Cognitive Flexibility and Creativity in People with Parkinson*s: A Pilot Study Exploring the Influence of Dopaminergic Regulation on Cognitive Flexibility and Creativity, with an Emphasis on Visual Art

Research reveals that Parkinson*s disease (PD) can significantly alter
condition, specifically cognitive flexibility and creative cognition. This has
been shown specifically in visual artistry in affected individuals, suggesting
that these changes in artistic output may reflect broader cognitive shifts
important for creativity. Creativity involves generating innovative ideas and
solutions, requiring cognitive flexibility, imagination, and the ability to
switch between different tasks or thought paradigms. These cognitive processes
seem to be influenced by PD and its treatments, especially dopamine replacement
therapy (DRT).

PD is a chronic neurodegenerative disorder that impairs neurons responsible for
producing dopamine, a neurotransmitter essential not just for motor control but
also for various cognitive functions, including cognitive flexibility. This
highlights the disease's complexity and the need for comprehensive research
approaches. The impact of PD on creativity, particularly in visual arts,
provides a unique perspective on cognitive changes in PD patients due to the
expressive nature of art.

Key research findings include:
1. Shift in Creative Cognition and Artistic Production: Studies show that PD
can enhance artistic skills and alter style, color, and tool usage, contrary to
expectations of reduced creativity. These changes may be linked to deficits in
visuo-spatial abilities and task-switching capabilities, affecting
three-dimensional thinking and the ability to navigate between conceptual
frameworks. Mood and color perception changes also play a role in altering
artistic expressivity and style.
2. Effects of Dopamine Regulation on Creativity: Research examining creativity
changes in PD patients, especially in relation to neuropsychiatric symptoms,
suggests that fluctuations in dopamine levels due to neurodegeneration and DRT
can either decrease or increase creativity.
3. Epidemiological Perspective: A study at Radboudumc found that 41% of PD
patients reported changes in creativity, with more experiencing decreases than
increases or fluctuations, indicating significant variability in creativity
changes among this group.
4. Cognitive Flexibility and Dopamine*s Function: Investigations into cognitive
flexibility in PD patients reveal a specific deficit in cognitive set-shifting,
particularly when dealing with competing information, which relates directly to
dopamine*s role in the brain's fronto-striatal circuitries.
5. Changes in Reinforcement Learning: A study by Tichelaar et al. explored
dopamine's influence on reinforcement learning in PD, finding that
medication-induced dopamine levels can affect cognitive processes and mood,
crucial for creativity and cognitive flexibility.

Despite these insights, research has yet to systematically explore how
PD-related dopaminergic regulation affects creativity and visual art production
comprehensively. Many studies focus on specific PD cohorts or on underlying
mechanisms like cognitive flexibility without examining how these changes
manifest in visible output and behaviour, including interpersonal differences
and personal expression.
Our study aims to bridge this gap by conducting a pilot study with a
comprehensive battery of tests on individuals with young-onset PD, varying in
DRT intake, and controls. The study will assess PD-related factors, global
cognition, neuropsychiatric behavior, baseline creativity, and artistic
activities. We will explore creative domains through a questionnaire based on
the Amusement Park Theoretical model of creativity and conduct in-depth
interviews to understand daily life creativity, the personal significance of
art, and the impact of mood disorders or behavioural changes related to PD and
medication.

Our main objective is to conduct a pilot study testing the applicability and
face/external validity of the battery in a young-onset PD cohort, alongside
age-matched healthy controls. We aim to gain deeper insights into the complex
interrelationships between visual art production, cognitive flexibility,
dopaminergic regulation, and PD symptoms. This study primarily serves as a
foundational step for testing the comprehensive battery of tests.
The secondary objective is to get first insights into potential relationships
of the explored secondary study endpoints measured through the set of tests.

Our study utilises a mixed-methods design combining quantitative and
qualitative methods to investigate the complex interactions between PD,
dopaminergic regulation, cognitive flexibility, creativity, and visual art. The
research protocol consists of five key test points: pre-questionnaire online,
screening session, two sessions one during ON and one during an OFF state, and
finally a semistructured interview carried out at the participant's home. These
tests will employ a mixture of validated assessments and semi-structured
interviews. Each test phase has been designed to ensure participants* comfort,
incorporating breaks to maintain the integrity of responses.

Participants will not experience a direct benefit by participating. However,
they contribute significantly to research and the intervention that may lead to
the development of new innovative intervention programs and clinical methods.
This study can be classified as a moderate risk study, because there is a
moderate chance of minimal damage, as well as, for some participants, minimal
chance of serious damage.