Creativity and dementia: a review

Enabling people living with dementia to make choices during creative workshops: a conversation analysis study of co-creativity, choice-sequences, and the supportive actions of carers

PURPOSE

Creative workshops can promote various positive outcomes for people with dementia, such as reductions in undesirable symptoms and achieving levels of autonomy. Although these are undoubtedly positive outcomes, there is little understanding of the specific processes that can enable such outcomes. To address this issue, our study investigates the interactional processes of "choice-sequences," in which a PlwD makes a choice pertaining to materials (e.g. pens, coloured papers) for a creative activity.

METHODS

This Conversation Analysis study draws upon around 60 hours of video-recorded creative workshops involving artists, people with dementia, and carers. Drawing upon the notion of "co-creativity," we examine the collaborative work that goes into accomplishing choice- sequences.

RESULTS

While these sequences typically begin with an artist presenting a choice to a PlwD, carers routinely enter these interactions and provide various forms of support needed to accomplish each basic action of a choice-sequence.

CONCLUSIONS

This study shows carers working alongside the artist to pursue the PlwD's choice in a triadic participation framework, and carers supporting the PlwD in a dyadic participation framework with the artist having exited the interaction. In providing such support, carers can utilize their understandings of the communicative norms and requirements of the PlwD.

The Effect of COVID-19 on Middle-Aged Adults' Mental Health: A Mixed-Method Case-Control Study on the Moderating Effect of Cognitive Reserve

The COVID-19 pandemic has increased the vulnerability of adults to mental health effects, and the study of protective factors has become crucial. Cognitive reserve (CR) is a well-known protective factor against cognitive decline and several health factors; however, its protective effect on mental health during the pandemic has been rarely addressed. Thus, this study explored, through a mixed-method design, the effect of CR on perceived distress and PTSD-like symptoms in middle-aged participants who have survived severe COVID-19 and a matched control group. A total of 432 participants filled out self-report measures of CR, PTSD, depression, and anxiety, and were also asked to provide narration about their COVID-19-related experience. COVID-19 significantly affected the chances of reporting different mental health symptoms; levels of CR played a protective role in reducing their severity. Moreover, adults with higher CR seemed to be more realistic, focusing less on positive emotions, and elaborating more on the sense of anxiety when describing their experience: this might be an indication of a lower use of suppression to regulate emotions. Practical implications of these findings and future directions have been also discussed.

The relationship between cognitive reserve and the spontaneous use of emotion regulation strategies in older adults: a cross-sectional study

BACKGROUND

Several studies reported cognitive reserve (CR) as an important factor in promoting healthy aging within a non-clinical aging population.

AIMS

The main goal of the present study is to investigate the link between higher levels of CR and more effective emotion regulation. In more detail, we examine the association between a number of CR proxies and the habitual use of two emotion regulation strategies, cognitive reappraisal and emotional suppression.

METHODS

Three hundred and ten older adults aged between 60 and 75 (mean = 64.45, SD = 4.37; 69.4% female) joined this cross-sectional study by filling out self-report measures of CR and emotion regulation.² RESULTS: Reappraisal and suppression use were correlated. Practicing different leisure activities constantly over many years, being more original and having a higher education promoted more frequent use of cognitive reappraisal. These CR proxies were also significantly related to suppression use, even though the percentage of variance explained was lower.

DISCUSSION AND CONCLUSIONS

Exploring the role played by the cognitive reserve on different emotion regulation techniques can be useful in understanding which variables predict the use of antecedent-focused (reappraisal) or response-focused (suppression) emotion regulation strategies in aging individuals.

Creativity across the lifespan: changes with age and with dementia

BACKGROUND

It is well known that older age is associated with losses in cognitive functioning. Less is known about the extent to which creativity is changing with age or dementia. Aim of the current study was to gain more insights into psychometric aspects of creativity in younger and older people as well as people with dementia.

