Visual artistic creativity in FTD may be linked to disease onset, genetics, environment

The emergence of visual artistic creativity among those with frontotemporal dementia may be linked to early lesion-induced activation of the visual cortex and may depend on environment or genetics, according to research presented in JAMA Neurology.

“[Visual artistic creativity (VAC)] is defined as the production of novel and aesthetically pleasing visual forms and is a process that depends heavily on visual mental imagery,” Adit Friedberg, MD, of the department of neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, and colleagues wrote.

Friedberg and fellow researchers aimed to describe the anatomical and physiological processes of VAC in those diagnosed with frontotemporal dementia.

Their case-control study initially involved records analysis of individuals with an FTD spectrum disorder. From an initial cohort of 734 patients, 689 were selected for further screening by a single behavioral neurologist based on emergence on novel visual artistic skills, substantial increase in amount of visual art created and change in the style of art produced. Seventeen met inclusion criteria (mean age 64.8 years, 49% female) and were matched to two separate control groups: those with FTD and not visually artistic, and healthy subjects. Evaluations were made at the University of California San Francisco Memory and Aging Center between January 2002 and May 2019, with subsequent analysis occurring between September 2019 and December 2021, which included clinical, neuropsychological, genetic and neuroimaging data.

Results showed that VAC emergence occurred early in the FTD disease course, with most patients experiencing the change either upon or shortly after symptom onset. However, four of the 17 individuals demonstrated VAC before symptom onset.

Among the visual art from 11 of the 17 patients (painting, quilting, sculpture, pottery and jewelry), bright colors were prevalent, but facial drawing and recognition were rare.

Researchers found VAC emergence was disproportionately observed in those diagnosed with temporal lobe predominant degeneration (eight of 17). Structural covariance analysis revealed that the volume of this dorsal occipital region was strongly correlated in those with VAC but not among those without VAC or in healthy controls, with a volume in the primary motor cortex corresponding to the right-hand representation.

“Future longitudinal studies are needed to further examine the hypothesis generated by this study and to shed light on other enhanced capacities arising early in the course of neurodegeneration,” Friedberg and colleagues wrote.