A rare form of dementia loosens an artist's constraints as it destroys her mind.

Five years ago, Bruce Miller, director of the UCSF Memory and Aging Center at the Medical Center, reported in the journal Neurology that a group of patients with frontotemporal dementia (FTD) -- a form of dementia caused by atrophy in regions of the brain different from those affected by Alzheimer's disease -- developed artistic skills and became less inhibited even as they lost their minds.

Now he has reported another fascinating phenomenon, illustrated by Jancy Chang, a talented Asian American artist and former high school art teacher. Chang's painting underwent a dramatic evolution as her ability to speak declined. "They became wilder and freer and more original," says Miller, the A.W. and Mary Margaret Clausen Distinguished Professor in Neurology.

In her early years as an artist, Chang painted mainly landscapes and representational paintings, either Western-style watercolors or classical Eastern brush paintings. Under the influence of FTD in her later years, she produced unusually provocative pieces that combined Eastern and Western styles. And they evolved even as her dementia progressed. From 1990 to 1993, for example, she created an exquisite series of highly patterned paintings based on the Chinese horoscope. In 1997 she began a new series of 12 male semi-nude figurative paintings. Later works had an intense emotional and impressionistic style.

"The ability to transcend ordinary social, physical and cognitive constraints is a feature of great artists," says Miller. "The release of the language-dominant patterns of thinking appears to be a key factor in the emergence of artistic skills in frontotemporal dementia patients. The release of frontal lobe functions involved with social restraints may have played a role in the later paintings of this artist."

Indeed, Miller believes that the case suggests that our brain wiring may be a major factor in determining the nature of our creativity. Chang, who retired from teaching in 1995, stopped producing new works after 2001, but continues to recall the paintings and the strategies she used to create them, even at a time when she had limited speech ability. "When she talks about her paintings, her language comes more freely and is more spontaneous than when any other topic is discussed," Miller remarks. "The last place one would expect to find any aptitude flourishing, let alone emerging, is in the brain of someone slowly wasting away with dementia, but the evidence is pretty dramatic."

Miller notes that such cases have changed his approach to dementia patients. "We typically don't think that something could be getting better, we only think about what's getting worse," he says. "Now I always ask if there's anything patients are doing very well, or better than before. It's a remarkable response to a dementing illness."