Rare form of dementia could unleash creativity

Neurological diseases can release a flood of new creativity in some people, as if opening some mysterious gateway. Auras of migraine and epilepsy may have influenced a long list of artists including Pablo Picasso, Vincent van Gogh, Edvard Munch, Giorgio de Chirico, Claude Monet and Georges Seurat. Traumatic brain injury (TBI) can lead to original thinking and new artistic drive. Emerging creativity is also a rare symptom of Parkinson’s disease.

But this burst of creativity is especially characteristic of frontotemporal dementia (FTD). Although a few rare cases of FTD are associated with improved verbal creativity, such as greater poetic gifts, increased wordplay and puns, a particularly prominent feature of this condition is increased creativity in the visual arts. Surprisingly, this burst of creativity indicates that the potential for creativity may lie dormant in some of us, only to be released by an illness that also causes loss of verbal ability.

(More on frontotemporal dementia)

The emergence of a bright creative spark in the face of a devastating neurological disease speaks of the extraordinary potential and resilience of the human brain. A new study published in the journal JAMA Neurology explores the roots of this phenomenon and provides insight into a possible cause. Researchers have found that as certain areas of the brain shrink in FTD, they no longer suppress or control other areas that support artistic expression.

Frontotemporal dementia is relatively rare — it affects about 60,000 people in the US — and is different from the much more common Alzheimer’s disease, a form of dementia that is dominated by memory deficits. FTD is named after two areas of the brain that can degenerate in this disease, namely the frontal and temporal lobes. Not every person with FTD has the same pattern of loss in these regions; instead, there are several options. For example, degeneration of the temporal lobes, which are the seat of speech in the brain, leads to difficulties in reproducing and understanding written and oral communication. Some people with FTD have impaired speech production in what is known as non-fluent FTD. Others may have difficulty understanding the meanings of words in semantic FTD.

People with FTD also experience degeneration of the frontal lobes, which typically involve a set of skills related to social behavior, empathy, planning, and decision making. Violation can lead to misjudgment and difficulty in understanding the point of view of others. The frontal lobes are also involved in the complex interplay of brain regions that support our social behavior, helping to balance base desires and urges with an understanding of social norms and morality. In a healthy brain, activity in the frontal lobes can override activity in other areas. This interchange is how the brain suppresses, for example, the reflex use of rude language, realizing that such responses can offend. However, researchers suspect that in FTD, damage to the frontal lobes reduces their ability to suppress other brain activity. Behavior becomes disinhibited and socially unacceptable.

Similarly, a recent study suggests that the loss of temporal lobe activity somehow disinhibits artistic creativity in some people. In this new work, the researchers examined the medical records of 689 people with FTD or related disorders looking for evidence of a new or increased interest in artistic pursuits. In total, they found this change in 17 people, or 2.5% of FTD participants. Most of these people painted, although some painted, sculpted, sculpted pottery, made jewelry, or quilted. FTD can sometimes be linked to certain genes, but none of these people had a known genetic cause for dementia. The majority in this creative group had either a semantic or non-fluent variant of the disease, suggesting that FTD significantly affected their temporal lobe.

See or speak?

The researchers then selected people to compare with this artistic group. One group included patients with FTD who were similar in many ways to artists (including diagnosis, age, sex, and education), but did not show artistic inclinations. The additional group matched the artists demographically (by age, gender, education, and other factors) but did not have any form of dementia or major health problems.

The research team used magnetic resonance imaging (MRI) to compare these three groups of people. Remarkably, brain scans have shown that people with FTD have reduced volume in the left temporal lobe—an area that is important for speech production—compared to healthy people. This atrophy was more pronounced in the artistic group than in the non-artistic group.

The scientists also found that some areas of the brain were relatively larger in artists with FTD. In particular, people with a smaller temporal lobe had more volume in the dorsomedial occipital lobe, an area involved in visual association, compared to FTD patients who were not creative. This finding means that although the temporal lobes were affected by FTD, this visual area was enlarged. In addition, in visual artists with FTD, the part of the motor cortex that controls movements in the right hand also showed a relative increase in volume. In fact, the larger the volume of the dorsomedial occipital lobe, the larger the volume of this motor cortex.

