Maurice Ravel and right-hemisphere musical creativity: influence of disease on his last musical works?

How Well Do We Understand Autistic Savant Artists: A Review of Various Hypotheses and Research Findings to Date

The authors investigated the artistic characteristics of autistic savant artists, hypotheses on the proximate and ultimate causes of their emergence, recent psychological and other studies about them, and psychological and neuroaesthetic studies about non-savant autistic individuals. The artistic features of autistic savant artists were significantly similar to those of outsider artists. Furthermore, the authors investigated the explanatory power of the paradoxical functional facilitation theory, the superior visual perception hypothesis, the "Hmmmmm" hypothesis, and the Neanderthal theory of autism regarding the emergence of autistic savant artists. In addition, we investigated whether an increase in savant characteristics was related to a decrease in the ability for social communication. The authors suggested that in studies on the aesthetic experience of non-savant autistic individuals, their aesthetic experience ability is never lower than that of neurotypical individuals and that some non-savant autistic individuals may potentially have artistic talent. Finally, the authors reviewed the effectiveness of the "autism savant spectrum syndromic disorder" proposed by some researchers. More scientific and systematic studies on autistic savant artists from a multidisciplinary perspective are warranted.

A Midsummer Night's Gene: The familial Neurological Illness of Felix Mendelssohn

Felix Mendelssohn Bartholdy (1805-1847) is widely regarded as one of the musical geniuses of the Romantic period. A prodigy akin to Mozart, Mendelssohn composed piano works, symphonies, and concertos at an early age but died young, at 38. His death has been attributed to neurological disease, but the mystery of his diagnosis is amplified by the fact that his sisters died under similar circumstances, including the renowned composer, Fanny Mendelssohn Hensel. Mendelssohn died after years of suffering from headaches, earaches, and mood disturbances. In the final year of his life, his acute decline was marked by stepwise, progressive neurologic deficits: gait disturbance, loss of sensation in the hands, partial paralysis, and, finally, loss of consciousness. The similar pattern of disease within his family suggests an underlying genetic link, though this may be multifactorial in nature. We present a thorough, posthumous differential diagnosis for Mendelssohn's illness, given his medical history, the familial pattern, and hints from within his music. Possible diagnoses include ruptured cerebral aneurysm with resultant subarachnoid hemorrhage, familial cerebral cavernous malformation, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Continued research into Mendelssohn's life may yield more information about his illness, death, and possibly true diagnosis.

Premorbid de novo artistic creativity in frontotemporal dementia (FTD) syndromes

The emergence of new artistic activities or shifts in artistic style in patients with frontotemporal dementia (FTD) syndromes is well documented at or after disease onset. However, a closer look in the literature reveals emerging artistic creativity also before FTD onset, although the significance and underlying pathology of such creative endeavors remain elusive. Here, we systematically review relevant studies and report an additional FTD case to elaborate on artistic activities that developed years before disease manifestation by paying particular attention to the sequence of events in individual patients' biography and clinical history. We further discuss the FTD patient's creative activities in the context of their life events, other initial or "premorbid" dementia symptoms or risk factors described in the literature such as mental illness and mild behavioral impairment (MBI), as well as changes in neuronal systems (i.e., neuroimaging and neuropathology). In addition to our FTD patient, we identified five published cases with an FTD syndrome, including three with FTD, one with primary progressive aphasia (PPA), and one with the behavioral variant of PPA (bvPPA). Premorbid novel creativity emerged across different domains (visual, musical, writing), with the FTD diagnosis ensuing artistic productivity by a median of 8 years. Data on late-life and pre-dementia life events were available in four cases. The late creative phase in our case was accompanied by personality changes, accentuation of personality traits, and cessation of painting activities occurred with the onset of memory complaints. Thus, premorbid personality changes in FTD patients can be associated with de novo creative activity. Stressful life events may also contribute to the burgeoning of creativity. Moreover, primary neocortical areas that are largely spared by pathology at early FTD stages may facilitate the engagement in artistic activities, offering a window of opportunity for art therapy and other therapeutic interventions during the MBI stage or even earlier.

