Dysphagia in patients with frontotemporal lobar dementia

Background: Hyperorality, compulsive eating and aspiration because of food gorging, has been described in patients with frontotemporal lobar dementia (FTLD), but swallowing function in this population has not been reported. Objective: To identify the swallowing status in a sample of patients with FTLD. Design: Case series. Setting: Referral center, ambulatory care. Patients: A consecutive series of referred patients with 3 variants of FTLD were asked to participate. Twenty-one patients were enrolled, including 9 with frontotemporal dementia, 7 with progressive nonfluent aphasia, and 5 with semantic dementia. Intervention: The patients underwent a fiberoptic endoscopic examination of swallowing to assess their ability to swallow liquids and food. Main Outcome Measures: Presence of dysphagia and nature of impaired swallowing. Results: Of the 21 patients, 4 caretakers reported swallowing difficulties. An instrumental examination revealed moderate swallowing abnormalities in 12 of the 21 patients. These abnormalities were not explained by compulsive eating behaviors, but seemed to reflect deficits in cortical and subcortical pathways connecting with the brainstem swallowing center. Conclusions: When assessed via instrumentation, swallowing abnormalities are found in many patients with FTLD. The appearance of dysphagia signals progression of FTLD to brainstem systems.