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

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.