Emergent creativity in frontotemporal dementia

Numerous papers report on connections between creative work and dementing illness, particularly in frontotemporal dementia (FTD), which may combine with motor neuron disease (FTD-MND). However, the emergence of FTD(-MND) patients' de novo artistic activities is rarely reported and underappreciated. Therefore, the present review summarizes relevant case studies' outcomes, capturing creativity's multifaceted nature. Here, we systematically searched for case reports by paying particular attention to the chronological development of individual patients' clinical symptoms, signs, and life events. We synoptically compared the various art domains to the pattern of brain atrophy, the clinical and pathological FTD subtypes. 22 FTD(-MND) patients were identified with creativity occurring either at the same time (41%) or starting after the disease onset (59%); the median lag between the first manifestation of disease and the beginning of creativity was two years. In another five patients, novel artistic activity was developed by a median of 8 years before the start of dementia symptoms. Artistic activity usually evolved over time with a peak in performance, followed by a decline that was further hampered by physical impairment during disease progression. Early on, the themes and objects depicted were often concrete and realistic, but they could become more abstract or symbolic at later stages. Emergent artistic processes may occur early on in the disease process. They appear to be a communication of inner life and may also reflect an attempt of compensation or "self-healing". The relative preservation of primary neocortical areas such as the visual, auditory, or motor cortex may enable the development of artistic activity in the face of degeneration of association cortical areas and subcortical, deeper central nervous system structures. It is crucial to understand the differential loss of function and an individual's creative abilities to implement caregiver-guided, personalized therapeutic strategies such as art therapy.

Do painters need their whole brain to excel?

Skilled professional artists are sometimes able to maintain their talents while other cognitive functions deteriorate due to brain diseases. The objective of this study is to asses the preserved artistry of a professional painter in spite of the presence of strokes affecting brain areas implicated in art expression. She had a neurologic evaluation and brain imaging after the stroke; painter-curators analyzed and compared the painter's pictorial artwork created before and after the stroke. In spite of cerebellar, visuospatial, motor, cognitive, and functional deficits likely related to strokes affecting bilateral cerebellar, left occipital, and right temporal-occipital areas, the patient was able to maintain most of their artistic painting skills.. After a short period of functional recovery, our patient showed discrepancy among their impaired cerebellar cerebral functions in day activities and their preserved painting abilities.

Emergence of artistic talent in progressive nonfluent aphasia: a case report

Some patients with frontotemporal lobar degeneration have developed artistic skills after the onset mainly in painting and music. Most of these cases have semantic dementia (SD), one of the frontotemporal lobar degeneration subtypes. In previously reported cases, the paintings made by patients with SD were usually hyper realistic, without a significant symbolic or abstract component. Here, we report on a patient with progressive nonfluent aphasia (PNFA), another frontotemporal lobar degeneration subtype, who started making creative bamboo crafts after PNFA onset. His techniques were completely his original; he devised the shapes of the crafts and made them without samples. His work did not become an obsessive preoccupation. The artistic style expressed by patients with PNFA differs from that expressed by patients with SD. Therefore, the underlying mechanisms for the emergence of artistic talent might differ between SD and PNFA.

Maurice Ravel's dementia: the silence of a genius

ABSTRACT Maurice Ravel is one of the most important French musicians. In the last years of his life, Ravel was victim of a dementia of uncertain etiology that caused aphasia, apraxia, agraphia and amusia. The artistic brain of the author of eternal musical compositions was progressively silenced due to his neurodegenerative disease. On the 90th anniversary of Boléro, this historical note revisits Ravel's case and discusses the relationship of his dementia to his artistic production. It illustrates the intimacy that can exist between art, music, creativity, and neurology.

The music of war: Seven World War 1 composers and their experience of combat

The effect of World War 1 military service on composers has been neglected in comparison with poets and artists. This article describes the wartime service of Arthur Bliss, Ralph Vaughan Williams, Ivor Gurney, EJ Moeran, Gordon Jacob, Patrick Hadley, and Maurice Ravel. The relationship between experiences of combat and the psychological health of these men is examined, with consideration being given to predisposition and possible causative influences of military service on their later careers, examined from individual and societal perspectives.

Anatomical Correlates of Non-Verbal Perception in Dementia Patients

Purpose: Patients with dementia who have dissociations in verbal and non-verbal sound processing may offer insights into the anatomic basis for highly related auditory modes.

Methods: To determine the neuronal networks on non-verbal perception, 16 patients with Alzheimer’s dementia (AD), 15 with behavior variant fronto-temporal dementia (bv-FTD), 14 with semantic dementia (SD) were evaluated and compared with 15 age-matched controls. Neuropsychological and auditory perceptive tasks were included to test the ability to compare pitch changes, scale-violated melody and for naming and associating with environmental sound. The brain 3D T1 images were acquired and voxel-based morphometry (VBM) was used to compare and correlated the volumetric measures with task scores.

