researchers show a loose profile of these changes across the subtypes of dementia.¹

Investigating the Changes in Eating Behaviors

The researchers used a 36-question caregiver questionnaire to investigate the frequency of eating behavior changes in frontal variant frontotemporal dementia (fv-FTD) and Alzheimer’s disease. They also wanted to establish if the subtypes of frontotemporal dementia – fv-FTD and semantic dementia – were characterized by different changes in eating behaviors.

Caregivers completed a questionnaire addressing the following categories:

• Swallowing problems
• Appetite change (e.g. eating more or less)
• Food preference (e.g. preferring sweets or other foods)
• Eating habits (e.g. declining table manners)
• Other oral behaviors (e.g. cramming food into mouth)

Of the 91 participants, 23 were diagnosed with fv-FTD, 25 with semantic dementia, and 43 with Alzheimer’s dementia. All but six of the participants were living at home with family caregivers.

Eating Behavior Profiles for Three Subtypes of Dementia

Based on the data collected, researchers were able to develop a profile of changes in eating behaviors across each subtype of dementia.

Frontotemporal Dementia (Frontal Variant)

According to the questionnaires completed by caregivers, 100% of patients with fv-FTD demonstrated at least one symptom of abnormal eating behavior. Participants demonstrated a high level (>75%) of change in appetite, food preferences, and eating habits. Participants with fv-FTD had the highest incidence of symptoms in all five categories compared to those with semantic dementia and Alzheimer’s disease.

These patients showed a notable increase in appetite, which led to weight gain in 30% of participants. Ninety-one percent of participants had a change in food preference – craving sweet foods. Patients with fv-FTD also crammed food into their mouth more often than the other two groups.

Semantic Dementia

Participants with semantic dementia demonstrated abnormal eating behaviors with 88% frequency according to caregiver reports. More specifically, these patients had a high level (>75%) of change in food preferences and eating habits.

Similar to fv-FTD, participants commonly experienced an increased appetite. In fact, 80% of participants with semantic dementia favored sweet foods. This group was also reported to have a higher tendency to eat non-edible objects compared to the other groups.

Alzheimer’s Dementia

Of the 43 participants with Alzheimer’s dementia, 58.1% demonstrated at least one symptom of abnormal eating behavior according to the questionnaire report. These participants consistently reported fewer symptoms of abnormal eating behaviors – having a lower percentage in all five categories – than patients in the other groups.

Unlike participants with fv-FTD and semantic dementia, patients with Alzheimer’s disease had a reduced appetite. They were also less likely to have changes in food preferences toward sweet foods, with only 21% of participants demonstrating this change. Alzheimer’s patients did retain eating habits at a higher rate than those with frontotemporal dementia.

Swallowing Problems Consistently Reported

Despite the differences in eating behavior changes, all three groups did report swallowing problems.

As an SLP, you are better equipped for a clinical assessment when you understand the loose profiles of behavior changes across different subtypes of dementia. Using these profiles and comparing your current observations with caregiver reports about prior eating behaviors can help you determine if there has been a change.