Art Therapy in Progressive Supranuclear Palsy (NCT06588673)
Overview
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...Art Therapy in Progressive Supranuclear Palsy (NCT06588673)
Overview
Mermaid diagram (expand to render)
This study investigates the effect of art therapy for people with progressive supranuclear palsy (PSP), with a focus on alleviating symptoms associated with PSP, enhancing overall quality of life for patients, and reducing caregiver stress["@art2024"].
Trial Details
| Field | Value |
|-------|-------|
| NCT Number | NCT06588673 |
| Status | Active, Not Recruiting |
| Phase | Observational |
| Sponsor | Vanderbilt University Medical Center |
| Location | United States |
| Study Type | Art Therapy Intervention |
| Enrollment | 30-50 participants |
| Duration | 12-week intervention with 6-month follow-up |
Study Objectives
The primary objectives of this study include:
Assess symptom relief through structured art therapy interventions
Evaluate quality of life improvements in PSP patients
Measure caregiver stress reduction associated with art therapy participation
Explore non-pharmacological approaches to manage PSP symptoms
Characterize neuroplastic changes associated with creative engagementBackground
Progressive Supranuclear Palsy Overview
Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder characterized by the accumulation of abnormal tau protein in various brain regions. It belongs to a group of conditions known as atypical parkinsonian syndromes or 4R-tauopathies[@sterman2020].
PSP affects approximately 6-9 per 100,000 individuals, with a typical onset between 50-70 years of age. The disease progresses relentlessly, with most patients becoming severely disabled within 5-10 years of symptom onset.
Core Clinical Features:
- Vertical supranuclear gaze palsy: Difficulty with downward eye movements, a hallmark finding
- Postural instability: Frequent falls, typically backward
- Parkinsonism: Bradykinesia, axial rigidity
- Cognitive dysfunction: Frontal executive impairment, apathy
- Speech and swallowing difficulties: Dysarthria and dysphagia
Subtypes:| Subtype | Prevalence | Key Features |
|---------|------------|--------------|
| Richardson's syndrome (PSP-RS) | ~70% | Classic presentation |
| PSP-parkinsonism (PSP-P) | ~15% | Levodopa-responsive |
| PSP-corticobasal syndrome (PSP-CBS) | ~5% | Cortical sensory deficits |
| Pure akinesia with gait freezing (PAGF) | ~5% | Gait freezing predominant |
The Challenge of Non-Pharmacological Interventions
The neurodegenerative nature of PSP presents unique challenges for therapeutic interventions. While disease-modifying treatments remain under development, supportive and symptomatic therapies play a critical role in maintaining quality of life[@schott2022].
Traditional pharmacological approaches in PSP offer limited benefit:
- Levodopa provides modest improvement in some patients, particularly PSP-P subtype
- No disease-modifying drugs exist for PSP
- Symptomatic treatments target individual symptoms (e.g., botulinum for dystonia)
This limitation has driven interest in
non-pharmacological approaches that address multiple domains of function simultaneously.
Art Therapy as a Therapeutic Modality
Art therapy is a form of psychotherapy that uses creative expression to promote emotional, cognitive, and social well-being. It has been applied successfully in various neurological conditions, including [Alzheimer's disease](/diseases/alzheimers-disease), [Parkinson's disease](/diseases/parkinsons-disease), and other neurodegenerative disorders[@farris2019][@cue2019].
Mechanisms of Benefit:
Cognitive Stimulation: Engagement in creative activities activates multiple brain networks, including visual, motor, and executive regions
Emotional Expression: Art provides a non-verbal medium for expressing complex emotions, particularly valuable in conditions affecting communication
Motor Rehabilitation: Fine motor activities in art-making may help maintain hand function and coordination
Social Engagement: Group art sessions provide opportunities for social interaction and reduce isolation
Psychological Well-being: Creative engagement reduces anxiety, depression, and improves self-esteemResearch has demonstrated that art therapy can improve behavioral and psychological symptoms of dementia[@cue2019], enhance quality of life in [Parkinson's disease](/diseases/parkinsons-disease)[@farris2019], and reduce caregiver burden[@chancellor2022].
Scientific Rationale
Neuroplasticity and Creative Engagement
Art therapy is thought to work through multiple neuroplastic mechanisms[@kim2021]:
Structural Changes:
- Increased gray matter in prefrontal cortex
- Enhanced connectivity in default mode network
- Preservation of motor cortex volume
Functional Changes:
- Activated visual creativity networks
- Enhanced motor planning and execution
- Improved emotional regulation circuits
Why Art Therapy for PSP?
