(gentle piano music)
- [Narrator] We are the paradoxical ape.
Bipedal, naked, large-brained.
Long the master of fire, tools, and language
but still trying to understand ourselves.
Aware that death is inevitable, yet filled with optimism.
We grow up slowly.
We hand down knowledge.
We empathize and deceive.
We shape the future from our
shared understanding of the past.
Carta brings together experts from diverse disciplines
to exchange insights on who we are
and how we got here.
An exploration made possible
by the generosity of humans like you.
- There's a long history of writing about savants
who emerge in childhood and I'm gonna talk about
a slightly different syndrome.
My friend Allan Snyder in Australia suggests
that this be called acquired savantism,
and so these are people who did not have artistic abilities
or talents who in the setting of neurodegenerative diseases
have acquired new artistic abilities and this is
the group that I lead in San Francisco
and almost everybody in that audience
has helped me in some way in this work.
So we know a lot about art and the brain
from lesions whether it's brain tumors,
strokes, brain trauma and there
are certain themes that have emerged.
One is that the right posterior parts of the brain,
parietal lobe in particular
are essential for the ability to copy
and probably along with the right temporal lobe
conjure up images that we want to put on a piece of paper.
The smallest lesion in that brain area
will devastate the ability to copy.
Not as bad as Dan's artwork, but along that spectrum.
Yeah, okay.
So less, little bit less known
I'm gonna touch on this today
about the left side of the brain,
but in general the senses that symbolic, linguistic,
conceptual aspects of art are associated
with left hemisphere and with injury to that part
of the brain there is a theme in the literature
of preservation of the ability to copy.
I began to study this not 'cause I thought about it
because it sort of ran into me in the study of patients
that I've seen with neurodegenerative disease
and I was taught going into my fellowship
that degenerative diseases hit the brain diffusely.
You could learn nothing about the functions
of the brain from studying neurodegenerative diseases,
but I think we've known really since the time of Pick
and Alzheimer that we have two major
pre-senile neurodegenerative conditions.
One that affects the front part of the brain,
often begins in the frontal insular
and sometimes anterior temporal lobes.
That's shown in blue.
These are disorders that are called
frontotemporal dementias.
They have a lack of Alzheimer pathology.
No plaques or tangles, and then Alzheimer's
usually a posteriorly predominant disease
that affects the hippocampus so very different anatomy
and very different sorts of syndromes
that we see in the setting of these two
distinctive neurodegenerative conditions.
There's been a lot written
about art and Alzheimer's disease.
I think many people get quite a bit of pleasure
working in with art therapists and with Alzheimer's disease
and you know I think what these disorders tell you
is your art is influenced by the part of the brain
that is injured, so because Alzheimer's disease
hits the posterior temporal parietal regions
sometimes worse on the right than the left,
sometimes the left worse than the right,
you lose precision.
There tends to be visuospatial difficulty,
but some things remain.
The ability to perceive color, simple shapes.
This is one of my patient's paintings, Megan Fox.
I think quite a beautiful piece
and a very nice use of color.
I think very typical of what we see
in the setting of Alzheimer's disease
and of course fine artists like de Kooning,
William Utermohlen were profoundly disrupted
in their ability to produce images of complex faces,
complex shape, and were left
with very simple, simple forms like this.
In frontotemporal dementia, there's a different
sort of story and this is a paper we wrote in 1998
focused on the emergence of new artistic skills
after the disease onset.
The theme was that visual creativity was more common
when the anterior temporal lobes,
or the left frontal lobe was
where the focal degeneration began.
These are often called primary progressive aphasias
because they affect language,
but remarkably in some individuals
we see an emergence of visual creativity.
Wrote about that in 1998.
Didn't understand the mechanism very well.
Starting to understand the circuitry that we think
emerges in the setting of this loss of function
in the dominant hemisphere.
So this was a patient, Jack,
that got me interested in this story.
He was a banker, he lived in Santa Barbara.
They did a special on him on ABC News
and Jack had never had the slightest interest in art.
In the 1980s his wife died, he became depressed,
he started working with an art therapist
and started painting.
What I learned about Jack is he painted repetitively.
He did many of the pictures that I saw over and over again.
This compulsive need to paint I think
was one of the reasons that his painting
was so interesting and successful.
This is I think one of his masterpieces.
When I saw him around 1995, Jack was obsessed with painting.
Profoundly aphasic head loss,
many of the words particularly nouns.
He drew this parrot that he remembered from Hawaii
yet couldn't tell me what this painting was.
Obsessed with the colors purple and yellow.
Like many of these patients, completely unable
to get him to describe the art of creating or why he did it.
The phrases I heard over and over again was
yellow and purple wave over me.
So he became obsessed with painting.
He painted purple things and yellow things
over and over again, progressively lost
social skills and language.
Visually profoundly preoccupied.
Jack used to walk the streets of Santa Barbara
with his caretaker looking for coins.
When I visited him in Santa Barbara I was sitting
at the table, immediately he says it's raining.
Now he had uncanny I think ability to focus visually.
So Jack produced this series of paintings.
This is a slightly later one, I think very Fauvist in style.
You can see an interesting strategy where the sail
is both the background and the sail.
Losing some of the precision that he had
I think as the disease creeps into
the parietal lobes more posteriorly.
A slightly later piece where he is really
losing the ability the way an Alzheimer patient
might paint precisely.
Again that theme of purple and yellow, Jack's obsession.
And then finally one of the last pieces he ever did.
I think quite whimsical, beautiful picture of a man.