METHOD

Our sample comprised three groups, (1) participants between age 18-30 years (n = 24), (2) participants 65 + years without cognitive impairment (n = 24), and (3) participants 65 + years with cognitive impairment / dementia (n = 23). Cognitive abilities were assessed via the Standard Progressive Matrices Test (SPM), Montreal Cognitive Assessment Test (MoCa), and Trail Making Test (TMT). Creativity was assessed via the Creative Reasoning Task (CRT), Test of Creative Thinking-Drawing Production (TCT-DP), and Alternate Uses Task (AUT).

RESULTS

Compared to younger people, older people scored significantly lower in only two out of eleven creativity sub-scores (one in the CRT and one in the TCT-DP). Performance in the SPM was significantly associated with these two sub-scores and age. Cognitively impaired older people had significantly lower scores in the creativity task AUT compared to cognitively healthy older people and younger people. The associations between MoCa and AUT scores were also significant.

CONCLUSION

Creativity appears relatively stable in older age, with exception of those creativity skills that are affected by abstract reasoning (SPM), which appear susceptible to aging. As our findings suggest, cognitive impairment in older age might impair only some aspects of creativity with other creativity aspects being comparable to cognitively healthy people. The age-related and the cognitive status-related effects seem to be independent. The preserved creative abilities can be used in dementia care programs.

Assessing creativity independently of language: A language-independent remote associate task (LI-RAT)

Most creativity measures are either complex or language-dependent, hindering cross-cultural creativity assessment. We have therefore developed and tested a simple, language-independent insight task based on pictures in the style of the widely used verbal remote associate task (RAT). We demonstrate that the language-independent RAT (LI-RAT) allows assessment of different aspects of insight across large samples with different languages. It also correlates with other creativity and general problem-solving tasks. The entire stimulus set, including its preliminary normative data, is made freely available. This information can be used to select items based on accuracy, mean solution time, likelihood to produce an insight, or conceptual and perceptual similarity between the pictures per item.

Can we really 'read' art to see the changing brain? A review and empirical assessment of clinical case reports and published artworks for systematic evidence of quality and style changes linked to damage or neurodegenerative disease

The past three decades have seen multiple reports of people with neurodegenerative disorders, or other forms of changes in their brains, who also show putative changes in how they approach and produce visual art. Authors argue that these cases may provide a unique body of evidence, so-called 'artistic signatures' of neurodegenerative diseases, that might be used to understand disorders, provide diagnoses, be employed in treatment, create patterns of testable hypotheses for causative study, and also provide unique insight into the neurobiological linkages between the mind, brain, body, and the human penchant for art-making itself. However-before we can begin to meaningfully build from such emerging findings, much less formulate applications-not only is such evidence currently quite disparate and in need of systematic review, almost all case reports and artwork ratings are entirely subjective, based on authors' personal observations or a sparse collection of methods that may not best fit underlying research aims. This leads to the very real question of whether we might actually find patterns of systematic change if fit to a rigorous review-Can we really 'read' art to illuminate possible changes in the brain? How might we best approach this topic in future neuroscientific, clinical, and art-related research? This paper presents a review of this field and answer to these questions. We consider the current case reports for seven main disorders-Alzheimer's and Parkinson's disease, frontotemporal and Lewy body dementia, corticobasal degeneration, aphasia, as well as stroke-consolidating arguments for factors and changes related to art-making and critiquing past methods. Taking the published artworks from these papers, we then conduct our own assessment, employing computerized and human-rater-based approaches, which we argue represent best practice to identify stylistic or creativity/quality changes. We suggest, indeed, some evidence for systematic patterns in art-making for specific disorders and also find that case authors showed rather high agreement with our own assessments. More important, through opening this topic and past evidence to a systematic review, we hope to open a discussion and provide a theoretical and empirical foundation for future application and research on the intersection of art-making and the neurotypical, the changed, and the artistic brain.

