Performance of patients with frontotemporal lobar degeneration on artistic tasks: A pilot study

Anauate, Maria Cristina; Bahia, Valéria Santoro; Nitrini, Ricardo; Radanovic, Marcia

doi:10.1590/S1980-57642014DN81000011

ABSTRACT

Several studies have addressed visuospatial and executive skills in artistic activities in Frontotemporal Lobar Degeneration (FTLD) and Alzheimer's disease (AD). Objective: To investigate the performance of FTLD patients compared to controls on two artistic tasks. Methods: Four FTLD patients with mean age of 57 (8.7) years and schooling of 12.2 (4.5) years plus 10 controls with mean age of 62.9 (8.6) years and schooling of 12.3 (4.6) years, were assessed using the Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and by a three-stage artistic protocol including visual observation, copying and collage, based on a Sisley painting. Results: FTLD patients had lower scores than controls on Visuospatial Perception, Copy, Collage, Examiner's Observation, and Total, showing distinct patterns of performance according to FTLD sub-type: semantic PPA, nonfluent PPA and bvFTD. Conclusion: FTLD patients presented impairment in the visuospatial and executive skills required to perform artistic tasks. We demonstrated that the application of the instrument as a complimentary method for assessing cognitive skills in this group of patients is possible. Further studies addressing larger and more homogeneous samples of FTLD patients as well as other dementias are warranted.

Key words:
art therapy; executive function; visual perception; frontotemporal lobar degeneration

RESUMO

Vários estudos relatam as habilidades visuoespaciais em atividades artísticas em Degeneração Lobar Frontotemporal (DLFT) e Demência de Alzheimer (DA). Objetivo: Investigar as alterações no desempenho de pacientes com DLFT comparados a controles em tarefas artísticas. Métodos: Quatro pacientes com DLFT (idade média de 57 (8,7) e escolaridade de 12,2 (4,5) anos) e 10 controles (idade média de 62,9 (86) e escolaridade de 12,3 (4,6) anos) foram avaliados através da Bateria de Avaliação Cognitiva de Terapia Ocupacional Lowenstein (LOTCA) e um protocolo de arte em três estágios: observação visual, cópia colorida e colagem baseada em uma pintura de Sisley. Resultados: Os pacientes com DLFT tiveram menores pontuações em Percepção Visoespacial, Cópia, Colagem, Observação do examinador e Total, mostrando distintos tipos de desempenho nos subtipos de DFT variante comportamental, APP não fluente e APP semântica. Conclusão: Os pacientes com DLFT apresentaram prejuízo nas habilidades executivas e visuoespaciais necessárias ao desempenho nas tarefas artísticas propostas. Evidenciamos ser possível a aplicação deste instrumento como método de avaliação complementar de habilidades cognitivas neste grupo de pacientes. Novos estudos em um grupo maior e mais homogêneo de pacientes com DLFT, bem como em outras demências, são necessários.

Palavras-chave:
terapia pela arte; função executiva; percepção visual; degeneração lobar frontotemporal

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REFERENCES

¹
Van Sommers P. A system for drawing and drawing-related neuropsychology. Cogn Neuropsychol 1989;6:117-164.
²
Rankin KP, Liu AA, Howard S, et al. A Case-controlled study of altered visual art production in Alzheimer's and FTLD. Cogn Behav Neurol 2007;20:48 -61.
³
Liu A, Miller BL. Visual art and the brain. In: Goldenberg G, Miller BL (Eds.), Handbook of Clinical Neurology, Vol. 88 (3rd series). Neuropsychology and behavioral neurology. New York: Elsevier, 2008:472-488.
⁴
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51: 1546-1554.
⁵
McKhann GM, Albert SM, Grossman M, et al. Clinical and pathological diagnosis of frontotemporal dementia. Report of the Work Group on Frontotemporal Dementia and Pick's Disease. Arch Neurol 2001; 58:1803-1809.
⁶
Annoni JM, Devuyst G, Carota A, Bruggimann L, Bogouusslavsky J. Changes in artistic style after minor posterior stroke. J Neurol Neurosurg Psychiatry 2005;76:797-803.
⁷
Maurer K, Prvulovic D. Paintings of an artist with Alzheimer's disease: visuoconstructional deficits during dementia. J Neural Transm 2004; 111:235-245.
⁸
Mendez MF, Mendez MA, Martin R, et al. Complex visual disturbances in Alzheimer's disease. Neurology 1990;40:439-443.
⁹
Henderson VW, Mack W, Williams BW. Spatial disorientation in Alzheimer's disease. Arch Neurol 1989;46:391-394.
¹⁰
Kirk A, Kertesz A. On drawing impairment in Alzheimer's disease. Arch Neurol 1991;48:73-77.
¹¹
Miller BL, Hou CE. Portraits of artists: emergence of visual creativity in dementia. Arch Neurol 2004;61:842-844.
¹²
Miller BL, Boone K, Cummings JL, et al. Functional correlates of musical and visual ability in frontotemporal dementia. Br J Psychiatry 2000; 176:458-463.
¹³
Miller BL, Cummings J, Mishkin F, et al. Emergence of artistic talent in frontotemporal dementia. Neurology 1998;51:978-982.
¹⁴
Mendez MF. Dementia as a window into the neurology of art. Med Hypotheses 2004;63:1-7.
¹⁵
Smith GE, Ivnik RJ. Normative neuropsychology. In Petersen RC (Ed.). Mild Cognitive Impairment. New York: Oxford, 2003:63-88.
¹⁶
Folstein MF, Folstein SE, McHugh PR. ''Mini-mental state'': a practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12:189-198.
¹⁷
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989; 37:725-729.
¹⁸
Pfeffer, RJ, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community J Gerontol 1982;37:323-329.
¹⁹
Paradela EMP, Lourenço RA, Veras RP. Validation of geriatric depression scale in a general outpatient clinic. Rev Saude Publica 2005;39: 918-23.
²⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
²¹
Katz, N, Itzkovich, M, Averbuch, S, Elazar, B. Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain injured patients: reliability and validity. Am J Occup Ther 1989;43:184-192.
²²
Drago V, Crucian GP, Foster PS, et al. Lewy body dementia and creativity: Case report. Neuropsychologia 2006;44:3011-3015.
²³
Seeley WW, Matthews BR, Crawford RK, et al. Unravelling Bolero: progressive aphasia, transmodal creativity and the right posterior neocortex. Brain 2008;131:39-49.
²⁴
de Souza LC, Volle E, Bertoux M, et. al. Poor creativity in frontotemporal dementia: a window into the neural bases of the creative mind. Neuropsychologia 2010;48:3733-3742.

