Anne Adams was an accomplished scientist. Then, as dementia claimed her brilliant mind, she became an accomplished and resolute artist — painting increasingly beautiful and elaborate works.
During the early stages of her illness, she created complex visual interpretations of classical music, such as George Gershwin’s Rhapsody in Blue and Maurice Ravel’s Boléro. Then she shifted to painting even more abstract concepts, such as numbers.
A recent UC San Francisco-led study of brain scans of Adams and other patients with the deadly “frontotemporal” variety of dementia has revealed the underlying mechanism behind this mysterious shift in creative expression.
As the brain region responsible for language is dying, it activates the visual processing area that drives creativity, according to Dr. Bruce Miller, the senior author of the recent study, a collaboration of 27 scientists published in the journal JAMA Neurology.
“This is a way that the brain copes with an insult,” said Miller, director of the UCSF Memory and Aging Center. “It mobilizes whatever circuits are still available and untouched.”
Similar yet different changes may help explain the mood and behavioral shifts sometimes seen in patients who have had other brain injuries or illnesses, such as stroke or Alzheimer’s disease, he said.
The UCSF research also offers insights into the workings of the healthy brain, engaged in a constant dance — some circuits turning on and others turning off.
On Friday night, Adams’ story — which, uncannily, parallels a similar burst of creativity and mental decline in the composer Ravel a century earlier — will be told on stage at the San Francisco Conservatory of Music in a one-night performance of the play UnRavelled. The performance, produced by the Association for Frontotemporal Degeneration, will be followed by a 30-minute panel discussion on creativity and brain science by UCSF’s Miller and other experts.
“It is a very beautiful, sad story that captures the birth of something extraordinary,” said Miller.
Frontotemporal dementia (FTD), which affects about 60,000 Americans, is different from Alzheimer’s disease. It typically affects people younger — in their 50s and 60s — such as actor Bruce Willis. It doesn’t affect memory; rather, it changes behavior and language. It is incurable, and there are no approved therapies to slow or alter its course.
Scientists previously thought that neurodegenerative diseases hit the brain everywhere, at once. Now they know that they start in a very small and specific region of the brain, targeting certain cells. But over time, the damage spreads and is lethal.
Misfolded proteins build up in the frontal and temporal lobes, disrupting and eventually killing cells called von Economo neurons. This part of the brain does a lot of things — but its most important job is language and social behavior.
A small subset of patients with a specific variant of FTD show a burst of visual creativity as they decline — painting or making montages, pottery, sculpture, jewelry, quilts, even welding colorful insect-like creatures. It is not known why some patients develop creativity and others don’t.
Patients who were artists become more visually obsessed. But even people with no previous interest in art become engaged in their new hobby for many hours a day.
When healthy, UCSF patient Victor Wightman had no interest in art; he enjoyed running, swimming and basketball. But at age 48, a year before his FTD diagnosis, he began painting images of animals and cartoon characters in vivid, almost electric, colors.
Another patient, Jancy Chang, was a talented Santa Cruz artist and teacher. After retirement at age 52 due to declining language skills, her paintings became much bolder, wilder and more original.
A third, Dick Smith, became a constant walker as he declined. He wasn’t experienced in art, and was too restless to focus. But as he circled, caregivers handed him a paint brush. With each restless loop, his colors changed.
Such research can accelerate the search for therapeutics and improve caregiving, said Susan Dickinson, CEO of the Association for Frontotemporal Degeneration.
“Everything we learn about the fundamental aspects of what this disease is, and how it affects the brain, will help us design strategies to intervene, or even prevent, the disease process,” she said. “And it offer clues for ways to help families stay connected with the people they love, helping maintain the quality of life as long as possible.”
“Even if patients don’t become beautifully creative, like Anne Adams did,” Dickinson said, “are there ways to help them stay active and feel purposeful?”
The link between FTD and new artistic talent was first described by Miller in 2007 in the journal Brain. The new UCSF study, led by behavioral neurologist Dr. Adit Friedberg, sought to understand why.
The team analyzed the records of 689 FTD patients and identified 17, or 2.5%, who had experienced a burst in visual creativity at the start of their dementia. It compared the brain scans of these patients to matched patients who did not show increased creativity, as well as the brains of mentally healthy people.
The scans revealed that the region of the frontal cortex, responsible for language, had shrunk in visually creative patients, while areas in the back of the brain on the right side, devoted to visual and spatial processing, were more active.
In healthy people, these visual regions may be inhibited by the dominant frontal cortex, said Miller. But when damaged, creativity is released.
This shift seems to reflect “neuroplasticity” — the ability of the brain to form new connections or reorganize itself, the study concluded. It also found an enlargement in the area of the brain that involves movement of the right hand.
“When one part of the brain doesn’t work as well, other areas may be able to work better than they did before,” said Miller.”
Periodic brain scans at UCSF offered a remarkable glimpse of changes in Anne Adams, from her diagnosis in 1997 until her death in 2007.
Trained in physics and chemistry, she earned a PhD in cell biology while raising four children. She taught and did research at the University of British Columbia, then left her career to take care of an injured son. To pass the time, she turned to art. Her initial works were simple drawings and architectural watercolors.
“She was very bright, and she was also artistic,” said her widower Robert Adams, 83, a professor emeritus of math at the University of British Columbia.
Increasingly drawn to repetition and abstraction, her work turned more vibrant. In a rendering of the mathematical ratio pi, she mapped a vivid matrix of its first 1,471 digits.
Her most ambitious piece, which took three months, deconstructed Ravel’s famous song Boléro. The insistent, rhythmic plod of the music — all 340 bars — was transformed into symbols and colors. The A note was painted silver; A-flat, copper; B, leaf green; B-flat, metallic green, and so on.
Just like Boléro‘s melody, her symbols repeated and repeated. With each crescendo, the rectangles grew taller.
Scientists now suspect that in the late 1920s, when Ravel composed Boléro, he also suffered from FTD. A man of order and perfection, his behavior turned erratic. Within several years, he lost the ability to translate music from his mind into notes.
Soon Anne began to struggle to find words and add numbers. Her paintings grew increasingly symmetrical. Her final works, achieved when she was nearly mute, moved towards photographic realism.
“Painting was something she could do easily,” Adams said. “Every morning, she would come down and go into her office and paint,” eight hours a day.”
Tragically, the illness slowly claimed both Anne’s words and skills. But her drive to paint persisted.
“She got to the stage where she’d come down, sit down at her desk, with the paints in front of her,” said Robert Adams. “And she’d just look at them.”