Putting the data together, the researchers concluded that the impact of this disease on the temporal lobe may lead to a decrease in control over the area of ​​the brain that generates visual associations. As a result, creativity is released. Meanwhile, the increased volume of the area of ​​the brain that controls the right hand probably reflects the use of this hand in the creation of works of art.

The researchers confirmed these ideas by observing changes in one person’s brain as her FTD progressed and creativity emerged. Positron emission tomography measured how much energy was being used by different areas of her brain. Comparison of brain scans showed that as a woman’s dementia progressed, her frontal and temporal lobes became significantly less active, and areas involved in visual associations became more active.

A new study suggests that in a healthy brain, the temporal lobe directly or indirectly suppresses activity in the dorsomedial occipital lobe, which supports visual association. But why does the part of the brain involved in verbal processing suppress visual areas? These findings suggest a reciprocal or even competitive relationship between our verbal abilities and visual artistic creation.

This understanding actually underlies the hypothesis of how our brains have changed over the course of human evolution: the “superior visual perception hypothesis.” Vision requires a lot of processing power from our brains—so much so that we often close our eyes to focus on what we hear, whether it’s music, speech, birdsong, or the sound of the waves. According to the evolutionary hypothesis, when our species first began to develop language, the brain diverted processing power from visual processing to support this new activity.

For example, visual processing helps us understand gestures, a non-verbal form of communication that likely preceded our use of verbal language. The computational tasks that supported the production and interpretation of gestures were also related to speech, and therefore, as we became more adept at language, gestures lost their primacy in communication. The areas of the brain responsible for gestures may have been replaced by those used for speech through an evolutionary process called exaptation, where parts of the body take on different or entirely new roles.

This hypothesis may explain why areas involved in verbal processing may somehow suppress activity associated with visual thinking. A new FTD study suggests that this evolutionary process is, in a sense, reversed in these artists with dementia.

aspiring artist

Brain injuries and neurodegenerative diseases often have tragic consequences. So it’s notable that these conditions can have seemingly positive effects, such as boosting creativity, and this discovery could help us understand the origins of innovation. Creativity is part of the essence of humanity, and in some way sets us apart from our hominin relatives. Is there an artist in each of us, waiting for a chance appearance?

Creativity is a complex behavior that requires several elements, including the ability to think outside the box and symbolically, persistence despite uncertainty, mastery of execution, and the ability to evaluate one’s creations. When considering the burst of artistic activity sometimes seen in FTD, all these factors must be weighed. In general, people with FTD perform poorly on tests of divergent thinking, suggesting that either this group of artists with the condition is very different from other people who have it, or that different aspects of artists with FTD are somehow heightened. creativity. Other studies show that aesthetic judgment is preserved in FTD, allowing affected individuals to appreciate the power of their finished artwork, although many find it difficult to recognize the emotional content in fine art.

Past research has also shown that creativity occurs when we loosen our self-critical thinking. For example, in FTD, the lack of self-censorship contributes to socially unacceptable behavior and may also mean that the artist’s “inner critic” is less vocal. Another facet of artistic success is practice. FTD is often accompanied by perseverative behavior, in which people repeat the same actions or statements or mentally fixate on an idea or behavior. Some scholars have suggested that the LTR artist benefits from a combination of behavioral disinhibition and repetitive practice. Indeed, it may also help explain the literary abilities of poetic people with FTD, who, unlike visually artistic people with the disease, have avoided significant losses in the language areas of the temporal lobes.

However, none of these ideas fully explain the flowering of artistic behavior in some people with FTD. The authors of the new study emphasize that FTD artists made up only a small percentage of the total number of people with this dementia they tested. Other factors such as artistic inclination and environment or circumstances conducive to creativity may be important.

An FTD artist can be caught in the middle of a perfect creative storm. Thus, studies of these individuals may reveal the subtle interplay between brain regions that results in remarkable behavior. The complexity of creativity makes it even more improbable that such an ability could be the result of neurodegeneration. Ultimately, these discoveries are a humble reflection of the human brain’s adaptability and seemingly limitless possibilities.

Are you a scientist specializing in neuroscience, cognitive science, or psychology? Have you read the recent peer-reviewed article you’d like to write about for Mind Matters? Please send suggestions to Scientific American Mind Matters Editor Daisy Juhas at [email protected].

This is a review and analysis article and the views expressed by the author or authors do not necessarily represent those of Scientific American.

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