Individuals with highly superior autobiographical memory do not show enhanced creative thinking

Creative ideas are thought to result from flexible recombination of concepts from memory. A growing number of behavioural and neuroscientific studies provide evidence of a link between episodic memory and divergent thinking; however, little is known about the potential contributions of autobiographical memory to creative ideation. To provide a novel perspective on this issue, we assessed measures of divergent and convergent creative thinking in a cohort (n = 14) of rare individuals showing Highly Superior Autobiographical Memory (HSAM). The HSAM cohort completed memory tasks in addition to a battery of creativity measures, including the Alternative Uses Task, Consequences Task and Remote Associates Task. We performed statistical analyses to establish whether there were any significant differences between HSAM and controls (n = 28) across these measures. Although HSAM participants were superior in the recall of autobiographical events compared to controls, we observed no overall difference between the groups in relation to the creativity measures. These findings suggest that the constructive episodic processes relevant to creative thinking are not enhanced in individuals with HSAM, perhaps because they are compulsively and narrowly focused on consolidation and retrieval of autobiographical events.

A Brief Report on Reviews of Existing Creative Art-Based Interventions in Dementia Care From 2010-2020

The following brief report provides an overview of previously published reviews in the context of creative arts-based interventions for persons with dementia. A total of 22 review articles were identified and summarized. Next steps are suggested for future studies that may wish to a) develop a new review, or b) create new studies filling in the gaps identified by the authors in this report.

Premorbid de novo artistic creativity in frontotemporal dementia (FTD) syndromes

The emergence of new artistic activities or shifts in artistic style in patients with frontotemporal dementia (FTD) syndromes is well documented at or after disease onset. However, a closer look in the literature reveals emerging artistic creativity also before FTD onset, although the significance and underlying pathology of such creative endeavors remain elusive. Here, we systematically review relevant studies and report an additional FTD case to elaborate on artistic activities that developed years before disease manifestation by paying particular attention to the sequence of events in individual patients' biography and clinical history. We further discuss the FTD patient's creative activities in the context of their life events, other initial or "premorbid" dementia symptoms or risk factors described in the literature such as mental illness and mild behavioral impairment (MBI), as well as changes in neuronal systems (i.e., neuroimaging and neuropathology). In addition to our FTD patient, we identified five published cases with an FTD syndrome, including three with FTD, one with primary progressive aphasia (PPA), and one with the behavioral variant of PPA (bvPPA). Premorbid novel creativity emerged across different domains (visual, musical, writing), with the FTD diagnosis ensuing artistic productivity by a median of 8 years. Data on late-life and pre-dementia life events were available in four cases. The late creative phase in our case was accompanied by personality changes, accentuation of personality traits, and cessation of painting activities occurred with the onset of memory complaints. Thus, premorbid personality changes in FTD patients can be associated with de novo creative activity. Stressful life events may also contribute to the burgeoning of creativity. Moreover, primary neocortical areas that are largely spared by pathology at early FTD stages may facilitate the engagement in artistic activities, offering a window of opportunity for art therapy and other therapeutic interventions during the MBI stage or even earlier.

Divergent Thinking Abilities in Frontotemporal Dementia: A Mini-Review

A large number of studies, including single case and case series studies, have shown that patients with different types of frontotemporal dementia (FTD) are characterized by the emergence of artistic abilities. This led to the hypothesis of enhanced creative thinking skills as a function of these pathological conditions. However, in the last years, it has been argued that these brain pathologies lead only to an augmented “drive to produce” rather than to the emergence of creativity. Moreover, only a few studies analyzed specific creative skills, such as divergent thinking (DT), by standardized tests. This Mini-Review aimed to examine the extent to which DT abilities are preserved in patients affected by FTD. Results showed that DT abilities (both verbal and figural) are altered in different ways according to the specific anatomical and functional changes associated with the diverse forms of FTD. On the one hand, patients affected by the behavioral form of FTD can produce many ideas because of unimpaired access to memory stores (i.e., episodic and semantic), but are not able to recombine flexibly the information to produce original ideas because of damages in the pre-frontal cortex. On the other hand, patients affected by the semantic variant are impaired also in terms of fluency because of the degradation of their semantic memory store. Potential implications, limitations, and future research directions are discussed.