Results: The SD group scored the lowest among 3 groups in pitch or scale-violated melody tasks. In the environmental sound test, the SD group also showed impairment in naming and also in associating sound with pictures. The AD and bv-FTD groups, compared with the controls, showed no differences in all tests. VBM with task score correlation showed that atrophy in the right supra-marginal and superior temporal gyri was strongly related to deficits in detecting violated scales, while atrophy in the bilateral anterior temporal poles and left medial temporal structures was related to deficits in environmental sound recognition.

Conclusions: Auditory perception of pitch, scale-violated melody or environmental sound reflects anatomical degeneration in dementia patients and the processing of non-verbal sounds are mediated by distinct neural circuits.

The "Ravel issue" and possible implications

Current research has noted that auditory stimuli via rhythmic cues can enhance speech in patients with basal ganglia lesions. The contribution of basal ganglia function in music perception and performance is a matter of discussion. The French composer Maurice Ravel suffered from a progressive degenerative cerebral disease of uncertain etiology, probably primary progressive aphasia. Based on the case of the famous composer, we present the hypothesis that the fact he adopted different uses of timbre could be attributed to the altered basal ganglia function during the disease evolution. Our assumption would like to add a point of view to the current diagnostic debate.

Creative Activities in Music--A Genome-Wide Linkage Analysis

Creative activities in music represent a complex cognitive function of the human brain, whose biological basis is largely unknown. In order to elucidate the biological background of creative activities in music we performed genome-wide linkage and linkage disequilibrium (LD) scans in musically experienced individuals characterised for self-reported composing, arranging and non-music related creativity. The participants consisted of 474 individuals from 79 families, and 103 sporadic individuals. We found promising evidence for linkage at 16p12.1-q12.1 for arranging (LOD 2.75, 120 cases), 4q22.1 for composing (LOD 2.15, 103 cases) and Xp11.23 for non-music related creativity (LOD 2.50, 259 cases). Surprisingly, statistically significant evidence for linkage was found for the opposite phenotype of creative activity in music (neither composing nor arranging; NCNA) at 18q21 (LOD 3.09, 149 cases), which contains cadherin genes like CDH7 and CDH19. The locus at 4q22.1 overlaps the previously identified region of musical aptitude, music perception and performance giving further support for this region as a candidate region for broad range of music-related traits. The other regions at 18q21 and 16p12.1-q12.1 are also adjacent to the previously identified loci with musical aptitude. Pathway analysis of the genes suggestively associated with composing suggested an overrepresentation of the cerebellar long-term depression pathway (LTD), which is a cellular model for synaptic plasticity. The LTD also includes cadherins and AMPA receptors, whose component GSG1L was linked to arranging. These results suggest that molecular pathways linked to memory and learning via LTD affect music-related creative behaviour. Musical creativity is a complex phenotype where a common background with musicality and intelligence has been proposed. Here, we implicate genetic regions affecting music-related creative behaviour, which also include genes with neuropsychiatric associations. We also propose a common genetic background for music-related creative behaviour and musical abilities at chromosome 4.

A case of expressive-vocal amusia in a right-handed patient with left hemispheric cerebral infarction

A 53-year-old right-handed woman had an extensive lesion in the left hemisphere due to an infarction caused by vasospasm secondary to subarachnoid bleeding. She exhibited persistent expressive-vocal amusia with no symptoms of aphasia. Evaluation of the patient's musical competence using the Montreal Battery for Evaluation of Amusia, rhythm reproduction tests, acoustic analysis of pitch upon singing familiar music, Japanese standard language tests, and other detailed clinical examinations revealed that her amusia was more dominantly related to pitch production. The intactness of her speech provided strong evidence that the right hemisphere played a major role in her linguistic processing. Data from functional magnetic resonance imaging while she was singing a familiar song, a scale, and reciting lyrics indicated that perilesional residual activation in the left hemisphere was associated with poor pitch production, while right hemispheric activation was involved in linguistic processing. The localization of infarction more anterior to the left Sylvian fissure might be related to the dominant deficits in expressive aspects of the singing of the patient. Compromised motor programming producing a single tone may have made a major contribution to her poor singing. Imperfect auditory feedback due to borderline perceptual ability or improper audio-motor associations might also have played a role.

