Creative thinking in Parkinson's disease: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract; confidence interval crossing zero indicates p > 0.05

• Effect Size: Cohen's d = -0.095 (small, non-significant effect favouring healthy controls)

• Primary Outcome: Divergent thinking task performance in PD patients on dopaminergic medications compared to healthy controls

• Nnt Or Sensitivity: Not applicable for this cognitive comparison meta-analysis; no NNT, sensitivity, or hazard ratio reported. The small Cohen's d (-0.095) is well below the threshold for clinical significance (conventionally d = 0.2 for small effects), indicating no meaningful between-group difference in divergent thinking.

• Confidence Interval: 95% CI: -0.308 to 0.118

Clinical Application

Divergent thinking assessments (e.g., Alternate Uses Task, verbal fluency tasks) are brief, low-cost, and feasible in outpatient neurology and neuropsychology settings without specialised equipment. Integration into routine cognitive screening for PD patients is clinically feasible. However, standardised norms for PD populations and validated cut-offs for divergent thinking tasks in this context remain limited, constraining clinical utility. In Australia, Parkinson's disease management is guided by Parkinson's Australia and RACGP clinical resources, with dopaminergic medications (levodopa/carbidopa combinations, dopamine agonists such as pramipexole and ropinirole) listed on the Pharmaceutical Benefits Scheme (PBS) for eligible patients. Neuropsychological assessment services are accessible through public neurology departments and private neuropsychology practices, with Medicare Benefits Schedule (MBS) item numbers available for cognitive assessment. The finding that divergent thinking may be preserved in treated PD patients has potential relevance for occupational therapy and cognitive rehabilitation programs, which are increasingly integrated into multidisciplinary PD care in Australian settings. TGA-approved dopaminergic agents used in Australian practice align with those used in the international studies included in this review. RACGP guidelines emphasise holistic cognitive management in PD, and this evidence could support the inclusion of creative and divergent thinking activities in non-pharmacological cognitive support programs, pending higher-certainty evidence. Adults with established Parkinson's disease who are receiving dopaminergic pharmacotherapy (levodopa, dopamine agonists, or combination regimens) and retain sufficient cognitive capacity to participate in structured neuropsychological assessment. The findings are less directly applicable to medication-naïve patients, those with PD dementia, or those in advanced disease stages.

Abstract

INTRODUCTION: Creativity in Parkinson's disease (PD) has aroused research interest due to its neurological underpinnings, which involve brain regions crucial for creative and divergent thinking (a core-process of creative thinking), and because of some patients who displayed an increased artistic drive following dopaminergic treatment. From a cognitive point of view, creative thinking underlies several cognitive abilities, such as executive functions and memory. Therefore, a better understanding of whether it is increased (or, at least, preserved) in PD patients can provide useful insights for sustaining cognitive functioning. The aim of the present study was to investigate whether PD patients regularly assuming dopaminergic medications present higher divergent thinking skills than healthy controls. METHODS: A meta-analysis was conducted according to the PRISMA guidelines to provide a statistical synthesis of the studies. Study quality was assessed using the QUADAS -2 tool. RESULTS: Ten studies were included in the meta-analysis, which indicated the absence of significant differences between PD patients and healthy controls in tasks assessing divergent thinking (Cohen's d = -0,095 (95% CI: -0,308, 0,118)). CONCLUSIONS: Such findings support the notion that divergent thinking can be spared by the disease, maybe constituting a possible resource for patients' cognitive functioning, as it involves those cognitive abilities that can compensate impairments in PD. Clinical implications and guidance to further studies and interventions to support PD patients' cognition were discussed.

References

1. 1.Colautti, L., Magenes, S., Pagnini, F., Silveri, M. C., Giovagnoli, A. R., & Antonietti, A. (2026). Creative thinking in Parkinson's disease: A systematic review and meta-analysis. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://doi.org/10.1080/13825580490904246