Differential effects of neurodegenerative disorders on verbal creative idea generation and its cognitive cornerstones

Clinical research has documented a heterogeneous effect of neurodegenerative disorders on creativity. Some disorders are associated with impaired creative performance, while others may preserve, or even enhance, it. However, the underlying cognitive mechanisms that give rise to the heterogeneous behavioural manifestations remain poorly understood. From a theory-driven approach, we conducted a neuropsychological investigation to examine how frontotemporal lobar degeneration (FTLD), and Alzheimer's Disease (AD) differentially affected the cognitive mechanisms underlying creative thought (semantic cognition, episodic memory, executive control functions). In parallel, we assessed participants' verbal creative idea generation performance using the ideational fluency task (also known as the Alternate Uses Task). We analysed data from 24 individuals with FTLD [clinical consensus diagnosis corticobasal syndrome (CBS: n=20) or progressive supranuclear palsy (PSP: n=4)], 24 individuals with clinical consensus diagnosis AD, and 24 healthy individuals. We reached four major conclusions. First, while both disease groups exhibited deficits in controlled semantic retrieval and executive control functions, only participants with AD exhibited degradation in semantic representations and episodic memory. Second, both disease groups generated fewer responses in both typical and creative conditions across objects that were context-free - i.e., associated with multiple contexts (e.g., brick) and context-bound -i.e., associated with a dominant context (e.g., table knife). Third, when given a context-free object prompt, the ability to generate novel responses appeared to be preserved in participants with FTLD, which contrasted with an impaired ability when prompted to give creative uses for the context-bound object. Fourth, participants with AD produced similar levels of response novelty for both context-free and context-bound objects. From a clinical-cognitive neuroscience perspective, this study demonstrates that distinct cognitive profiles resulting from different neurodegenerative conditions yield differential effects on creative thought. As the first study to show that the contextual information of semantic stimuli can mediate the novelty of verbal responses, we suggest that future research should carefully examine how this factor influences creative task performance.