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

J. D. Woolley, M. L. Gorno-Tempini, W. W. Seeley, K. Rankin, S. S. Lee, B. R. Matthews, B. L. Miller

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153 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1424-1433
Number of pages10
Issue number14
StatePublished - Oct 1 2007


ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Woolley, J. D., Gorno-Tempini, M. L., Seeley, W. W., Rankin, K., Lee, S. S., Matthews, B. R., & Miller, B. L. (2007). Binge eating is associated with right orbitofrontal-insular-striatal atrophy in frontotemporal dementia. Neurology, 69(14), 1424-1433.