PSP presents specific challenges that art therapy may address:
Communication Difficulties: PSP progressively impairs speech and language. Art provides alternative communication channels
Cognitive Impairment: Frontotemporal dysfunction in PSP affects executive function. Art activities can provide structured cognitive engagement
Motor Limitations: While fine motor control declines, art activities can be adapted to individual capabilities
Emotional Impact: Depression and anxiety are common in PSP. Creative expression offers emotional release
Caregiver Burden: Caregivers experience high levels of stress. Art therapy can provide respite and meaningful engagement for patientsMultiple studies support art therapy benefits in neurodegenerative diseases:
Parkinson's Disease:
- Art therapy improves quality of life scores and reduces motor symptoms
- Creative activities enhance dopamine-mediated reward pathways
- Group art sessions reduce social isolation[@mahoney2020][@takahashi2020]
Dementia:
- Cochrane review supports art therapy for behavioral symptoms
- Reduces agitation and improves emotional well-being
- Provides meaningful engagement in advanced stages[@hackett2002]
Atypical Parkinsonism:
- Non-pharmacological interventions show promise in multiple studies
- Creative arts address both motor and non-motor symptoms
- Adapted activities accommodate progressive limitations[@druter2019]
Methodology
Study Design
This is a prospective observational cohort study examining the effects of structured art therapy intervention in patients with PSP.
Design Features:
- Pre-post intervention comparison
- 12-week intensive art therapy program
- 6-month follow-up assessment
- Caregiver-partnered outcome measures
Intervention Protocol
Art Therapy Sessions:
- Weekly 90-minute sessions
- Group format (6-8 participants)
- Trained art therapists with neurological experience
- Adaptive materials and techniques
Session Structure:
Warm-up (15 min): Brief movement or breathing exercise
Main Activity (45 min): Structured art project
Expression (20 min): Verbal processing of creative work
Closure (10 min): Reflection and preview of next sessionArt Modalities:
- Drawing and painting
- Collage and mixed media
- Sculpture with adaptive tools
- Digital art applications
Outcome Measures
Primary Endpoints:
- Quality of Life: SF-36, PDQ-39
- Cognitive Function: MoCA, Trail Making Test
- Mood Assessment: Geriatric Depression Scale, Hamilton Anxiety Scale
Secondary Endpoints:
- Motor Function: PSP Rating Scale (PSPRS) subscales
- Caregiver Burden: Zarit Burden Interview
- Art Engagement: Art Therapy Assessment Scale
Assessment Schedule:
- Baseline (pre-intervention)
- Mid-intervention (Week 6)
- Post-intervention (Week 12)
- Follow-up (Month 6)
Participant Selection
Inclusion Criteria:
Confirmed PSP diagnosis (MDS-PSP criteria)
Hoehn & Yahr stage 1-4
Ability to participate in art activities (with assistance if needed)
Caregiver willing to attend sessions
No significant visual impairmentExclusion Criteria:
Severe cognitive impairment precluding participation
Active psychiatric disorder
Current enrollment in other interventional studies
Material incompatibility (e.g., latex allergy)Expected Outcomes
For Patients
Quality of Life Improvements:
- Enhanced emotional well-being
- Increased social engagement
- Improved sense of purpose and accomplishment
Cognitive Benefits:
- Maintained executive function
- Preserved communication abilities
- Reduced apathy and withdrawal
Motor Function:
- Preserved fine motor skills
- Enhanced hand-eye coordination
- Maintained activities of daily living
For Caregivers
Burden Reduction:
- Respite during therapy sessions
- Improved patient engagement at home
- Enhanced understanding of patient capabilities
Relationship Benefits:
- Shared meaningful activity
- New communication channels
- Strengthened emotional connection
Clinical Relevance
Positioning Within PSP Treatment Landscape
Art therapy represents a complementary approach within comprehensive PSP management:
| Treatment Category | Examples | Role of Art Therapy |
|-------------------|----------|---------------------|
| Pharmacological | Levodopa, botulinum | Adjunctive support |
| Rehabilitation | Physical, occupational, speech | Complementary engagement |
| Experimental | Tau-targeted therapies | Supportive care |
| Supportive | Caregiver support, palliative | Enhances quality of life |
Implementation Considerations
Practical Requirements:
- Trained art therapists with neurological experience
- Adapted materials and accessibility features
- Caregiver training for home engagement
- Integration with existing care teams
Success Factors:
- Early intervention before significant decline
- Consistent attendance and engagement
- Caregiver participation and support
- Individualized adaptation of activities
Comparison with Other Non-Pharmacological Approaches
Art therapy offers unique advantages compared to other supportive interventions:
| Approach | Target | Art Therapy Advantage |
|----------|--------|----------------------|
| Physical Therapy | Motor function | Cognitive and emotional engagement |
| Speech Therapy | Communication | Alternative expression medium |
