title: Energy expenditure in frontotemporal dementia: a behavioural and imaging study.
abstract: SEE FINGER DOI101093/AWW312 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer's disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke's Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala, regions previously suggested to be involved exclusively in social and emotion processing in frontotemporal dementia. These neural correlates overlap the network involved in eating behaviour in frontotemporal dementia, suggesting a complex interaction between eating behaviour, autonomic function and energy homeostasis. As such the present study suggests that increased heart rate and autonomic changes are prevalent in behavioural variant frontotemporal dementia, and are associated with changes in energy expenditure. An understanding of these changes and neural correlates may have potential relevance to disease progression and prognosis.
authors: 1 Neuroscience Research Australia, Sydney, Australia rebekah.ahmed@sydney.edu.au j.hodges@neura.edu.au.|2 University of New South Wales, Sydney, Australia.|3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia.|4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia.
authors: Rebekah M
authors: RM
authors: Ahmed
authors: 1 Neuroscience Research Australia, Sydney, Australia.|2 University of New South Wales, Sydney, Australia.|3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia.
authors: Ramon
authors: R
authors: Landin-Romero
authors: 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors: Tinh-Hai
authors: TH
authors: Collet
authors: 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors: Agatha A
authors: AA
authors: van der Klaauw
authors: 1 Neuroscience Research Australia, Sydney, Australia.|2 University of New South Wales, Sydney, Australia.|3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia.|4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia.
authors: Emma
authors: E
authors: Devenney
authors: 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors: Elana
authors: E
authors: Henning
authors: 4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia.
authors: Matthew C
authors: MC
authors: Kiernan
authors: 1 Neuroscience Research Australia, Sydney, Australia.|2 University of New South Wales, Sydney, Australia.|3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia.
authors: Olivier
authors: O
authors: Piguet
authors: 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors: I Sadaf
authors: IS
authors: Farooqi
authors: 1 Neuroscience Research Australia, Sydney, Australia rebekah.ahmed@sydney.edu.au j.hodges@neura.edu.au.|2 University of New South Wales, Sydney, Australia.|3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia.
authors: John R
authors: JR
authors: Hodges
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D001284:Atrophy / Q000473:pathology; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D004734:Energy Metabolism / Q000502:physiology*; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D057180:Frontotemporal Dementia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
keywords: autonomic function; frontotemporal dementia; heart rate; metabolism; physiology