Emergent creativity in frontotemporal dementia

Numerous papers report on connections between creative work and dementing illness, particularly in frontotemporal dementia (FTD), which may combine with motor neuron disease (FTD-MND). However, the emergence of FTD(-MND) patients' de novo artistic activities is rarely reported and underappreciated. Therefore, the present review summarizes relevant case studies' outcomes, capturing creativity's multifaceted nature. Here, we systematically searched for case reports by paying particular attention to the chronological development of individual patients' clinical symptoms, signs, and life events. We synoptically compared the various art domains to the pattern of brain atrophy, the clinical and pathological FTD subtypes. 22 FTD(-MND) patients were identified with creativity occurring either at the same time (41%) or starting after the disease onset (59%); the median lag between the first manifestation of disease and the beginning of creativity was two years. In another five patients, novel artistic activity was developed by a median of 8 years before the start of dementia symptoms. Artistic activity usually evolved over time with a peak in performance, followed by a decline that was further hampered by physical impairment during disease progression. Early on, the themes and objects depicted were often concrete and realistic, but they could become more abstract or symbolic at later stages. Emergent artistic processes may occur early on in the disease process. They appear to be a communication of inner life and may also reflect an attempt of compensation or "self-healing". The relative preservation of primary neocortical areas such as the visual, auditory, or motor cortex may enable the development of artistic activity in the face of degeneration of association cortical areas and subcortical, deeper central nervous system structures. It is crucial to understand the differential loss of function and an individual's creative abilities to implement caregiver-guided, personalized therapeutic strategies such as art therapy.

Autism, autistic traits and creativity: a systematic review and meta-analysis

Psychometric, historiometric and psychiatric studies are controversial on a hypothetical link between psychopathology and creativity. In this study, we will try to contribute to this debate by analysing the case of autism. Is there a relationship between autism and creativity? If so, can we find the same relationship in a watered-down form in subjects with autistic traits? In order to answer these questions, we carried out a systematic literature review of the studies on this topic published in the last 10 years. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We also conducted a meta-analysis of data. We found that in the clinical population there are fewer creative performances than in control groups; nonetheless, it is possible to delineate a medium creative profile of subjects with autism. The average creative profile of people with autism shows that they are inhibited in fluency and flexibility, but that they display a high level of detail and a particularly high level of originality in works either generated during tests or created in private time. In particular, the level of detail reached in the latter condition seems to be higher in the autistic population than in the control groups. Better linguistic skills appear to be linked to better creative performances. Linguistic tests, if compared with visual and performative tests, seem to favour the expression of originality in subjects with autism. Although our data on autistic traits are compatible with the hypothesis that a high level of autistic traits is a watered-down replica of the cognitive profile of subjects with autism, we have no sufficient data to support this hypothesis.

The Affective Creativity of a Couple in Dementia Care

The capacity to feel and express themselves in response to worldly surroundings is a defining feature of who a person living with dementia is, and can have profound effects on the ways in which they think, act and express creativity. Drawing on a year of intensive collaborative work with residents living with dementia in an Orthodox Jewish care home in London, I extend our perceptions and understandings of how a couple experiences their day-to-day lives, with particular attention paid to their affective practice in creativity. I demonstrate how the affective creativity of the couple emerges, circulates, and transforms as a spouse's dementia develops, whilst feeling bodies continuously (re)make relations and familiarize themselves with the immediate surroundings through the making of artworks.

Acceptability and feasibility study of a six-week person-centred, therapeutic visual art intervention for people with dementia

BACKGROUND

There has been increasing interest in dementia, the arts and creativity across different disciplines in recent years, with previous literature illustrating the benefits of visual arts for people with dementia.

METHOD

A mixed-methods, quasi-experimental, pre/post design to assess the feasibility, acceptability and preliminary efficacy of a newly developed therapeutic, person-centred visual art intervention for people with dementia attending a day care centre or residing in an assisted living facility.

RESULTS

Five themes were identified from the interviews. Two themes reflected the feasibility/acceptability and the perceived impacts of the intervention, and three themes represented perceived successful elements: participant choice, socialisation and mentally stimulating activities. The quantitative data tentatively indicated enhanced social functioning and quality of life scores post-intervention.

CONCLUSION

These findings indicate that engagement with visual art is effective for people with dementia, and taking into account the factors that impact on feasibility and acceptability will promote future robust evaluation.

