ImportanceThe neurological substrates of visual artistic creativity (VAC) are unknown. VAC is demonstrated here to occur early in frontotemporal dementia (FTD), and multimodal neuroimaging is used to generate a novel mechanistic hypothesis involving dorsomedial occipital cortex enhancement. These findings may illuminate a novel mechanism underlying human visual creativity.ObjectiveTo determine the anatomical and physiological underpinnings of VAC in FTD.Design, Setting, and ParticipantsThis case-control study analyzed records of 689 patients who met research criteria for an FTD spectrum disorder between 2002 and 2019. Individuals with FTD and emergence of visual artistic creativity (VAC-FTD) were matched to 2 control groups based on demographic and clinical parameters: (1) not visually artistic FTD (NVA-FTD) and (2) healthy controls (HC). Analysis took place between September 2019 to December 2021.Main Outcomes and MeasuresClinical, neuropsychological, genetic, and neuroimaging data were analyzed to characterize VAC-FTD and compare VAC-FTD with control groups.ResultsOf 689 patients with FTD, 17 (2.5%) met VAC-FTD inclusion criteria (mean [SD] age, 65 [9.7] years; 10 [58.8%] female). NVA-FTD (n = 51; mean [SD] age, 64.8 [7] years; 25 [49.0%] female) and HC (n = 51; mean [SD] age, 64.5 [7.2] years; 25 [49%] female) groups were well matched to VAC-FTD demographically. Emergence of VAC occurred around the time of onset of symptoms and was disproportionately seen in patients with temporal lobe predominant degeneration (8 of 17 [47.1%]). Atrophy network mapping identified a dorsomedial occipital region whose activity inversely correlated, in healthy brains, with activity in regions found within the patient-specific atrophy patterns in VAC-FTD (17 of 17) and NVA-FTD (45 of 51 [88.2%]). Structural covariance analysis revealed that the volume of this dorsal occipital region was strongly correlated in VAC-FTD, but not in NVA-FTD or HC, with a volume in the primary motor cortex corresponding to the right-hand representation.Conclusions and RelevanceThis study generated a novel hypothesis about the mechanisms underlying the emergence of VAC in FTD. These findings suggest that early lesion-induced activation of dorsal visual association areas may predispose some patients to the emergence of VAC under certain environmental or genetic conditions. This work sets the stage for further exploration of enhanced capacities arising early in the course of neurodegeneration.

Hopelessness in parents has implications for parents' own well‐being as well as their ability to meet the needs of their children. In the present study, we examined the effect of maladaptive behaviors in children with autism on parental hopelessness, with particular attention to whether parental reflective functioning would moderate the effect of maladaptive behaviors on parental hopelessness. Our sample included 68 parents of children with autism between the ages of 3 and 18. Findings revealed a significant positive relationship between maladaptive behaviors in the children and hopelessness in the parents. Moreover, parental reflective functioning moderated the effect of child maladaptive behaviors on parental hopelessness, such that children's maladaptive behaviors were positively associated with parental hopelessness in parents with low (but not high) reflective functioning. Findings suggest parental reflective functioning may be a protective factor against parental hopelessness, and thus a possible target for interventions for hopelessness in parents whose children with autism exhibit greater maladaptive behaviors.

BackgroundClinical experience in dementia indicates high risk for financial mismanagement, with grave consequences for patients and families. However, to date there has been little scientific study of real world financial errors in dementia or differential vulnerability in different syndromes.MethodCaregivers for people with Alzheimer’s disease (n = 50), behavioral variant frontotemporal dementia (bvFTD, n = 58), and primary progressive aphasia (PPA, n = 39) reported whether care recipients had made financial mistakes within the last year; and if so, categorized these as resulting from: (a) being too trusting or gullible, (b) being wasteful or careless with money, or (c) trouble with memory. In a pre‐registered analysis (https://archive.org/details/osf-registrations-vupj7-v1), we examined two hypotheses regarding vulnerability in different syndromes. Hypothesis 1: Financial mistakes due to being too trusting or gullible and being wasteful or careless with money are more prevalent in bvFTD than in Alzheimer’s disease. Hypothesis 2: Financial mistakes due to trouble with memory are more prevalent in Alzheimer’s disease than in bvFTD.Result32% of Alzheimer’s disease caregivers, 51.7% of bvFTD caregivers, and 30.7% of PPA caregivers reported financial errors in the last year. Concordant with our Hypothesis 1, people with bvFTD were more likely than those with Alzheimer’s disease to make mistakes referable to being too trusting or gullible (OR 4.90, 95% CI 1.55‐19.2, p = 0.012) and to being wasteful or careless (OR 4.41, 95% CI 1.55‐14.7, p = 0.009) in analyses corrected for age, gender, and education. Contrary to Hypothesis 2, people with bvFTD and with Alzheimer’s disease were nearly equally likely to make financial mistakes due problems with memory (bvFTD OR 1.05, 95% CI 0.43‐2.59, p>0.9). In a planned exploratory analysis, no significant differences were found between Alzheimer’s disease and PPA.ConclusionOur positive findings for Hypothesis 1 are concordant with other studies demonstrating socioemotional impairment and insensitivity to adverse outcomes in bvFTD. Meanwhile, our negative finding for Hypothesis 2 may cohere with other work indicating comparable memory impairment in bvFTD and Alzheimer’s disease. More broadly, our findings indicate that caregiver reports can distinguish mechanisms underlying financial mismanagement across different syndromes.