Enhanced artistic creativity with temporal lobe degeneration.

Sir
It is unusual to find a previously non-artistic individual who develops skill in art, late in life, particularly in the face of a progressive dementia.1 We have three patients who became accomplished painters after the appearance of frontotemporal dementia.2 All three improved artistically during the early and middle stages of their illness. All had a temporal variant3 of frontotemporal dementia where the anterior temporal lobes are dysfunctional but the frontal lobes are relatively spared. One such patient is described.

A 68-year-old right-handed man was seen for an illness of 12 years' duration. A previously successful businessman, at age 56 he began to describe “open” and “closed” periods. When “closed”, he was agitated and dysphoric and experienced lights and sounds as exquisitely intense and painful. When “open”, lights and sounds produced a euphoria that enhanced creativity. Over the next decade, he painted the images visualised when “open” or “closed”. At age 58, he became verbally repetitive, anomic, and disinhibited. He changed clothes in public parking lots, shoplifted, and insulted strangers. He remained sensitive to light and showed heightened visual awareness to his environment. Although he had shown no previous interest in art, at 56 he began painting for the first time. Over the next decade he drew with increasing precision and detail. He repeated his subject matter, experimenting with different colours, gradually improving the presentation. The first paintings featured brightly coloured shapes. By 57, colours became harder and object edges were cleanly defined. His first drawings were done quickly, but later works were crafted with care; he took hours to complete single lines (figure, top). Between ages 63 and 66 his work won awards at local art shows. At age 67 his work began to deteriorate and by 68 he drew bizarre doll-like figures. On examination at age 68, he was remote and irritable, showing little facial emotion. He displayed heightened interest in his environment, commenting extensively on colours and sounds. His mini-mental state examination score was 15. Verbal output was fluent but a semantic anomia and a mild comprehension deficit were present. He did not recognise the meaning of many words. He generated two words beginning with the letter “D”, but 17 novel designs (superior performance). An electroencephalogram was normal. Magnetic resonance imaging showed bitemporal atrophy. Single photon emission computed tomography revealed bilateral temporal hypoperfusion, worse on the right than the left (figure, bottom). Frontal perfusion was normal. The highest perfusion occurred in the right posterior parietal and occipital cortex.