"Art, Colors, and Emotions" Treatment (ACE-t): A Pilot Study on the Efficacy of an Art-Based Intervention for People With Alzheimer's Disease

Increasing evidence suggests that non-pharmacological therapies impact on neuropsychiatric symptoms and quality of life in people with Alzheimer’s disease. Among these, art-based interventions seem particularly suitable for elders’ rehabilitation as they act both on cognitive functions and quality of life. However, their benefits are not yet appropriately explored. The main aim of this quasi-experimental study was to test the feasibility and the likely efficacy of a novel multi-dimensional visual art intervention for people with Alzheimer’s disease (PWAD), named Art, Colors, and Emotions treatment (ACE-t). A group of PWAD (N = 10) was recruited from the Memory Clinic of Don Gnocchi Foundation to take part in the ACE-t. A historical control group that followed a usual care program (N = 10) was used for comparison. We considered both feasibility output (adherence and acceptability) and efficacy outcome measures (neuropsychological and neurobehavioral scales). We observed a good adherence to and acceptability of the ACE-t. The following significant intervention-related changes were also observed in ACE-t with respect to usual care: improvement in general cognition, as assessed with the Alzheimer’s Disease Assessment Scale–Cognitive, amelioration in language, and in executive functions, and reduction in Neuropsychiatric Inventory Scale score. In conclusion, ACE-t could be considered as a suitable intervention for the rehabilitation of PWAD, with positive effects on the cognitive and the behavioral status. ACE is a promising new art-based intervention that merits further research, including confirmatory trials of our preliminary results.

A Comparison of Divergent Thinking Abilities Between Healthy Elderly Subjects and MCI Patients: Preliminary Findings and Implications

Objective

Divergent thinking (DT) has attracted research interest because of its potential role in early diagnosis and rehabilitation programs for patients affected by neurodegenerative diseases. Recently, DT has received even more attention because of its proven relationship with cognitive reserve (CR) and the possibility of a standardized assessment. However, few studies have investigated this ability in dementia patients, and even less is known about patients affected by Mild Cognitive Impairment (MCI). Thus, this study aims to investigate DT abilities in MCI patients.

Methods

A total of 25 MCI patients and 25 healthy controls subjects (HC; from a random selection of 50) matched for age, gender, and educational level were enrolled. General cognitive functioning was measured by the Montreal Cognitive Assessment (MoCA), while the Abbreviated Torrance Test for Adults (ATTA) was selected to measure DT.

Results

MANOVA analysis did not reveal any significant differences in DT abilities between MCI patients and HC except for the figural indicator score. A logistic hierarchical regression analysis revealed that the figural indicator score added an 8% of accuracy in the prediction of the group variable over the general cognition measure (MoCA).

Conclusion

MCI patients seem to perform significantly worse than HC only in the figural DT score and this evidence has significant practical implications. First, that figural DT seemed to decrease even earlier than verbal DT and could therefore be taken into account for early diagnosis of MCI patients. On the contrary, the sparing of all the other DT skills (such as verbal DT skills, fluency, flexibility, originality, and elaboration) may suggest that, given its relationship with CR, verbal DT could instead be considered a possible target for prevention or early cognitive stimulation interventions.

Profiles in paint: contrasting responses to a common artistic exercise by people with different dementias

Paintings could offer insight into the varied experiences of people with different dementias. In this project, a single exercise - the painting of a group of objects in still-life - was used to capture artistic production in four artists with different diagnoses of dementia and four healthy artists. Whilst quantitative studies provide important insights into the neuroanatomical supports for artistic actions, autonomous art exercises may yield deeper understanding of the individual creative experience in the context of neurodegenerative disease.

