In FTD, Brain Atrophy Lifts Lid on Creative Circuits

People with frontotemporal dementia grapple with behavioral, language, and cognitive problems as their disease worsens. It may be small comfort but for a few, their disease sparks an artistic flair, unveiling previously hidden talents in painting, sculpting, or other visual arts. In the February 27 JAMA Neurology, William Seeley and Bruce Miller at the University of California, San Francisco, and colleagues pinpoint brain networks that may underlie this strange flourish. The researchers identified a cluster of frontotemporal brain regions that shrank in people with FTD. In healthy controls, these regions collectively squelch activity in the dorsal occipital cortex, an area involved in visual perception. In people with FTD, loss of this suppression may allow artistic tendencies to bloom. Not everyone with FTD was so impelled, suggesting that other influences are at play. Beyond FTD, the findings illuminate brain networks that enable visual artistry.

  • Some people with FTD blossom as artists. For a while.
  • Atrophy in the frontal and temporal lobe may undo suppression of the dorsal occipital cortex.
  • This may underlie emergent visual creativity.

Miller and others have studied the phenomenon of emergent visual creativity in FTD for 27 years (Miller et al., 1998; Geser et al., 2021). Take the 56-year-old businessman who complained of periods of intense light sensitivity (Miller et al., 1996). He had never dabbled in art but suddenly felt an urge to paint. As his disease worsened, he honed his craft over the following decade, winning awards at local art shows for his brightly colored canvasses. Like many other new artists with FTD, he suffered from degeneration of the anterior temporal lobes with relative sparing of frontal lobes, and the posterior parts of his brain displayed heightened activity. At the time, Miller hypothesized that loss of anterior temporal lobe circuits that had been suppressing the posterior visual cortex may have amplified visual experiences, motivating him to paint.

Flood of Color. A man with FTD produced many brightly colored paintings (top). SPECT scans of his brain indicated hypoperfusion in the temporal lobe, but elevated perfusion in posterior regions. [Courtesy of Miller et al., The Lancet, 1996.]

In the current study, first author Adit Friedberg and colleagues put this hypothesis to the test. Friedberg combed through the records of participants in UCSF’s longitudinal cohort study on FTD spectrum disorders. Within detailed interviews of 689 people with FTD and their caregivers, Friedberg identified 17 who developed a visual creativity along with their disease. The authors matched these 17 with 51 people with FTD who did not develop artistic skills, as well as 51 healthy controls. Among the 17 newly minted artists, eight had semantic variant primary progressive aphasia (svPPA), three had behavioral variant FTD, and the remaining six had other forms of FTD. None carried autosomal-dominant mutations in C9orf72, GRN, or MAPT genes, suggesting this emergent creativity is not dependent on a particular molecular etiology.

For most of the 17 artists, their visual creativity emerged around the time of FTD symptom onset. Most painted, although some gravitated to drawing, sculpture, pottery, photography, quilting, or jewelry making. They worked with bright colors and rarely portrayed human faces. When they did, they often rendered them with bizarre expressions. In some cases, semantic deficits came through in the art. For example, two sculptors with svPPA created animals that lacked typical features of the species.

To explore the mechanisms involved in this phenomenon, the researchers first mapped atrophy patterns seen on MRI scans. This analysis revealed no significant differences between artists and non-artists with FTD.

The scientists next pinpointed the top 1 percent of regions most ravaged in people with the disease and asked how these functionally connect to other regions of the brain. Referencing functional connectivity maps generated in healthy controls, Friedberg found that, collectively, the regions most shrunken in FTD shared another characteristic. They all appeared to suppress activity in the dorsomedial occipital cortex, a region involved with visual perception. While shrinkage of these inhibitory regions occurred regardless of artistic ability, it was most extensive among artists. The authors posit that frontotemporal lobe degeneration may have effectively boosted activity in the visual cortex, perhaps intensifying visual experiences.

FTD Gallery. Artwork from people with different forms of frontotemporal dementia. [Courtesy of Friedberg et al., JAMA Neurology, 2023.]

Serial FDG-PET scans from one woman supported this idea. After she had started painting, her glucose metabolism waned in her frontal and temporal regions but ramped up in the occipital cortex. Together, the findings suggested that frontotemporal degeneration may take the brakes off inhibitory signals that suppress visual perception. Then, if conditions are right, the person may be compelled to pick up a paintbrush or sculpt some clay.

Atrophy Begets Activity? In an emergent artist with svPPA, the left anterior temporal lobe had atrophied most (left, blue). In healthy controls, this region correlates with less neural activity in the dorsal occipital cortex (right, red). FTD may strengthen activity in these dorsal regions, which are involved in visual perception [Courtesy of Friedberg et al., JAMA Neurology, 2023.]

Finally, the researchers found evidence that those who became artists were indeed flexing their creative muscles. Only in the artists with FTD did the volume of the dorsomedial occipital cortex correlate tightly with volume in the left primary motor cortex that controls the right hand. Friedberg thinks these visual and motor centers of the brain are working together, and the correlation reflects strengthening of neural circuitry as these artists put their new skills to use. “This structural brain difference may imply that neuroplastic processes may occur in parallel to the disease process,” Friedberg said. “I think that these processes should be further explored and characterized since they may potentially pave the way to novel therapies.”

Sadly, active artistic expression, which can last eight years or more, does not slow the progression of FTD overall. —Jessica Shugart

Comments

No Available Comments

Make a Comment

To make a comment you must login or register.

References

Paper Citations

  1. Miller BL, Cummings J, Mishkin F, Boone K, Prince F, Ponton M, Cotman C. Emergence of artistic talent in frontotemporal dementia. Neurology. 1998 Oct;51(4):978-82. PubMed.
  2. Geser F, Jellinger KA, Fellner L, Wenning GK, Yilmazer-Hanke D, Haybaeck J. Emergent creativity in frontotemporal dementia. J Neural Transm (Vienna). 2021 Mar;128(3):279-293. Epub 2021 Mar 12 PubMed.
  3. Miller BL, Ponton M, Benson DF, Cummings JL, Mena I. Enhanced artistic creativity with temporal lobe degeneration. Lancet. 1996 Dec 21-28;348(9043):1744-5. PubMed.

Further Reading

No Available Further Reading

Primary Papers

  1. Friedberg A, Pasquini L, Diggs R, Glaubitz EA, Lopez L, Illán-Gala I, Iaccarino L, La Joie R, Mundada N, Knudtson M, Neylan K, Brown J, Allen IE, Rankin KP, Bonham LW, Yokoyama JS, Ramos EM, Geschwind DH, Spina S, Grinberg LT, Miller ZA, Kramer JH, Rosen H, Gorno-Tempini ML, Rabinovici G, Seeley WW, Miller BL. Prevalence, Timing, and Network Localization of Emergent Visual Creativity in Frontotemporal Dementia. JAMA Neurol. 2023 Apr 1;80(4):377-387. PubMed.

Annotate

To make an annotation you must Login or Register.