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Brain Advance Access originally published online on December 5, 2007
Brain 2008 131(1):39-49; doi:10.1093/brain/awm270
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© The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Unravelling Boléro: progressive aphasia, transmodal creativity and the right posterior neocortex

William W. Seeley1, Brandy R. Matthews1, Richard K. Crawford1, Maria Luisa Gorno-Tempini1, Dean Foti2, Ian R. Mackenzie3 and Bruce L. Miller1

1Memory and Aging Center, Department of Neurology, UCSF, 2Department of Medicine, Division of Neurology, and 3Department of Pathology, University of British Columbia, Canada

Correspondence to: William W. Seeley, M.D., Box 1207, 350 Parnassus Ave, Ste. 706, San Francisco, CA 91413-1207, USA. E-mail: wseeley{at}memory.ucsf.edu

Most neurological lesion studies emphasize performance deficits that result from focal brain injury. Here, we describe striking gains of function in a patient with primary progressive aphasia, a degenerative disease of the human language network. During the decade before her language deficits arose, Anne Adams (AA), a lifelong scientist, developed an intense drive to produce visual art. Paintings from AA's artistic peak revealed her capacity to create expressive transmodal art, such as renderings of music in paint, which may have reflected an increased subjective relatedness among internal perceptual and conceptual images. AA became fascinated with Maurice Ravel, the French composer who also suffered from a progressive aphasia, and painted his best-known work, ‘Boléro’, by translating its musical elements into visual form. Later paintings, achieved when AA was nearly mute, moved towards increasing photographic realism, perhaps because visual representations came to dominate AA's mental landscape during this phase of her illness. Neuroimaging analyses revealed that, despite severe degeneration of left inferior frontal-insular, temporal and striatal regions, AA showed increased grey matter volume and hyperperfusion in right posterior neocortical areas implicated in heteromodal and polysensory integration. The findings suggest that structural and functional enhancements in non-dominant posterior neocortex may give rise to specific forms of visual creativity that can be liberated by dominant inferior frontal cortex injury.

Key Words: primary progressive aphasia; corticobasal degeneration; voxel-based morphometry; cross modal integration; creativity

Abbreviations: AA, Anne Adams; CBD, corticobasal degeneration; IFC, inferior frontal cortex; PPA, primary progressive aphasia; STS, superior temporal sulcus; VBM, voxel-based morphometry.

Received July 14, 2007. Revised October 8, 2007. Accepted October 8, 2007.


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