Co-creativity, well-being and agency: A case study analysis of a co-creative arts group for people with dementia

At the heart of this paper is an exploration of artistic co-creativity involving people with dementia and their partners. Co-creativity promotes a relational approach to creativity which nurtures inclusion and participation. This paper investigates how co-creativity can affect well-being from the perspectives of people with dementia and their carers; and explores how well-being and agency might be usefully reconsidered. The article draws on findings from a small-scale study ‘With All’ that focused on music and dance as non-verbal and therefore inclusive artforms. A range of disciplinary perspectives, from psychology, philosophy and social sciences, inform the study. The research used an intrinsic case-study methodology and within this a mixed-methods approach was adopted. This included dialogic interviews, video data analysis and the Canterbury Well-being Scale (CWS). Thematic analysis of the interviews and video data revealed three key themes: autonomy, connections, and art as an enabler. These themes captured the experiences of the participants and facilitated a more nuanced understanding of wellbeing and agency in the context of living with dementia. The analysis of the CWS indicated some improvements in well-being. Following this analysis using multiple data sources, the paper argues that well-being and agency are best understood as relational, and ongoing, rather than completed states. Further both wellbeing and agency contain their opposites (ill-being and passivity). This innovative exploration highlighted the importance of co-creative collaboration as a method that was considered valuable by participants, and that therefore should be further considered in future research with people living with dementia.

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Co-creativity is an inclusive method.

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Co-creativity is valued by people with dementia

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Agency and well-being are linked.

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Agency and well-being are relational.

Why would Parkinson's disease lead to sudden changes in creativity, motivation, or style with visual art?: A review of case evidence and new neurobiological, contextual, and genetic hypotheses

Parkinson's disease (PD) is a devastating diagnosis with, however, potential for an extremely intriguing aesthetic component. Despite motor and cognitive deficits, an emerging collection of studies report a burst of visual artistic output and alterations in produced art in a subgroup of patients. This provides a unique window into the neurophysiological bases for why and how we might create and enjoy visual art, as well as into general brain function and the nature of PD or other neurodegenerative diseases. However, there has not been a comprehensive organization of literature on this topic. Nor has there been an attempt to connect case evidence and knowledge on PD with present understanding of visual art making in psychology and neuroaesthetics in order to propose hypotheses for documented artistic changes. Here, we collect the current research on this topic, tie this to PD symptoms and neurobiology, and provide new theories focusing on dopaminergic neuron damage, over-stimulation from dopamine agonist therapy, and context or genetic factors revealing the neurobiological basis of the visual artistic brain.

Conceptualising and Understanding Artistic Creativity in the Dementias: Interdisciplinary Approaches to Research and Practise

Creativity research has a substantial history in psychology and related disciplines; one component of this research tradition has specifically examined artistic creativity. Creativity theories have tended to concentrate, however, on creativity as an individual phenomenon that results in a novel production, and on cognitive aspects of creativity, often limiting its applicability to people with cognitive impairments, including those with a dementia. Despite growing indications that creativity is important for the wellbeing of people living with dementias, it is less well understood how creativity might be conceptualised, measured and recognised in this population, and how this understanding could influence research and practise. This paper begins by exploring prevailing concepts of creativity and assesses their relevance to dementia, followed by a critique of creativity and dementia research related to the arts. Perspectives from researchers, artists, formal and informal caregivers and those with a dementia are addressed. We then introduce several novel psychological and physiological approaches to better understand artistic-related creativity in this population and conclude with a conceptualisation of artistic creativity in the dementias to help guide future research and practise.

Co-creativity: possibilities for using the arts with people with a dementia

Purpose

The purpose of this paper is to explore the concept of co-creativity in relation to artistic practice with people with a dementia. The aim of the discussion is to outline how co-creativity offers fresh approaches for engaging artists and people with dementia, can contribute to less restrictive understandings of “creativity” and above all, expand the understanding of people with a dementia as creative, relational and agential.

Design/methodology/approach

In order to examine current conceptions of co-creativity and to inform the artistic practice, relevant literature was explored and eight expert interviews were conducted. The interviews were thematically analysed and are included here.

Findings

This paper consequently demonstrates that improvisation, structure, leadership and equality are central elements of co-creative processes and outlines how co-creativity can offer fresh insights into the way in which the arts can engage people with a dementia, the relationship between creativity and dementia and the transformative potential of the co-creative arts for those living with a dementia.