Publication Dates

Publication in this collection
Jan-Mar 2014

History

Received
10 Sept 2013
Accepted
20 Nov 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Van Sommers P. A system for drawing and drawing-related neuropsychology. Cogn Neuropsychol 1989;6:117-164.

[2] ²
Rankin KP, Liu AA, Howard S, et al. A Case-controlled study of altered visual art production in Alzheimer's and FTLD. Cogn Behav Neurol 2007;20:48 -61.

[3] ³
Liu A, Miller BL. Visual art and the brain. In: Goldenberg G, Miller BL (Eds.), Handbook of Clinical Neurology, Vol. 88 (3rd series). Neuropsychology and behavioral neurology. New York: Elsevier, 2008:472-488.

[4] ⁴
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51: 1546-1554.

[5] ⁵
McKhann GM, Albert SM, Grossman M, et al. Clinical and pathological diagnosis of frontotemporal dementia. Report of the Work Group on Frontotemporal Dementia and Pick's Disease. Arch Neurol 2001; 58:1803-1809.

[6] ⁶
Annoni JM, Devuyst G, Carota A, Bruggimann L, Bogouusslavsky J. Changes in artistic style after minor posterior stroke. J Neurol Neurosurg Psychiatry 2005;76:797-803.

[7] ⁷
Maurer K, Prvulovic D. Paintings of an artist with Alzheimer's disease: visuoconstructional deficits during dementia. J Neural Transm 2004; 111:235-245.

[8] ⁸
Mendez MF, Mendez MA, Martin R, et al. Complex visual disturbances in Alzheimer's disease. Neurology 1990;40:439-443.

[9] ⁹
Henderson VW, Mack W, Williams BW. Spatial disorientation in Alzheimer's disease. Arch Neurol 1989;46:391-394.

[10] ¹⁰
Kirk A, Kertesz A. On drawing impairment in Alzheimer's disease. Arch Neurol 1991;48:73-77.

[11] ¹¹
Miller BL, Hou CE. Portraits of artists: emergence of visual creativity in dementia. Arch Neurol 2004;61:842-844.

[12] ¹²
Miller BL, Boone K, Cummings JL, et al. Functional correlates of musical and visual ability in frontotemporal dementia. Br J Psychiatry 2000; 176:458-463.

[13] ¹³
Miller BL, Cummings J, Mishkin F, et al. Emergence of artistic talent in frontotemporal dementia. Neurology 1998;51:978-982.

[14] ¹⁴
Mendez MF. Dementia as a window into the neurology of art. Med Hypotheses 2004;63:1-7.

[15] ¹⁵
Smith GE, Ivnik RJ. Normative neuropsychology. In Petersen RC (Ed.). Mild Cognitive Impairment. New York: Oxford, 2003:63-88.

[16] ¹⁶
Folstein MF, Folstein SE, McHugh PR. ''Mini-mental state'': a practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12:189-198.

[17] ¹⁷
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989; 37:725-729.

[18] ¹⁸
Pfeffer, RJ, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community J Gerontol 1982;37:323-329.

[19] ¹⁹
Paradela EMP, Lourenço RA, Veras RP. Validation of geriatric depression scale in a general outpatient clinic. Rev Saude Publica 2005;39: 918-23.

[20] ²⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[21] ²¹
Katz, N, Itzkovich, M, Averbuch, S, Elazar, B. Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain injured patients: reliability and validity. Am J Occup Ther 1989;43:184-192.

[22] ²²
Drago V, Crucian GP, Foster PS, et al. Lewy body dementia and creativity: Case report. Neuropsychologia 2006;44:3011-3015.

[23] ²³
Seeley WW, Matthews BR, Crawford RK, et al. Unravelling Bolero: progressive aphasia, transmodal creativity and the right posterior neocortex. Brain 2008;131:39-49.

[24] ²⁴
de Souza LC, Volle E, Bertoux M, et. al. Poor creativity in frontotemporal dementia: a window into the neural bases of the creative mind. Neuropsychologia 2010;48:3733-3742.

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