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Thursday, June 5, 2003

NATURAL SELECTIONS

Losing your mind may produce great art


Inevitably, we learn a lot about ourselves when something goes wrong. By studying what happens to people afflicted by various forms of brain degeneration, for example, we have learned a lot about how the brain works. This generally means that by understanding what goes wrong when specific parts of the brain die, we gain an insight into the function of that part of the brain.

Yet brain degeneration does not always have wholly negative effects. A surprising new finding is that as some forms of dementia progress and various brain functions are impaired, other brain abilities are stimulated.

In the May 27 issue of the journal Neurology, there is a report of an artist whose skill improved as her dementia progressed. The woman was a high-school art teacher who had emigrated to the United States from China as a teenager and studied painting in college. She had completed a master's degree in fine arts, combining training in Western representational art and Chinese brush-painting.

She was diagnosed with frontotemporal dementia, a rare type of dementia that is often genetic and usually develops in people in their 50s. It is often confused with Alzheimer's disease, but differs in several important ways.

First, FTD patients suffer by cerebral atrophy (brain "shrinkage") in the frontal and anterior temporal lobes of the brain, while Alzheimer's affects the hippocampal, posterior temporal and parietal regions. Alzheimer's patients have characteristic plaques in the brain, but these are absent in FTD patients.

Alzheimer's patients experience severe memory loss, sometimes seeming to "time travel" in their memories, believing themselves to be at a previous stage in their lives. FTD patients, however, typically remain oriented to their current time and place. FTD patients are also able to recall information about the present and past and retain spatial awareness (they can navigate and locate their surroundings accurately).

Although rare, FTD may account for 2-5 percent of dementia cases (in the United States that translates into 140,000-350,000 cases of dementia) and for as many as 25 percent of presenile dementias. It occurs predominantly after age 40 and usually before age 65, with equal incidence in men and women. In nearly half of the patients, a family history of dementia exists in a first-degree relative (parent or sibling), suggesting a strong genetic component in these cases.

In 1986, the Chinese-American artist began to have difficulty in grading and lesson planning, and in 1995 she retired at the age of 52. By then she could no longer control the classroom or remember students' names.

The artist was seen by neurologist Bruce Miller, of the University of California, San Francisco, who was also the lead author of the report in Neurology. He found that the artist had suffered cell loss in the left frontal lobe, an area important in language, planning and organization and regulating social behavior. It explains why she had trouble in her teaching duties.

Yet while her teaching ability suffered, her paintings evolved.

Prior to the onset of FTD, the artist painted mainly landscapes and representational paintings, either in Western-style watercolors or classical Eastern brush-paintings. As the disease progressed, she started merging the Eastern and Western styles of painting.

"Her painting became wilder and freer and more original as her language declined," Miller said. "From 1990-93 she created an exquisite series of highly patterned paintings based on the Chinese horoscope, and in 1997 she began a new series of 12 male nude figurative paintings. It was clear that she was released from the formal restraints of her training. Her later pieces were no longer realistic, but had an intense emotional and impressionistic style."

The artist now has limited speech ability, and she stopped producing new works after 2001. But she is still able to recall the paintings and the strategies she used to create them. "When she talks about her paintings, her language comes more freely and is more spontaneous than when any other topic is discussed," Miller said.

Miller has reported on other frontotemporal dementia patients with no previous artistic ability who developed an interest in and talent for art as the disease progressed.

"The ability to transcend ordinary social, physical and cognitive constraints is a feature of great artists," Miller said. "The release of the language-dominant patterns of thinking appears to be a key factor in the emergence of artistic skills in frontotemporal dementia patients. The release of frontal lobe functions involved with social restraints may have played a role in the later paintings of this artist."

The startling suggestion is that language, one of the most remarkable of human abilities, inhibits creativity.

"This case suggests that our brain wiring may be a major factor in determining the nature of our creativity," said Miller.

And it should temper our view of patients with dementia.

"We typically don't think that something could be getting better; we only think about what's getting worse," he said. "Now I always ask if there's anything patients are doing very well, or better than before. It's a remarkable response to a dementing illness."

Rowan Hooper welcomes comments at rowan.hooper@tcd.ie


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