Research limitations/implications

The paper discusses some of the difficulties that are inherent a co-creative approach, including power relations and the limitations of inclusivity. Due to ethical restrictions, the paper is limited by not including the perspectives of people living with a dementia.

Practical implications

This paper paves the way for future research into co-creative processes in a variety of different contexts.

Social implications

A more nuanced understanding of co-creativity with people with dementia could challenge the dominant biomedical and social paradigms that associate “dementia” with irretrievable loss and decline by creating opportunities for creative agency.

Originality/value

This exploration of co-creativity with people with dementia is the first of its kind and contributes to the wider understanding of co-creativity and co-creative practice.

Brain Areas Subserving Torrance Tests of Creative Thinking: An Functional Magnetic Resonance Imaging Study

Background and Purpose

Torrance Tests of Creative Thinking (TTCT) is a well-known and commonly used measure of creativity. However, the TTCT-induced creative hemodynamic brain activity is rarely revealed. The purpose of this study is to elucidate the neural correlates of creative thinking in the setting of a modified version of the figural TTCT adapted for an functional magnetic resonance imaging (fMRI) experiment.

Methods

We designed a blocked fMRI experiment. Twenty-five participants (11 males, 14 females, mean age 19.9±1.8) were asked to complete the partially presented line drawing of the figural TTCT (creative drawing imagery; creative). As a control condition, subjects were asked to keep tracking the line on the screen (line tracking; control).

Results

Compared to the control condition, creative condition revealed greater activation in the distributed and bilateral brain regions including the left anterior cingulate, bilateral frontal, parietal, temporal and occipital regions as shown in the previous creativity studies.

Conclusions

The present revealed the neural basis underlying the figural TTCT using fMRI, providing an evidence of brain areas encompassing the figural TTCT. Considering the significance of a creativity test for dementia patients, the neural correlates of TTCT elucidated by this study may be valuable to evaluate the brain function of patients in the clinical field.

Verbal and visual divergent thinking in aging

According to the peak and decline model divergent thinking declines at a specific age (in or after middle age). However, if divergent thinking declines steadily in aging still has to be clarified. In order to explore the age-related changes in verbal and visual divergent thinking, in the present study a sample of 159 participants was divided in five age groups: young adults (18-35 years), middle-aged adults (36-55), young old (56-74), old (75-85) and the oldest-old (86-98). Two divergent thinking tasks were administered: the alternative uses for cardboard boxes, aimed at assessing verbal ideational fluency, flexibility and originality; the completion drawing task, aimed at assessing visual ideational fluency, flexibility and originality. Results showed that after peaking in the young adult group (20-35 years) all components of verbal and visual divergent thinking stabilized in the middle-aged adult group (36-55 years) and then started declining in the young old group (56-75). Interestingly, all components were found to be preserved after declining. Yet, verbal and visual divergent thinking were found at the same extent across age groups, with the exception of visual ideational fluency, that was higher in the young old group, the old group and the oldest-old group than verbal ideational fluency. These results support the idea that divergent thinking does not decline steadily in the elderly. Given that older people can preserve to some extent verbal and visual divergent thinking, these findings have important implications for active aging, that is, divergent thinking might be fostered in aging in order to prevent the cognitive decline.

Neuropsychiatry of creativity

In this paper, we review in brief the development of ideas that over time have tried to explain why some individuals are more creative than others and what may be the neurobiological links underlying artistic creativity. We note associations with another unique human idea, that of genius. In particular, we discuss frontotemporal dementia and bipolar, cyclothymic mood disorder as clinical conditions that are helping to unravel the underlying neuroanatomy and neurochemistry of human creativity. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

Visualizer cognitive style enhances visual creativity

In the last two decades, interest towards creativity has increased significantly since it was recognized as a skill and as a cognitive reserve and is now always more frequently used in ageing training. Here, the relationships between visual creativity and Visualization-Verbalization cognitive style were investigated. Fifty college students were administered the Creative Synthesis Task aimed at measuring the ability to construct creative objects and the Visualization-Verbalization Questionnaire (VVQ) aimed at measuring the attitude to preferentially use either imagery or verbal strategy while processing information. Analyses showed that only the originality score of inventions was positively predicted by the VVQ score: higher VVQ score (indicating the preference to use imagery) predicted originality of inventions. These results showed that the visualization strategy is involved especially in the originality dimension of creative objects production. In light of neuroimaging results, the possibility that different strategies, such those that involve motor processes, affect visual creativity is also discussed.