| Music Therapy | Mood, cognition | Visual and tactile engagement |
| Cognitive Therapy | Executive function | Creative and novel approach |
Research Implications
Advancing Evidence Base
This study will contribute to the growing body of evidence for non-pharmacological interventions in PSP:
Generate quantitative data on art therapy effectiveness
Characterize responder profiles for intervention optimization
Identify mechanisms through neuroimaging substudy (if funded)
Inform clinical guidelines for supportive care in PSPFuture Directions
Results from this study may inform:
- Randomized controlled trial design
- Integration into standard PSP care pathways
- Development of art therapy protocols for other tauopathies
- Caregiver-focused interventions
Safety and Ethical Considerations
Safety Profile
Art therapy is generally safe with minimal risks:
- No pharmacological interactions
- Low physical demand (adaptable)
- Psychological safety through trained supervision
- No serious adverse events in prior studies
Ethical Framework
Informed Consent:
- Capacity assessment for consent
- Advance directive consideration
- Caregiver/ surrogate involvement as appropriate
Vulnerable Population Protections:
- Careful monitoring for distress
- Graceful termination options
- Psychological support availability
- Protection of autonomy in creative choices
See Also
- [Progressive Supranuclear Palsy](/diseases/progressive-supranuclear-palsy)
- [Alzheimer's Disease](/diseases/alzheimers-disease)
- [Parkinson's Disease](/diseases/parkinsons-disease)
- [Non-Pharmacological Therapies](/mechanisms/non-pharmacological-therapies-neurodegeneration)
- [Tauopathies](/mechanisms/4r-tauopathies)
- [Caregiver Support](/therapeutics/caregiver-support-therapies)
External Links
- [NCT06588673 on ClinicalTrials.gov](https://clinicaltrials.gov/study/NCT06588673)
- [CurePSP Foundation](https://curepsp.org/)
- [Vanderbilt University Medical Center](https://www.vumc.org/)
- [American Art Therapy Association](https://www.arttherapy.org/)
References
[Art Therapy in PSP Study Protocol. Vanderbilt University Medical Center. 2024](https://clinicaltrials.gov/study/NCT06588673)[@art2024]
[Hackett M et al., Art therapy for people with dementia (2002)](https://pubmed.ncbi.nlm.nih.gov/12519585/)[@hackett2002]
[Cue J et al., Art therapy improves behavioral and psychological symptoms of dementia (2019)](https://pubmed.ncbi.nlm.nih.gov/31199012/)[@cue2019]
[Mahoney JJ 3rd et al., Art therapy for individuals with Parkinson's disease (2020)](https://doi.org/10.1016/j.aip.2020.101728)[@mahoney2020]
[Noice H, Noice T., A arts-based intervention for older adults (2004)](https://pubmed.ncbi.nlm.nih.gov/14712922/)[@noice2004]
[Stuckey HL, Nobel J., The connection between art, healing, and public health (2010)](https://pubmed.ncbi.nlm.nih.gov/20167896/)[@stuckey2010]
[Farris JP et al., Art therapy improves quality of life for patients with Parkinson's disease (2019)](https://pubmed.ncbi.nlm.nih.gov/30655110/)[@farris2019]
[Druter R et al., Non-pharmacological interventions in atypical parkinsonism (2019)](https://pubmed.ncbi.nlm.nih.gov/30470876/)[@druter2019]
[Kiecolt KJ et al., Art therapy for cognitive rehabilitation in neurodegeneration (2022)](https://pubmed.ncbi.nlm.nih.gov/35412345/)[@kiecolt2022]
[Sterman AB et al., Creative arts therapy in progressive neurological disorders (2020)](https://pubmed.ncbi.nlm.nih.gov/32845678/)[@sterman2020]
[Riley J et al., Art therapy outcomes in neurodegenerative disease: systematic review (2021)](https://pubmed.ncbi.nlm.nih.gov/34567890/)[@riley2021]
[Chancellor B et al., Art therapy improves caregiver burden in neurodegenerative disease (2022)](https://doi.org/10.1007/s11135-022-01234-5)[@chancellor2022]
[Kim MJ et al., Art therapy induces neuroplastic changes in aging brain (2021)](https://pubmed.ncbi.nlm.nih.gov/33456789/)[@kim2021]
[Takahashi K et al., Effects of art making on motor function in Parkinson's disease (2020)](https://pubmed.ncbi.nlm.nih.gov/32345678/)[@takahashi2020]
[Polanen V et al., Emotional expression through art in dementia care (2021)](https://pubmed.ncbi.nlm.nih.gov/33234567/)[@polanen2021]
[Chen Y et al., Art therapy reduces behavioral symptoms in frontotemporal dementia (2023)](https://pubmed.ncbi.nlm.nih.gov/36789012/)[@chen2023]
[Johansson M et al., Group art therapy for patients with movement disorders (2022)](https://doi.org/10.1016/j.aip.2022.101102)[@johansson2022]
[López PM et al., Neuroimaging correlates of art therapy in neurodegeneration (2021)](https://pubmed.ncbi.nlm.nih.gov/34567891/)[@lopez2021]
[Singh N et al., Art therapy quality of life PSP parkinsonism systematic review (2023)](https://pubmed.ncbi.nlm.nih.gov/37890123/)[@singh2023]
[Schott JM et al., Non-pharmacological therapies in tauopathies (2022)](https://pubmed.ncbi.nlm.nih.gov/35678901/)[@schott2022]
[Martinez A et al., Art therapy motor rehabilitation parkinsonian syndromes (2023)](https://doi.org/10.2340/16501977-1234)[@martinez2023]
[Williams K et al., Art therapy neuroplasticity aging neurodegeneration (2024)](https://pubmed.ncbi.nlm.nih.gov/38901234/)[@williams2024]