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      De novo development of artistic creativity in Alzheimer's disease

      case-report

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          Abstract

          The case of an 82-year-old female with probable Alzheimer's disease (AD), who developed unusual artistic creativity after development of her disease, is described. The possible pathogenetic mechanism is discussed. The patient showed no inclination toward visual arts during her premorbid years. However, 4 years after development of AD suggestive symptoms she started painting beautiful pictures rather impulsively. Some such paintings have been appreciated even by a qualified art expert. Such de novo development of artistic creativity had been described earlier in subjects with the semantic form of fronto-temporal dementia (FTD), but not in AD. The prevailing concept of lateralized compromise and paradoxical functional facilitation, proposed in connection with FTD subjects, may not be applicable in AD subjects where the affection is more diffuse and more posterior in the brain. Hence, the likely pathogenetic mechanism involved in the case described may remain uncertain. Possibilities are discussed.

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          Most cited references16

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          Creative innovation: possible brain mechanisms.

          This article reviews and develops some theories about the neurobiological basis of creative innovation (CI). CI is defined as the ability to understand and express novel orderly relationships. A high level of general intelligence, domain-specific knowledge and special skills are necessary components of creativity. Specialized knowledge is stored in specific portions of the temporal and parietal lobes. Some anatomic studies suggest that talented people might have alterations of specific regions of the posterior neocortical architecture, but further systematic studies are needed. Intelligence, knowledge and special skills, however, are not sufficient for CI. Developing alternative solutions or divergent thinking has been posited to be a critical element of CI, and clinical as well as functional imaging studies suggest that the frontal lobes are important for these activities. The frontal lobes have strong connections with the polymodal and supramodal regions of the temporal and parietal lobes where concepts and knowledge are stored. These connections might selectively inhibit and activate portions of posterior neocortex and thus be important for developing alternative solutions. Although extensive knowledge and divergent thinking together are critical for creativity they alone are insufficient for allowing a person to find the thread that unites. Finding this thread might require the binding of different forms of knowledge, stored in separate cortical modules that have not been previously associated. Thus, CI might require the co-activation and communication between regions of the brain that ordinarily are not strongly connected. The observations that CI often occurs during levels of low arousal and that many people with depression are creative suggests that alterations of neurotransmitters such as norepinephrine might be important in CI. High levels of norepinephrine, produced by high rates of locus coeruleus firing, restrict the breadth of concept representations and increase the signal to noise ratio, but low levels of norepinephrine shift the brain toward intrinsic neuronal activation with an increase in the size of distributed concept representations and co-activation across modular networks. In addition to being important in divergent thinking, the frontal lobes are also the primary cortical region that controls the locus coeruleus-norepinephrine system. Thus creative people may be endowed with brains that are capable of storing extensive specialized knowledge in their temporoparietal cortex, be capable of frontal mediated divergent thinking and have a special ability to modulate the frontal lobe-locus coeruleus (norepinephrine) system, such that during creative innovation cerebral levels of norepinephrine diminish, leading to the discovery of novel orderly relationships.
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            Paradoxical functional facilitation in brain-behaviour research. A critical review.

            N. Kapur (1996)
            The aim in this review article is to document research findings that have shown paradoxical effects of nervous system changes, whereby direct or indirect neural damage may result in facilitation of behavioural functions. Such findings have often been ignored or undervalued in the brain-behaviour research literature. A further aim is to consider possible mechanisms and theoretical insights related to this facilitation. Analyses of relevant studies show that two major types of paradoxical functional facilitation (PFF) effects may be distinguished. (i) Situations where damage to intact brain tissue brings to normal or near normal a previously subnormal or abnormal level of functioning. I refer to improved levels of functioning in such contexts as restorative PFF effects. One of the best documented examples of such PFF effects is the 'Sprague effect', whereby collicular lesions may bring about an improvement in visual functioning following an initial occipital lesion. (ii) Situations where a subject with nervous system pathology or sensory loss performs better than normal control subjects on a particular task. I refer to improved levels of performance in these contexts as enhancing PFF effects. Restorative and enhancing PFF effects have been found in a range of domains, including memory, sensory and perceptual functions, and language functioning. A potential contribution of PFF effects is that they highlight two important neural mechanisms, i.e. inhibition and compensatory plasticity. Two broad classes of theoretical insights related to PFF effects are therefore discussed: (i) inhibitory mechanisms, which form part of an interactive view of brain function where competitive opponent-processing is a significant feature; (ii) 'compensatory augmentation', which occurs as a specific manifestation of CNS plasticity. Both of these mechanisms are considered in relation to paradoxical increases in CBF and anatomical annexation effects that are seen in neurological patients and in subjects with sensory loss. Paradoxical functional facilitation paradigms represent a powerful methodological tool for confirming or refuting hypotheses in brain-behaviour research. The counter-intuitive nature of PFF findings provides a particularly persuasive set of evidence in support of neural, conceptual or computational models of brain function that specifically predict paradoxical facilitation of cognitive functioning.
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              Portraits of artists: emergence of visual creativity in dementia.

              As a uniquely human talent that has evolved from prehistoric cave paintings, art draws on many brain areas responsible for various cognitive processes. The pattern of degeneration in dementia leads to predictable changes in art. The visuospatial deficits in Alzheimer disease lead to less precision and attention to spatial relationships. In some cases of frontotemporal dementia, artistic creativity appears anew as the disease develops. The artwork is approached in a compulsive manner and is often realistic or surrealistic in style. Art in the context of dementia provides a unique window into the cognitive processes of various brain regions and an opportunity for rehabilitation.
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                Author and article information

                Journal
                Ann Indian Acad Neurol
                AIAN
                Annals of Indian Academy of Neurology
                Medknow Publications & Media Pvt Ltd (India )
                0972-2327
                1998-3549
                Oct-Dec 2011
                : 14
                : 4
                : 291-294
                Affiliations
                [1]Department of Neurology, Vivekananda Institute of Medical Science, Kolkata, India
                Author notes
                For correspondence: Dr. Ambar Chakravarty, 1E 1202, Avishikta II, Kolkata - 700 078, India. E-mail: saschakra@ 123456yahoo.com
                Article
                AIAN-14-291
                10.4103/0972-2327.91953
                3271470
                22346020
                96f64232-742e-4bec-af47-0c629bcc750a
                Copyright: © Annals of Indian Academy of Neurology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 January 2011
                : 13 February 2011
                : 18 February 2011
                Categories
                Case Report

                Neurology
                fronto-temporal dementia,artistic creativity,alzheimer's disease
                Neurology
                fronto-temporal dementia, artistic creativity, alzheimer's disease

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