THE “ARS-PD STUDY”

 

An exploratory pilot trial investigating feasibility and therapeutic potential of artistic experience in patients with parkinson’s disease

Dr. Alberto Cucca PI/MD, Lice Ghilardi MD, Alessandro Di Rocco MD and Daniele Volpe MD

Background

The creative process of art making art is arguably unique to our species. Art creation is regarded as one of the most culturally ubiquitous human behaviors. The fact that humans display inordinate capacity for art creation likely reflects the unique neurological organization of the human brain and the potential for artistic experience to engage complex neurobehavioral functions promoting both individual and collective survival.

 

From a neurologic viewpoint, growing experimental evidence supports the therapeutic role of artistic experience to improve quality of life in patients burdened by various neuropsychiatric diseases, including primary dementing illnesses, depression, and post-traumatic stress disorder. In patients with Parkinson’s Disease (PD), recent exploratory studies reported significant benefits in both motor and non-motor symptoms of the disease, as well as in psychosocial adaptation and emotional well-being. A recent randomized controlled trial involving clay manipulation reported specific improvements in self-expression and mood as compared to non-equivalent treatments based on physical exercise and game playing.

 

Indeed, the process of art making relies on sophisticated neurological mechanisms that can be used to enhance specific brain functions. However, the exact mechanisms underlying these benefits remain to be elucidated. A first hypothesis posits that by working on achieving artistic goals, patients with PD may actively train neural networks involved in multisensory processing and sensory-motor integration. Mounting evidence from electrophysiological, imaging and behavioral studies, suggests that PD involves a generalized dysfunction of sensory-motor integration, resulting in a specific deficit in organizing and guiding movements in space. Systematic perceptual biases may directly affect complex motor functions such as balance and locomotion. In patients with PD, restricted visual-spatial processing, particularly when compounded with impaired proprioceptive integration, has been linked to navigational veering, freezing of gait, and recurrent falls.

 

Preliminary results from our group showed significant improvements on visual recognition and visual-constructional abilities in patients with PD following a 10 weeks art therapy program (Alberto Cucca, “ExplorARTPD Study”, Grant ID: # C17-00191). These improvements were accompanied by changes in brain connectivity highlighting a functional reorganization of associative cortical networks, thus suggesting the potential for controlled artistic experience to improve faulty perceptual functions in these patients.

 

Further, clinical improvements observed with art programs in patients with PD may be explained in light of neurologic mechanisms specifically related to pleasurable aesthetic experiences and changes in subjects’ hedonic tone.

 

Computational studies utilizing probabilistic selection tasks to probe decision making in patients with PD strongly suggest a pathological learning model dominated by punishment over reward-mediated reinforcements. In these patients, the lack of gratification from pleasurable experiences resulting from incorrect stimulus-punishment association may favor the onset of depression, anxiety, and apathetic behaviors. Artistic experience based on exposure to art creations may play an important role in modulating incentive salience and hedonic impact, therefore counteracting these negative symptoms.

 

Consistently, preliminary results from our group suggest that artistic experience may significantly improve patients’ self-efficacy and quality of life.  By virtue of its multilayered construct, artistic experience may indeed improve well-being, functional independence and quality of life in patients with PD to a greater extent than any uni-dimensional rehabilitative approach alone. However, the current lack of clarity surrounding the specific therapeutic mechanisms underlying this intervention as well as its long-term feasibility limits its extensive use in clinical practice.

 

Aims

The present study aims to advance the current understanding regarding feasibility, safety and therapeutic potential of artistic experience to improve quality of life, clinical symptoms, brain connectivity, cortical plasticity, and motor function in patients with PD.

 

To this end, we will investigate the effects of a predetermined multisensorial art therapy intervention (MS-AT) specifically designed to improve psychological wellbeing, sensory-motor integration and quality of life in this clinical population.

 

The specific scopes of the present proposal are therefore:

to determine whether 20 sessions of MS-AT are feasible and safe for people affected by PD with various degrees of motor and psychological disability;
to determine whether 20 sessions of MS-AT significantly affect quality of life and clinical symptoms in these patients;
to assess the effects of 20 sessions of MS-AT on brain plasticity, motor function and gait profile in these patients in order to explore the potential underlying therapeutic mechanisms of this intervention.

 

Clinical Significance and Potential Impact

To date, available evidence supporting the guided use of artistic experience to improve clinical symptoms of PD remains sparse and confined to small studies, often carried out with exploratory designs. With the present proposal, we aim to assess feasibility and rehabilitative potential of artistic experience in subjects with PD while exploring its neural underpinnings. Our research group is at the frontline in the development of innovative models of rehabilitation aiming to address patients’ disabilities through multidimensional, person-centered approaches. We believe that the knowledge gained through this study will significantly help in refining optimal therapeutic protocols and generalizing potential benefits from artistic experience to broader clinical populations.