Stroke, music, and creative output: Alfred Schnittke and other composers

Alfred Schnittke (1934-1998), a celebrated Russian composer of the twentieth century, suffered from several strokes which affected his left cerebral hemisphere. The disease, however, did not diminish his musical talent. Moreover, he stated that his illness in a way facilitated his work. The composer showed amazingly high productivity after his first and second injuries of the central nervous system. The main topic of this chapter is the effect of strokes on Schnittke's output, creativity, and style of music. A brief biography of the composer with the chronology of his brain hemorrhages is included. In addition, the influence of cerebrovascular lesions on creative potential of other prominent composers such as Benjamin Britten, Jean Langlais, Vissarion Shebalin, Igor Stravinsky, and Ira Randall Thompson is discussed.

Paul Wittgenstein's right arm and his phantom: the saga of a famous concert pianist and his amputation

Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887-1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel's Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.

Music and dementia

There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia.

Hearing and music in dementia

Music is a complex acoustic signal that relies on a number of different brain and cognitive processes to create the sensation of hearing. Changes in hearing function are generally not a major focus of concern for persons with a majority of neurodegenerative diseases associated with dementia, such as Alzheimer disease (AD). However, changes in the processing of sounds may be an early, and possibly preclinical, feature of AD and other neurodegenerative diseases. The aim of this chapter is to review the current state of knowledge concerning hearing and music perception in persons who have a dementia as a result of a neurodegenerative disease. The review focuses on both peripheral and central auditory processing in common neurodegenerative diseases, with a particular focus on the processing of music and other non-verbal sounds. The chapter also reviews music interventions used for persons with neurodegenerative diseases.

Positive Clinical Neuroscience

Disorders of the brain and its sensory organs have traditionally been associated with deficits in movement, perception, cognition, emotion, and behavior. It is increasingly evident, however, that positive phenomena may also occur in such conditions, with implications for the individual, science, medicine, and for society. This article provides a selective review of such positive phenomena – enhanced function after brain lesions, better-than-normal performance in people with sensory loss, creativity associated with neurological disease, and enhanced performance associated with aging. We propose that, akin to the well-established field of positive psychology and the emerging field of positive clinical psychology, the nascent fields of positive neurology and positive neuropsychology offer new avenues to understand brain-behavior relationships, with both theoretical and therapeutic implications.

Artistic creativity and dementia

Artistic ability and creativity are defining characteristics of human behavior. Behavioral neurology, as a specialty, believes that even the most complex behaviors can be modeled and understood as the summation of smaller cognitive functions. Literature from individuals with specific brain lesions has helped to map out these smaller regions of cognitive abilities. More recently, models based on neurodegenerative conditions, especially from the frontotemporal dementias, have allowed for greater nuanced investigations into the various functional anatomies necessary for artistic behavior and possibly the underlying networks that promote creativity.

Shadows and darkness in the brain of a genius: aspects of the neuropsychological literature about the final illness of Maurice Ravel (1875-1937)

In 1948 the famous French neurologist Théophile Alajouanine published the article "Aphasia and artistic realization", a landmark in the field of research about aphasia, which discussed the case of the composer Maurice Ravel (1875-1937). Since then, many researchers have explored the final illness of the composer. In 2003 Medical Science Monitor published 2 articles about the case. In this article we intend to present works published on the Ravel case, to discuss them, and to suggest a general overview on the topic. Many hypotheses have been proposed by researchers, but complete diagnosis is still an enigma, since no post-mortem was made. The most up-to-date perspective seems to point to comorbidity of superimposed elements, which might date back to the composer's fragile youth.

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.

What makes Maurice Ravel's deadly craniotomy interesting? Concerns of one of the most famous craniotomies in history

Maurice Ravel (1875-1937), the great impressionist-classicist composer of many popular compositions, such as the Boléro, suffered from a progressive disease and died following an exploratory craniotomy by Clovis Vincent. The history of his progressive dementia and the contribution of a car accident, following which he was unable to function, have received a certain amount of interest in the neurological literature previously, but his deadly craniotomy was not evaluated from a neurosurgery perspective. The car accident in 1932, with the probable consequence of a mild-to-moderate traumatic brain injury, could be the key event in his life, triggering the loss of his ability to compose. It is clear that he never recovered from his injury and within a year he became completely unable to function. His dementia progressed dramatically. This event needs to be kept in mind. In 1937, Ravel died after the craniotomy performed by Vincent, but only a speculative, retrospective diagnosis is possible since an autopsy was not undertaken.

