A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration

Abstract

Background: Frontotemporal lobar degeneration (FTLD) can result in a decline in behavior, language, and motor function. Mealtime disturbances are a common and significant outcome of FTLD. Disturbances during mealtimes can arise from dysphagia or may occur secondary to behavioral changes such as rapid eating, mealtime rigidity, and altered diet preferences. Summary: Few studies have comprehensively evaluated eating behavior or dysphagia in individuals presenting with FTLD pathology despite the potential impact on medical safety and individual quality of life. Dysphagia is reported in the late stages of frontotemporal dementia and early in the motor subtypes of FTLD. The identification of dysphagia can alert individuals and medical teams to disease progression and provide insight into the nature and spread of the underlying neuropathology. Improved understanding of eating behaviors can improve individual care and may enhance diagnostic accuracy. Key Message: Aberrant eating behavior and swallowing difficulties are reported in the conditions associated with FTLD neuropathology. The consequences of mealtime disturbances include health risks associated with an increased BMI and aspiration, reduction of an individual’s independence, and an increase in caregiver stress and burden. Here we review and summarize the literature on eating behavior and swallow impairments (dysphagia) in each of the syndromes caused by FTLD.

Mortality rates in Alzheimer's disease and non-Alzheimer's dementias: a systematic review and meta-analysis

“…31 Besides, rapid eating and dysphagia are common in patients with frontotemporal degeneration, and these symptoms might increase the risk of choking, aspiration pneumonia, and mortality. 32 Importantly, people with frontotemporal degeneration might have a younger age at onset and diagnosis than people with Alzheimer's disease, and thereby the mortality rate after diagnosis might be attenuated during the followup period. For example, Gerritsen and colleagues 33 studied people with youngonset dementia who experienced their first symptoms before the age of 65 years and reported a longer survival time for people with fronto temporal degeneration than for people with Alzheimer's disease.…”

Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?

“…The CSE has been criticised for its lack of diagnostic ability, particularly in identifying aspiration. Yet, it has also been argued that the CSE is an essential part of holistic dysphagia management for acute-care with rapidly changing patient status, short lengths of stay; and non-acute care where patient behaviour, co-morbidities, fatigue, and fluctuations in physical, respiratory and cognitive abilities, are important considerations for safe eating (American Speech-Language-Hearing Association (ASHA), 2020; McAllister et al, 2020) This is particularly relevant when considering oral intake over an entire meal and mealtime behaviours for people with dementia, COPD exacerbations, cerebral palsy, traumatic brain injury, and others (ASHA, 2020;Howle, Baguley, & Brown, 2014;Lewis, Walterfang, Velakoulis, & Vogel, 2018). The CSE þ CA allows for functional assessment, ongoing follow-up and regular patient contact, facilitating person-centred care.…”

“…Aspiration is only one (non-obligatory) sign of dysphagia and does not necessarily lead to aspiration pneumonia (Langmore et al, 1998). Other parameters might include nutrition and hydration outcomes, oral vs. non-oral routes of intake, functional independence versus the need for assistance or close supervision and confirmed aspiration pneumonia (American Speech-Language-Hearing Association, 2020; Lewis et al, 2018;Murray, Scholten, & Doeltgen, 2018). The outcomes of holistic dysphagia assessment and management should be evaluated considering the personal impact of activity, participation and wellbeing, not just the impairment, in keeping with the International Classification of Functioning, Disability and Health (ICF) (Skeat & Perry, 2005).…”

Handgrip strength as an indicator of decreased cognitive function in the elderly

“…23 Frontotemporal dementia is characterized by the appearance of a decrease in various aspects, including behavior, language and motor function. 26…”