Where do bright ideas occur in our brain? Meta-analytic evidence from neuroimaging studies of domain-specific creativity

Many studies have assessed the neural underpinnings of creativity, failing to find a clear anatomical localization. We aimed to provide evidence for a multi-componential neural system for creativity. We applied a general activation likelihood estimation (ALE) meta-analysis to 45 fMRI studies. Three individual ALE analyses were performed to assess creativity in different cognitive domains (Musical, Verbal, and Visuo-spatial). The general ALE revealed that creativity relies on clusters of activations in the bilateral occipital, parietal, frontal, and temporal lobes. The individual ALE revealed different maximal activation in different domains. Musical creativity yields activations in the bilateral medial frontal gyrus, in the left cingulate gyrus, middle frontal gyrus, and inferior parietal lobule and in the right postcentral and fusiform gyri. Verbal creativity yields activations mainly located in the left hemisphere, in the prefrontal cortex, middle and superior temporal gyri, inferior parietal lobule, postcentral and supramarginal gyri, middle occipital gyrus, and insula. The right inferior frontal gyrus and the lingual gyrus were also activated. Visuo-spatial creativity activates the right middle and inferior frontal gyri, the bilateral thalamus and the left precentral gyrus. This evidence suggests that creativity relies on multi-componential neural networks and that different creativity domains depend on different brain regions.

Frontal lobe neurology and the creative mind

Concepts from cognitive neuroscience strongly suggest that the prefrontal cortex (PFC) plays a crucial role in the cognitive functions necessary for creative thinking. Functional imaging studies have repeatedly demonstrated the involvement of PFC in creativity tasks. Patient studies have demonstrated that frontal damage due to focal lesions or neurodegenerative diseases are associated with impairments in various creativity tasks. However, against all odds, a series of clinical observations has reported the facilitation of artistic production in patients with neurodegenerative diseases affecting PFC, such as frontotemporal dementia (FTD). An exacerbation of creativity in frontal diseases would challenge neuroimaging findings in controls and patients, as well as the theoretical role of prefrontal functions in creativity processes. To explore this paradox, we reported the history of a FTD patient who exhibited the emergence of visual artistic productions during the course of the disease. The patient produced a large amount of drawings, which have been evaluated by a group of professional artists who were blind to the diagnosis. We also reviewed the published clinical cases reporting a change in the artistic abilities in patients with neurological diseases. We attempted to reconcile these clinical observations to previous experimental findings by addressing several questions raised by our review. For instance, to what extent can the cognitive, conative, and affective changes following frontal damage explain changes in artistic abilities? Does artistic exacerbation truly reflect increased creative capacities? These considerations could help to clarify the place of creativity—as it has been defined and explored by cognitive neuroscience—in artistic creation and may provide leads for future lesion studies.

A matched filter hypothesis for cognitive control

The prefrontal cortex exerts top-down influences on several aspects of higher-order cognition by functioning as a filtering mechanism that biases bottom-up sensory information toward a response that is optimal in context. However, research also indicates that not all aspects of complex cognition benefit from prefrontal regulation. Here we review and synthesize this research with an emphasis on the domains of learning and creative cognition, and outline how the appropriate level of cognitive control in a given situation can vary depending on the organism's goals and the characteristics of the given task. We offer a matched filter hypothesis for cognitive control, which proposes that the optimal level of cognitive control is task-dependent, with high levels of cognitive control best suited to tasks that are explicit, rule-based, verbal or abstract, and can be accomplished given the capacity limits of working memory and with low levels of cognitive control best suited to tasks that are implicit, reward-based, non-verbal or intuitive, and which can be accomplished irrespective of working memory limitations. Our approach promotes a view of cognitive control as a tool adapted to a subset of common challenges, rather than an all-purpose optimization system suited to every problem the organism might encounter.