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

Abstract

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.Parkinson's disease (PD) is a neurodegenerative disease affecting roughly 0.3% of the population, rising rapidly to 3% over the age of sixty-five (Gillies et al., 2014). PD progressively impacts brain cells' ability to produce the neurotransmitter dopamine, and leading, along with spreading brain lesions, to a number of symptoms from issues with motor control and cognitive processes (including language and memory), as well as sensory, and emotional regulation (Chaudhuri et al., 2006;Sveinbjornsdottir, 2016). These symptoms can only be slowed but not presently cured by a combination of medications or invasive procedures, thus, in conjunction with an aging world population, making PD an increasingly pressing target for research.At the same time, and in addition to its obvious medical importance, emerging evidence also suggests something quite surprising that can accompany the disease onset: As reported in a number of case studies, with diagnosis and antiparkinsonian treatment, a subset of individuals appear to experience a sudden awakening of artistic creativity and desire, and/or changes in the style or even in the quality of their produced art. A survey by Joutsa et al. (2012a) has in fact suggested such changes in up to 20% of respondents. This can be found with famous artists, for example Salvador Dali (Forsythe et al., 2017), and is documented on the website of the Parkinson's Disease Foundation, which until recently kept a database of visual artworks in addition to other

Parkinson’s disease and changes in the appreciation of art: A comparison of aesthetic and formal evaluations of paintings between PD patients and healthy controls

“…Evidence suggests connections to increased felt reward, heightened impulsivity and creativity, or lowered inhibition, with patients reporting feeling freer, more spontaneous (Chatterjee et al, 2006;Lhommée et al, 2014;Pinker, 2002;Walker, Warwick, & Cercy, 2006), and often reporting a needed outlet for their creative expression (Kulisevsky, Pagonabarraga, & Martinez-Corral, 2009). This is also supported by some empirical comparisons using standardized visual and non-visual/verbal measures (Canesi, Rusconi, Isaias, & Pezzoli, 2012, Canesi et al, 2016, with such changes typically suggested to relate to DA-related or other functional changes throughout the mesolimbic reward and prefrontal mesocortical regions (Lauring et al, 2019).…”

“…Within the above PD symptoms and stages, researchers have begun uncovering intriguing indication for impact on art or aesthetic processing/experience (see again also Figure 1). This is noted primarily in case studies or anecdotal reports involving art production and changes in the output of artists (Inzelberg, 2013;Lauring et al, 2019), and may suggest at least potential reciprocal effects on art viewing or aesthetic appreciation.…”

“…Previous studies have typically considered individuals in the early diagnosed stages of PD, but with a generally wide-timespan (with a Mean of 10.9 years; HY Stages 1 to 4 (Lauring et al, 2019; see also Lakke, 1999), and involve two main findings: (1) Case studies have documented novices to art production who suddenly show a burst of artistic interest, felt creativity, and even urge or need to make art (e.g., Chatterjee, Hamilton, & Amorapanth, 2006;Lakke, 1999;Pinker, 2002). Evidence suggests connections to increased felt reward, heightened impulsivity and creativity, or lowered inhibition, with patients reporting feeling freer, more spontaneous (Chatterjee et al, 2006;Lhommée et al, 2014;Pinker, 2002;Walker, Warwick, & Cercy, 2006), and often reporting a needed outlet for their creative expression (Kulisevsky, Pagonabarraga, & Martinez-Corral, 2009).…”

“…A recent survey by Joutsa, Martikainen, and Kaasinen (2012) suggests this may touch upwards of 20% of patients; it can occur with established artists (Forsythe, Williams, & Reilly, 2017) and with individuals who have never before shown artistic interest (Lhommée et al, 2014;Inzelberg, 2013). Case studies also report changes in style, theme, color, technique, or even in the aesthetic quality-often argued to be improved-of produced images (Lauring et al, 2019).…”

“…However, despite the interest and emerging findings regarding making art (Lauring et al, 2019), the impact of PD on how we view art or on aesthetic appreciation-arguably much more general tasks across the human population-has not been investigated.…”