If you’ve never heard of Radiolab, I highly recommend listening to their podcasts. A couple months ago, I was driving back to school and listening to one titled “Unraveling Bolero.” My dad had sent it to me multiple times and told me that he thought I would really enjoy it, but I continued to push it off. Once I finally listened to it, I was immediately fascinated by the story they told.

The podcast tells of a successful scientist named Anne Adams. After her son was in a car accident, she decided to stay home full time to take care of him. While spending her time at home with her son, she suddenly decides to become a full time painter and obsessively paints strawberries.

After a while, she starts to paint other things as well. The one that gathered some attention was her painting titled Unraveling Bolero. Anna set out to create a painting of Maurice Ravel’s famous composition titled Bolero. How she could have possibly painted a piece of music? Well, she deconstructed the entire composition and matched pitches, melodies and bases to colors; for example, B flat was a metallic green. The end result was a creation consisting of two panels. The thought that went into creating this is astounding. Unraveling Bolero started to reveal her repetitive, obsessive tendencies.

Now, let’s travel back in time a bit. The man who composed Bolero is named Maurice Ravel. When making this composition, he decided to repeat the melody continuously instead of developing it; he simply had the orchestration grow around the melody. Six years later, Bolero started to forget words. By 1935, Ravel couldn’t write or speak anymore. He tried to relearn the alphabet – to no avail.

Let’s go back to Anne. Six years after Anne created her painting, she started to also have problems with forgetting words and speaking. Eventually, it was found that she had frontotemporal dementia (FTD). Interestingly, this is what Ravel was found to have as well; this was discovered when an autopsy revealed one of the lobes in the brain had sunk because it was disintegrating. Both had a major interest in the composition Bolero, which highlighted their obsession with repetition.

Now, what is frontotemporal dementia? In short, it refers to a group of disorders that are caused by progressive nerve loss in the frontal or temporal lobes of the brain (2). Essentially, portions of the lobes shrink, or atrophy (4).

It is classified into three clinical variants: (1)

• Behavioral-variant: associated with early behavioral and executive deficits
• Non-fluent variant: deficits in speech, grammar, and word output
• Semantic-variant: disorder of semantic knowledge and naming

Symptoms may include some of the following (although there are MANY more as well): (4)

• Repetitive, compulsive behavior
• Apathy
• Lack of judgment and inhibition
• Lack of awareness of thinking or behavioral changes
• Impairment or loss of speech
• Tremors
• Rigidity

Sadly, the cause of frontotemporal dementia is unknown. Possibilities include mutations on several genes, although that itself likely would not cause FTD. Many people with FTD have these small structures called Pick bodies in their brain cells, which have an abnormal amount (or type) of protein (3). It is hard to narrow any complex disease or health condition down to a single cause, because there are so many interacting factors that may cause problems.

Okay, since we know a bit about FTD, let’s go back to Anne and Ravel. Where did this obsession with repetition come from? Although there is not an explicit answer for this, there are a couple theories out there. There are several parts of the brain that can inhibit certain occurrences (such as if the basal ganglia said “move, eat, run”), and there is a possibility that the structures in the brain dedicated to language can help inhibit some of these. However, when the language part of the brain is not able to do that, then certain motor commands may flow up, too. In the early stages of their illnesses, Anne and Ravel had the ability to make sense of it all and create either amazing artwork or a famous musical composition. There was enough of the cortex available to act upon this desire to repeat. However, as their cortices atrophied, they could make less and less sense of these impulses, and they made simpler creations.

This story of Anne and Ravel helps show how this disease is a problem many people face, and that it can manifest in different ways. There needs to be more research on it, and more people should know what it is.

References:

1. Bang, J. Spina, S. Miller, B. Frontotemporal dementia. The Lancet. 386:24-30. https://doi.org/10.1016/S0140-6736(15)00461-4.
2. “Frontotemporal Dementia.” Alzheimer’s Disease and Dementia. https://http://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/frontotemporal-dementia.
3. “Frontotemporal Dementia.” Frontotemporal Dementia. Johns Hopkins Medicine Health Library. https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/frontotemporal_dementia_134,77.
4. “Frontotemporal Dementia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Oct. 2016. https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737.