Disrupted facial empathy in drawings from artists with frontotemporal dementia

The sense of empathy may be altered by brain disease. We report the drawing performance of four artists who developed frontotemporal dementia (FTD). The first three, but not the fourth, had a prominent decrease in empathy for others as well as alterations in their caricatures of people. Their drawings of faces became distorted, menacing, skeleton-like, or 'alien'. None of the four had facial recognition difficulties, problems in interpreting facial emotions, or a decreased appreciation of the distinction between animate and inanimate objects. Functional brain imaging in the patients revealed bilateral frontal hypometabolism or hypoperfusion, and the three with altered drawings had additional prominent involvement of the right temporal lobe. These FTD patients and the literature suggest that FTD, possibly with greater right temporal involvement, disrupts the sense of empathy from human faces.