A study has identified the potential brain structures and their connections that lead some frontotemporal dementia patients to start painting or producing other forms of art

The man in behavioral neurologist Adit Friedberg’s office could not speak. “He could not even utter a single word,” Friedberg said. The man had lost his ability to understand or produce words, and had been diagnosed with primary progressive aphasia, a form of frontotemporal dementia (FTD).

He was, however, painting — and often. His wife placed a pile of his work on Friedberg’s desk and asked, “What is he trying to tell me?”

Some people with dementia such as this patient develop or experience increased visual creativity even as their brains degenerate. The underlying mechanism, though, was unknown until a recent study led by Friedberg and others, which uncovered the potential brain structures involved and the connections between them.

Sudden development of new strengths — such as artistic creativity — and not just deficits, could be an important signal of neurodegeneration, allowing for earlier monitoring or even treatment, said neurologist Bruce Miller, the director of the UCSF Memory and Aging Center, and co-author of the study, which was published in JAMA Neurology.

The work also helps us understand different forms of creativity, Friedberg said, because it’s unclear “whether overlapping brain mechanisms are responsible for generating an inspiring art piece or inventing a transformative technology.”

Other instances of artistic development

The couple’s visit in 2018 intrigued Friedberg who was completing her residency at Tel Aviv Sourasky Medical Center. She began digging into the scientific literature, looking for evidence of links between neurodegeneration and artistic creativity.

She learned about Anne Adams, the focus of a 2008 study by neurologists Bill Seeley, Miller and their colleagues at the University of California at San Francisco.

Adams was a scientist who, in her 40s, left academia to care for her son who had been in a serious car accident. She began painting and, even after her son recovered, never returned to the laboratory. Adams fully immersed herself in her art, becoming more obsessive as signs of FTD — specifically primary progressive aphasia — emerged.

FTD is a group of neurodegenerative disorders caused by the death of neurons in the frontal and temporal lobes of the brain, regions that control social behavior and language, respectively.

Reading about this stunning surge of visual creativity in the face of neurological deterioration, Friedberg was struck by the “hidden potential that can be evoked in the setting of disease,” she said.

Friedberg, a research fellow at the UCSF Memory and Aging Center, who led the recent study with Miller, Seeley and their colleagues, now knows why it might happen.

Burst of creativity amid neurological decline

An increase in visual artistic creativity is unusual in neurodegenerative diseases.

“Often, it’s the opposite,” said Raquel Gutiérrez Zúñiga, a neurologist at Hospital Universitario Sanitas La Moraleja in Madrid, who was not involved in the study. Even artists, when they develop a neurodegenerative disease such as Alzheimer’s, “their styles become more simplistic,” she said.

Miller published the first case report of visual artistic creativity in a person with FTD in 1996. The patient, a man in Santa Barbara, had never been an artist, but suddenly “became obsessed with painting,” Miller said.

Miller became fascinated by the idea that something as terrible as neurodegeneration could yield something positive.

“In neurology, we’re so good at describing deficits,” he said. “For me, and I think for most people, it was a paradox. It was not something we were trained to think about.”

As his curiosity grew, Miller encountered more FTD patients with visual artistic creativity. “I started to see people coming into my office who had carved ducks out of wood or who had welded beautiful insectlike creatures or who had started painting,” he said.

For decades, case studies rolled in, as did hypotheses for how enhanced creativity could arise in patients whose brains were deteriorating. The leading theory, Miller said, was that as regions at the front of the brain break down, regions farther back in the brain, including those involved in vision, increase their activity to compensate.

With little data — partly because only a small percentage of FTD patients experience visual artistic creativity (Friedberg and Miller found 2.5 percent in their study) — teasing apart a mechanism wasn’t possible. “A group study was needed,” Friedberg said, because it would help identify patterns between and unique to those patients.