As he lost the ability to paint,
this was replaced by the compulsion to brush his teeth.
He did this over and over again.
And as we learned later, Jack had a form
of frontotemporal dementia.
A very interesting form that
has been called semantic dementia,
or semantic variant of primary progressive aphasia.
It's a subtype of frontotemporal dementia.
It was what Pick described in 1892.
It affects predominantly the two anterior temporal lobes.
One it affects the left side,
which most of my artists come from this group.
You lose your knowledge about words.
You lose your knowledge eventually
about things in the world.
Unlike Alzheimer's disease,
the naming deficit isn't improved by clues.
They don't know what that word means.
The anatomy is very focal, so I think as these individuals
lose function in the amygdala anterior temporal lobes,
orbital frontal cortex there's disinhibition,
progressive language disturbance,
but often visuospatial skills are profoundly spared.
These are people whose only point on a cognitive test
is drawing a complex visual figure.
So this is you know something
that is often spared in these individuals
and in a subgroup there is a new emergence of
interest in painting and increased visual creativity.
I always thought this was first described by a neurologist
but on a trip to Colombia around 2006
I was reading 100 Years of Solitude
by Gabriel Garcia Marquez and I came across his description,
the first description of
semantic dementia I think in the literature.
It's the town of Macondo, people are dying
of a sleeping sickness and he describes
what happens to them.
"He discovered he had trouble
"remembering every object in the laboratory.
"He didn't know what they were.
"He marked them with their respective names
"so that all he had to do was read the inscription
"in order to identify them.
"This is the cow.
"She must be milked every morning
"so that she will produce milk
"and the milk must be boiled
"in order to be mixed with coffee."
Gorgeous description, "they went on living in a reality
"that was slipping away, momentarily captured
"by words but which would escape irremediably
"when they forgot the values of written letters."
So around the time that I discovered this piece
from Gabriel Garcia Marquez,
we had a patient very much like the villager in Macondo.
So this is my patient Bob,
who like many of these individuals
know that they're losing words,
know that they're losing knowledge
about facts in their world
and you can see here just like Garcia Marquez's description,
he's putting down these names, these words.
Compulsively, repetitively, fully catheter, endocarditis,
he knows that his world is slipping away
just in the way Gabriel Garcia Marquez described it.
I don't think, and be glad to talk
about this with anyone online, offline
that Marquez actually saw a case of semantic dementia.
I think he was writing about his own writer's block
and I think this is what he conceptualized at the time.
So we couldn't resist, this is Bob's
who drew a cow quite beautifully.
His elephant I think rather whimsical,
certainly better than Dan and I could do
I think in the copies, but yeah.
So this is a degenerative disease.
The concepts for these animals often nouns first,
verbs relatively spared, look like
they come out of evolution.
I appreciated that picture of Darwin earlier.
So the dog looks a little bit like a cat.
It looks like some features of a cow,
and similarly the cat has features of the dog.
The fish to me looks very much like a penguin,
but I think as you're watching this patient
with semantic dementia lose their conceptual knowledge
around what distinctive animals really are.
And of course if you don't know what an animal is,
you don't know what color to give it.
So we asked this patient to draw the frog
and put the color in.
He drew a pink frog, not the green one which he should.
This is my latest favorite set of pieces.
This is a gentleman who we're going to describe
for the Journal of JAMA.
He became obsessed with welding.
He was not an artist.
This is his bird, and you can see it has got
that same quality of mixed metaphor.
The bird has features of an insect
and I think this really has taught me
that what an artist does is put down on a canvas
the way that they see the world, okay.
So just a couple conclusion points.
Our poet laureate Kay Ryan from Marin County
has taught us at the UCSF about
the neuroscientist Emily Dickinson
and I think Emily Dickinson you know
had a very modern way of thinking about the brain.
And so when I was thinking about these patients
I came across this poem by her
and I think she was interested in moral decay,
but this is really the decay of
neurodegenerative diseases as we understand it in 2017.
Crumbling, or the dementia, is not an instant act
and we now know probably 20 years before we see a patient
with one of these diseases that
the degenerative process has begun.
"A fundamental pause, dilapidation's
"processes are organized decays."
Totally contradicts the idea the dementias
hit the brain diffusely.
These are organized decays in very specific circuits.
Other circuits are spared.
"'Tis first a cobweb on the soul."
This is the misfolded protein
that Rusty Gage and Dan Geschwind talk and write about.
"Cuticle of dust a borer in the axis
"an elemental rust.
"Ruin is formal Devil's work
"consecutive and slow.
"Fail in an instant, no man did slipping"
or the dementing process "is Crash's law."
So we see the crash, but I think what these artists
have told me is that there is a period
when this process is beginning
where certain parts of the brain
may be particularly immune to the degenerative process.
They are spared and possibly begin to remodel
and we've written a little bit about this
describing an artist named Anne Adams.
So the conclusion is it's I think a beautiful
but also a very sad story.
Artistic creativity may emerge
with left hemisphere dysfunction.
I think we have some data from the artist Anne Adams
that there is rewiring of right posterior parietal regions.
Very area that Karen Burman showed as probably dysfunctional
in kids with Williams Syndrome.
Insights into the degenerative process
suggest that sometimes a new strength
may herald the degenerative process,
but I think understanding people's strengths
are critical for diagnosis and care
and I think also this gives us insight into our humanity
and almost everyone has touched on this.
Brain asymmetry is at the core of our strengths,
but also at the core of our weaknesses.
So thank you.
(applause)