Acquired and congenital disorders of sung performance: A review

Many believe that the majority of people are unable to carry a tune. Yet, this widespread idea underestimates the singing abilities of the layman. Most occasional singers can sing in tune and in time, provided that they perform at a slow tempo. Here we characterize proficient singing in the general population and identify its neuronal underpinnings by reviewing behavioral and neuroimaging studies. In addition, poor singing resulting from a brain injury or neurogenetic disorder (i.e., tone deafness or congenital amusia) is examined. Different lines of evidence converge in indicating that poor singing is not a monolithic deficit. A variety of poor-singing "phenotypes" are described, with or without concurrent perceptual deficits. In addition, particular attention is paid to the dissociations between specific abilities in poor singers (e.g., production of absolute vs. relative pitch, pitch vs. time accuracy). Such diversity of impairments in poor singers can be traced to different faulty mechanisms within the vocal sensorimotor loop, such as pitch perception and sensorimotor integration.

Unravelling Boléro: progressive aphasia, transmodal creativity and the right posterior neocortex

Most neurological lesion studies emphasize performance deficits that result from focal brain injury. Here, we describe striking gains of function in a patient with primary progressive aphasia, a degenerative disease of the human language network. During the decade before her language deficits arose, Anne Adams (AA), a lifelong scientist, developed an intense drive to produce visual art. Paintings from AA's artistic peak revealed her capacity to create expressive transmodal art, such as renderings of music in paint, which may have reflected an increased subjective relatedness among internal perceptual and conceptual images. AA became fascinated with Maurice Ravel, the French composer who also suffered from a progressive aphasia, and painted his best-known work, 'Boléro', by translating its musical elements into visual form. Later paintings, achieved when AA was nearly mute, moved towards increasing photographic realism, perhaps because visual representations came to dominate AA's mental landscape during this phase of her illness. Neuroimaging analyses revealed that, despite severe degeneration of left inferior frontal-insular, temporal and striatal regions, AA showed increased grey matter volume and hyperperfusion in right posterior neocortical areas implicated in heteromodal and polysensory integration. The findings suggest that structural and functional enhancements in non-dominant posterior neocortex may give rise to specific forms of visual creativity that can be liberated by dominant inferior frontal cortex injury.

Selected observations on amusia

Amusia appears primarily as a defect in processing pitch. The deficit extends to musical memory and recognition, singing and timing of music. Clinical studies of acquired brain lesions show that dysphasia is not necessarily accompanied by amusia, and acquired amusia without aphasia has been reported. These dissociations suggest some degree of autonomy in the function of these mechanisms.

The movement disorder of Maurice Ravel

It has long been known that in the last years of his life Maurice Ravel (1875-1937) suffered from a progressive neurological illness. Despite several proposed diagnostic hypotheses, the precise nature of his illness remains elusive.

[Interest of neurophysiological exploration in clinical psychiatry]

Cerebral functional exploration using Event related potentials (ERPs) is greatly relevant in clinical psychiatry. Although ERP usefulness as a diagnostic tool is limited due to the complexity of psychiatric diagnosis, which raises theoretical, methodological and ethical problems that cannot be resolved by neurobiological methods, ERP offers relevant information in 3 different topics: the choice of psychotropes in pharmacotherapy; the description and understanding of cognitive processes; the psychotherapeutic relation. 1) Converging arguments from experimental studies support the hypothesis that the amplitude of P300 and CNV as well as the loudness dependence of the auditory N1/P2 response (LDAEP) are regulated by central catecholaminergic and serotoninergic neurotransmission. These systems also are the target of several psychotropes, and therefore the neurophysiological assessment may bring reliable indicators to predict favourable response to psychotropes and drug intolerance. 2) Moreover the assessment of Reaction Times and P300 and VCN parameters, jointly recorded in a single investigation, brings information about the self-organization and self-regulation of cerebral functioning, and might help the clinicians to understand the functional meaning of attentional disorders in Psychiatry. 3) Finally, the discussion of the neurophysiological results with the patient, in comparing objective and subjective data, might help him to better understand his/her difficulties and to modify his/her subjective experience of the disease.

The neural networks of music

Recent neuropsychological, transcranial Doppler sonographic, positron emission tomographic and functional nuclear magnetic resonance studies have indicated that musical perception is not dependent on the right hemisphere but on neural networks corresponding to the fundamental components of music in both hemispheres. In the brain there is no centre for music. Musicians have cerebral characteristics, anatomical as well as functional, which are correlated with the age at which they began their musical studies. This argues for cortical reorganization as a result of musical training. Whether these characteristics are to be ascribed to cortical plasticity alone, or to an innate structural property, or to both, remains an open question, however. Investigation of chromosomal defects, biochemical abnormalities and morphological features of congenital and degenerative brain diseases can provide further insight into the cerebral substrate of musicality.