Divergent thinking in Alzheimer's and frontotemporal dementia

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.

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.

Systematic Review of the Proposed Associations between Physical Exercise and Creative Thinking

The objective of this study was to evaluate the association between physical exercise and creative thinking. A systematic review approach was employed by searching PubMed, Google Scholar and PsychInfo databases. Among the evaluated 13 studies, 92% indicated a beneficial relationship. However, 77% were vulnerable to moderate-high risk for methodological bias, suggesting adherence to standardized and controlled research initiatives should be promoted. There appears to be weak to modest support for acute, moderate-intensity exercise to benefit creativity. Exercise timing relative to creativity assessment protocols should be addressed and further detailed. Creativity scoring procedures must be refined, and an increased focus on the motivational components of exercise may help guide researchers in measuring creative thoughts and behavior. Broader concluding claims that creativity, in general, is improved or impaired by exercise, is as problematic as sweeping statements that exercise improves or impairs a measure as dynamic as intelligence. Scientific inquiries must specify precisely which outcome characteristics are changing in line with research interventions. This review identifies several fallible linkages between physical activity and creativity. Too few studies were conducted on strong methodological foundations, perpetuating the risk for undermining or inaccurately inflating the potential association between exercise and creative thinking behavior.

Shall we use non-verbal fluency in schizophrenia? A pilot study

Over the last few years, numerous studies have attempted to explain fluency impairments in people with schizophrenia, leading to heterogeneous results. This could notably be due to the fact that fluency is often used in its verbal form where semantic dimensions are implied. In order to gain an in-depth understanding of fluency deficits, a non-verbal fluency task - the Five-Point Test (5PT) - was proposed to 24 patients with schizophrenia and to 24 healthy subjects categorized in terms of age, gender and schooling. The 5PT involves producing as many abstract figures as possible within 1min by connecting points with straight lines. All subjects also completed the Frontal Assessment Battery (FAB) while those with schizophrenia were further assessed using the Positive and Negative Syndrome Scale (PANSS). Results show that the 5PT evaluation differentiates patients from healthy subjects with regard to the number of figures produced. Patients׳ results also suggest that the number of figures produced is linked to the "overall executive functioning" and to some inhibition components. Although this study is a first step in the non-verbal efficiency research field, we believe that experimental psychopathology could benefit from the investigations on non-verbal fluency.

The five-point test: reliability, validity and normative data for children and adults

The present study provides normative data from a sample of 257 healthy children and 608 adults on a modified version of the Five-Point Test (5PT). The 5PT is a structured and standardized test measuring figural fluency functions. Interrater reliability, test-retest-reliability and construct validity of this measure were analyzed. The sensitivity of the task for cognitive disturbances of patients with neurological diseases was proven by analyzing the test performance in the 5PT of patients with Parkinson's disease. Finally, normative data stratified by age and corrected for education level is provided. The results of the present study confirm the value of the 5PT in the measurement of figural fluency functions in clinical examination and neuropsychological research.

Creativity and dementia: a review

In these last years, creativity was found to play an important role for dementia patients in terms of diagnosis and rehabilitation strategies. This led us to explore the relationships between dementia and creativity. At the aim, artistic creativity and divergent thinking are considered both in non-artists and artists affected by different types of dementia. In general, artistic creativity can be expressed in exceptional cases both in Alzheimer's disease and Frontotemporal dementia, whereas divergent thinking decreases in dementia. The creation of paintings or music is anyway important for expressing emotions and well-being. Yet, creativity seems to emerge when the right prefrontal cortex, posterior temporal, and parietal areas are relatively intact, whereas it declines when these areas are damaged. However, enhanced creativity in dementia is not confirmed by controlled studies conducted in non-artists, and whether artists with dementia can show creativity has to be fully addressed. Future research directions are suggested.