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

William W. Seeley, Brandy R. Matthews, Richard K. Crawford, Maria Luisa Gorno-Tempini, Dean Foti, Ian R. Mackenzie, Bruce L. Miller
DOI: http://dx.doi.org/10.1093/brain/awm270 39-49 First published online: 5 December 2007

Summary

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.

  • primary progressive aphasia
  • corticobasal degeneration
  • voxel-based morphometry
  • cross modal integration
  • creativity
  • Abbreviations:
    Abbreviations:
    AA
    Anne Adams
    CBD
    corticobasal degeneration
    IFC
    inferior frontal cortex
    PPA
    primary progressive aphasia
    STS
    superior temporal sulcus
    VBM
    voxel-based morphometry.
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