The research was presented during the Movement Disorder Society's 13th International Congress of Parkinson's Disease and Movement Disorders, in Paris, France.
"You usually hear just the negative things about dopamine agonists — about the gambling and about the spending money," said Alina Batir MD, from the Centre Hospitalier Universitaire (CHU) de Grenoble, in France, who led the research team. "We wanted to show that there are also good things that happen with dopamine agonists."
Emerging Creativity
PD is characterized by loss of cognitive function such as flexibility, conceptualization, and visuospatial abilities, the researchers write. Creativity arises out of such cognitive skills and therefore should be lost in PD, they note, but case studies have documented the emergence of creativity enhancement in patients with Parkinson's disease.
In this study, Dr. Batir and colleagues set out to see whether creativity may be part of a spectrum of behavioral changes, most of them not so positive, that are seen with dopamine agonists.
To do this, they assessed cognition, behaviors, and mood fluctuations in 33 patients with PD (11 patients deemed to be creative and 22 controls) before and 1 year after undergoing subthalamic deep-brain stimulation. The 2 groups were about the same in terms of baseline cognitive function.
The creative patients were selected based on their score on a newly developed 4-point behavioral scale for PD patients, where 0 indicates a lack of creativity. Creative individuals had to score more than 2 on the scale.
Five of these patients were creative before the onset of PD, and 6 had their creativity emerge when they started taking dopamine agonists. "These patients painted, they were writing and planning poetry," said Dr. Batir.
Before the deep-brain-stimulation surgery, there was no difference in total dopamine-replacement therapy between the 2 groups, but the creative patients took significantly more dopamine agonists than controls (mean of 402 mg/day compared with 270 mg/day; P = .01). Compared with controls, the creative group had higher scores for mania, hobbyism, and "on" euphoria, but about the same level of gambling, shopping, hypersexuality, and irritability.
Following the surgery, dopamine-replacement therapy was reduced by a mean of 68.6% in both creative and control patients, said Dr. Batir. "They had the same doses of dopamine therapy and the same doses of agonists, but it was drastically decreased."
Both groups experienced about the same improvement in Unified Parkinson's Disease Rating Scale (UPDRS) motor scores (52%) and stimulation parameters. Apathy increased in both groups.
Only 1 of the 11 creative patients was still creative after surgery and the attendant reduction in dopamine agonists. The creativity of even that 1 patient seemed to be altered, said Dr. Batir. "She was painting less than before and there was a change in her paintings; the colors became more vivid."
The patients who lost their creativity said they missed it, said Dr. Batir. She added that she is not optimistic that their creativity would return. "You can increase the dopamine agonist little by little and see if creativity will return or not, but I don't think we could increase it to the same dose as before surgery."
Complex Array of Effects
Commenting on this research, Kapil Sethi, MD, professor of neurology and director of the movement-disorders program at the Medical College of Georgia, in Augusta, said the study illustrates the "complex array" of altered behaviors induced by dopamine agonists in PD.
He said these behaviors range from the more common and potentially harmful impulse-control disorders such as pathological gambling to the potentially beneficial ones such as creativity.
"The treating physician should be aware of this broad range of effects when prescribing these agents," he said.
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