Department of Geriatric Psychiatry, Klinikum Christophsbad, Faurndauer Str. 6-28, 73035, Göppingen, Germany.
Institute of Clinical Neurobiology, Vienna, Austria.
J Neural Transm (Vienna). 2021 Mar;128(3):279-293. doi: 10.1007/s00702-021-02325-z. Epub 2021 Mar 12.
Numerous papers report on connections between creative work and dementing illness, particularly in frontotemporal dementia (FTD), which may combine with motor neuron disease (FTD-MND). However, the emergence of FTD(-MND) patients' de novo artistic activities is rarely reported and underappreciated. Therefore, the present review summarizes relevant case studies' outcomes, capturing creativity's multifaceted nature. Here, we systematically searched for case reports by paying particular attention to the chronological development of individual patients' clinical symptoms, signs, and life events. We synoptically compared the various art domains to the pattern of brain atrophy, the clinical and pathological FTD subtypes. 22 FTD(-MND) patients were identified with creativity occurring either at the same time (41%) or starting after the disease onset (59%); the median lag between the first manifestation of disease and the beginning of creativity was two years. In another five patients, novel artistic activity was developed by a median of 8 years before the start of dementia symptoms. Artistic activity usually evolved over time with a peak in performance, followed by a decline that was further hampered by physical impairment during disease progression. Early on, the themes and objects depicted were often concrete and realistic, but they could become more abstract or symbolic at later stages. Emergent artistic processes may occur early on in the disease process. They appear to be a communication of inner life and may also reflect an attempt of compensation or "self-healing". The relative preservation of primary neocortical areas such as the visual, auditory, or motor cortex may enable the development of artistic activity in the face of degeneration of association cortical areas and subcortical, deeper central nervous system structures. It is crucial to understand the differential loss of function and an individual's creative abilities to implement caregiver-guided, personalized therapeutic strategies such as art therapy.
大量文献报道了创造性工作与痴呆症之间的联系，尤其是在额颞叶痴呆症（FTD）中，这种疾病可能与运动神经元病（FTD-MND）合并。然而，FTD（-MND）患者新发的艺术活动却很少被报道和重视。因此，本综述总结了相关病例研究的结果，捕捉了创造力的多面性。在这里，我们通过特别关注个体患者的临床症状、体征和生活事件的时间发展，系统地搜索了病例报告。我们综合比较了各种艺术领域与脑萎缩模式、临床和病理 FTD 亚型的关系。我们共确定了 22 例 FTD（-MND）患者，他们的创造力要么同时出现（41%），要么在疾病发病后开始出现（59%）；疾病首次发作与创造力开始之间的中位数潜伏期为两年。在另外五名患者中，新的艺术活动是在痴呆症状开始前中位数 8 年发展起来的。艺术活动通常随着时间的推移而发展，表现达到高峰，随后由于疾病进展导致身体受损，表现进一步下降。早期，所描绘的主题和对象通常是具体和现实的，但在后期阶段可能变得更加抽象或具有象征意义。新的艺术创作过程可能在疾病早期发生。它们似乎是内在生活的一种表达，也可能反映了一种补偿或“自我疗愈”的尝试。初级新皮质区域（如视觉、听觉或运动皮质）的相对保留，可能使在联合皮质区域和皮质下、更深的中枢神经系统结构退化的情况下，发展艺术活动成为可能。了解功能的差异丧失和个体的创造力对于实施护理人员指导的个性化治疗策略（如艺术治疗）至关重要。
