1. This case-control study of 689 patients with frontotemporal dementia demonstrated that visual artistic creativity emerged in 17 patients (2.5%), often manifested early in the disease, and was disproportionately associated with temporal lobe-predominant degeneration.
2. This study proposes potential mechanisms for visual artistic creativity in frontotemporal dementia and highlights the need for future research to examine larger cohorts and factors facilitating the emergence of this phenomenon.
Evidence Rating Level: 3 (Average)
Study Rundown: Recent evidence suggests that certain individuals with frontotemporal dementia (FTD) may exhibit visual artistic creativity. The underlying hypothesis posits that degeneration of the frontal and anterior lobes, which typically inhibit the posterior visual-spatial systems, may facilitate VAC in these patients. This case-control study examined the clinical, anatomical, and genetic features of FTD patients with VAC. Patients were prospectively recruited from the Memory and Aging Center (San Francisco, California) between 2002 and 2019. Two control groups were created: a) not visually artistic FTD (NVA-FTD) and b) healthy controls (HC). The primary outcomes were clinical, anatomical, and physiological data between cohorts. Among 689 eligible patients with FTD, 17 met the criteria for VAC-FTD; 51 patients were in each of the NVA-FTD and HC cohorts. Generally, VAC presented early in the course of FTD and was observed in 4 (32.5%) patients prior to FTD symptoms. Temporal lobe-predominant degeneration occurred in 8 out of 17 (47.1%) VAC-FTD patients. Clinically, VAC-FTD patients had higher Mini Mental Status Exam scores compared to NVA-FTD patients. On anatomical assessment with magnetic resonance imaging, VAC-FTD and NVA-FTD demonstrated similar patterns of atrophy in the anterior temporal lobes, amygdala, striatum, and left insula, as expected in patients with FTD. Furthermore, structural covariance analysis demonstrated that patients with VAC-FTD had significantly greater positive structural correlation when assessing cortical brain regions with the dorsomedial occipital region of interest (median [IQR] Pearson r: VAC-FTD: 0.74 [0.61-0.81]; NVA-FTD: 0.55 [0.45-0.68]; HC: 0.54 [0.46-0.65]). Overall, this case-control study demonstrated that 2.5% of patients with FTD exhibited VAC, often observed early in the disease course and disproportionately associated with the temporal lobe-predominant degeneration subtype. One limitation of this study is the small sample size. Future studies that assess larger cohorts and factors that facilitate VAC emergence are warranted.
Click to read the study in JAMA Neurology
Relevant Reading: Brain networks for visual creativity: a functional connectivity study of planning a visual artwork
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