What Causes Fronto-Temporal Dementia?
Whilst many cases of fronto-temporal dementia are genetic, in the cases that Miller studied there was no history of the disease. Throughout his study, however he was able to identify similarities in the patients' make-up. Miller explains, 'The majority of the patients that I studied did not have a strong family history of this illness. It therefore remains somewhat mysterious, however there are two important findings in these patients. One is that the neuro-chemical, serotonin is profoundly depleted and I think that this leads some of them to crave chocolate, sweets and to overeat. In others I think that you develop a profound compulsion which is due to the lack of serotonin. This compulsion contributes to the art and music that they produce, because they become obsessed with their art and they do it over and over again and I think that this constant repetition really is at the core of their success.'
Degeneration Of The Left Side Of The Brain
The anatomy of other types of dementia, such as in Alzheimer's disease is very different. In fronto-temporal dementia the pattern of deterioration is unique and as Miller's study shows the degeneration in the left side of the brain, could allow creative impulses to come through. He continues: 'What I discovered when I went through all of my patient population, which is now in the hundreds, was that only a small percentage of the patients showed this blossoming of visual or musical capability. It seemed to be a group who degenerated primarily on the left side of the brain and the left temporal lobe. This degeneration knocks out language in a profound way and these people loose the meaning of words.' As the individual looses these abilities, what is happening elsewhere in the brain? Miller explains:
'We think that the abilities that remain and indeed flourish are probably in the back part of the brain in the posterior temporal and parietal lobe. I have started to think of the left hemisphere as a bully, a dominant hemisphere that suppresses these visual and musical abilities and when it is turned off we can see some of these abilities that were obviously, always there. '
The Art In the Absence of a Linguistic Side of the Brain
It might be assumed that the patients would demonstrate a leaning towards abstract art, with little or no reliance on symbolism. However, whilst the choice of media varied from patient to patient - music, painting and verse - Miller was able to identify what he believes to be the source of their creativity: 'These patients give us a hint of what goes on in the right hemisphere. They had totally non-symbolic art there was no abstract, conceptual component to it. What they tended to do was produce an image which was dependent on memory and their imagination. In some cases these images were modified by components in the left hemisphere.' 'Without language we still see extraordinary human production'
The Chocoholic Whistler - A Case Study
Out of the blue one of Miller's patients decided that she would like to whistle. She began to compose limericks mostly about her beloved pet dog. As she worked on perfecting her whistling technique she would often whistle very complicated classical musical pieces. As common with other patients', she was partial to chocolate and the staff began to refer to her as the Chocoholic Whistler. In Miller's view the rhymes and tunes that the woman recites have been learned and reproduced. She is drawing on an element of her past and is most likely unaware of what she is doing. Miller outlines:
'I don't think there is any music theory, it is just whatever tunes that are jangling around in the brain that just come out into the world. The awareness of these people is very minimal, I think they enjoy doing their work, but don't self reflect on it very much and don't talk about it.'
Conscious Thought Without Language
Miller's research allows scientists to make a clearer map of the brain and it is hoped that with new functional imaging techniques, which parts of the brain are being activated during different illnesses can be established. The findings of this study also go some way to addressing the debate concerning whether conscious thought is possible without language. In Miller's mind there can be no doubt: 'These are people who have minimal language and in some cases no language, but they continue to produce very beautiful paintings or music. It suggests that the right hemisphere has a very different contribution to consciousness, but also a very important contribution and without language we still see this extraordinary human production.'
Symptoms Of Fronto-Temporal Dementia
According to the Dementia Research Group, this form of degenerative brain disorder is characterised by:
Behavioral Disorder
Language Impairment
Early Loss Of Social And Personal Awareness
Early Disinhibition
Mental Rigidity And Inflexibility
Perseverative Behaviour
Utilisation Behaviour
Loss Of Insight
Affective Symptoms
Speech Disorder