Behavioral Variant Frontotemporal Dementia as a Model for Understanding the Cognitive and Cerebral Determinants of Verbal Creativity

Although creativity is an essential cognitive function to adapt to an ever-changing world, its neurocognitive and cerebral bases still need clarification. Current models highlight the interaction between associative and executive processes underpinned by the default mode, executive control and salience networks, with a central role of the prefrontal cortex. Hence, behavioral variant frontotemporal dementia (bvFTD), principally impacting the prefrontal cortex and the intrinsic connectivity of these three creativity-related networks, represents a unique model to study creativity. In 14 bvFTD patients and 20 matched controls, we used a simple word-to-word association task (FGAT) to explore the specific cognitive processes involved in the production of creative semantic associations. We dissociated four key cognitive components: spontaneous associative thinking, inhibition of unoriginal responses, intentional remote associative thinking, and verbal initiation. Using voxel-based morphometry and resting-state functional connectivity, we uncovered each component’s critical brain regions and their intrinsic connectivity profiles. BvFTD patients were impaired in the last three components. Two components, cognitive inhibition and intentional remote thinking, mediated the link between atrophy in critical regions and an independent measure of creative abilities. These findings advance our understanding of creative neurocognition, distinguishing components of creative thinking and clarifying their critical cerebral bases, and participate in the characterization of creativity impairment in patients with bvFTD.