The behavior of ingesting feces, known as coprophagia, is a distressing symptom that can manifest in individuals living with advanced neurocognitive disorders. This action is a complex, non-volitional behavioral disturbance stemming from the physical deterioration of the brain due to dementia. Coprophagia is categorized as a form of Pica, which is the consumption of non-food items, and signals significant changes within the brain’s regulatory and cognitive systems. Understanding the underlying biological and environmental factors is important for effective intervention.
How Dementia Alters Brain Function and Inhibition
Dementia pathology directly damages brain regions responsible for controlling impulses and making judgments. The frontal lobes, particularly the prefrontal cortex, are centers for executive functions, including behavioral inhibition and social appropriateness. Damage to these areas causes a breakdown of the brain’s “braking system,” leading to disinhibition and impulsive behaviors.
A loss of inhibitory control means the individual cannot suppress the urge to act on impulses, including the oral exploration of inappropriate matter. This loss of social and behavioral norms is a feature of dementia, especially in types like frontotemporal dementia (FTD). Brain scans of dementia patients exhibiting coprophagia often show atrophy in the medial temporal lobe, which includes structures like the amygdala. This neurodegeneration causes the individual to lose the cognitive ability to recognize feces as waste and inappropriate for consumption, potentially perceiving it as a neutral object for oral fixation.
Sensory Misperception and Environmental Confusion
Altered sensory perception compounds the cognitive failure to distinguish between food and non-food items. Dementia can damage the parts of the brain that interpret sensory signals, leading to misinterpretation. Visual perception difficulties, for example, can lead to the misidentification of feces as something edible, especially in low light.
The senses of smell (anosmia) and taste (dysgeusia) are often affected, altering how the patient perceives substances. A diminished sense of smell removes the natural deterrent that human waste presents, making the material less aversive. Furthermore, a lack of environmental stimulation or boredom can cause the person to seek oral stimulation, leading to exploratory behavior where anything within reach is put into the mouth.
Underlying Medical and Nutritional Triggers
While brain changes are the root cause, certain physiological and nutritional issues can act as secondary triggers for Pica and coprophagia. Severe nutritional deficiencies, particularly a lack of micronutrients like iron or zinc, are known to sometimes induce cravings for non-food items. Ensuring adequate nutritional intake may help mitigate this potential factor.
Certain medications prescribed for dementia or other conditions can also contribute to the behavior by altering appetite, taste perception, or increasing confusion. Gastrointestinal discomfort, such as severe constipation or fecal impaction, can lead to agitation and an increased focus on the bowel area. A comprehensive medical assessment is necessary to rule out these reversible physical factors that may be exacerbating the compulsive behavior.
Managing and Preventing Coprophagia
Management strategies focus on proactive environmental and behavioral adjustments to minimize the opportunity for the behavior to occur. Increased supervision is a direct and simple step to ensure that caregivers are present to intervene and redirect the person before ingestion can happen. The physical environment must be kept clean, with all accessible waste promptly removed to eliminate the source of the temptation.
Behavioral interventions center on redirection and providing appropriate alternatives for oral or sensory fixation. Offering non-toxic items designed for safe chewing, or engaging the person in stimulating activities, can satisfy the need for oral stimulation and reduce boredom. Implementing a consistent, scheduled toileting regimen is also effective, as it minimizes the time feces are available to the patient. If behavioral modifications are insufficient, medical professionals may consider pharmacological treatments, such as certain antipsychotic medications, which have been shown to stop the behavior.