Evaluation of artwork produced by Alzheimer's disease outpatients in a pilot art therapy program

Witkoski, Silvia Andreis; Chaves, Márcia Lorena Fagundes

doi:10.1590/S1980-57642008DN10200016

Abstract

The use of art as therapy for patients with Alzheimer's disease is characterized by the opportunity of art expression and is conducted with therapeutic purposes. Art in the context of dementia provides a unique window into the cognitive processes of various brain regions.

Objective:

To evaluate association between the severity of cognitive deficit and artwork (type, material, and quality) produced by AD patients in a pilot program.

Methods:

Eleven patients were evaluated in a weekly quasi-experiment study following 125 sessions of art therapy over a period of 31 months. Patients were diagnosed with Alzheimer's disease (N=11) according to standard criteria. The Mini Mental State Examination and a battery of cognitive tests were used to assess cognitive deficit.

Results:

Different types of artwork were observed during the sessions for most patients. The selection of drawing or modeling showed significant association with severity of cognitive deficit. Type of material, as well as quality of artwork, also showed a similar association with deficit severity.

Conclusion:

The significant association between type of work, drawing or modeling, with severity of cognitive impairment could be influenced by a range of damaged cognitive functions (including visuospatial), and by inadequate perception of graphic elements.

Key words:
art therapy; dementia; Alzheimer's disease.

Resumo

O uso da arteterapia em pacientes com doença de Alzheimer é uma oportunidade de expressão, conduzida com objetivo terapêutico. A arte no contexto da demência fornece uma abertura única para o acesso ao processamento cognitivo com suporte em várias áreas cerebrais.

Objetivo:

Avaliar associação entre gravidade do déficit cognitivo e produto artístico (tipo, material, e qualidade) desenvolvido por pacientes com DA num programa piloto.

Métodos:

Onze pacientes foram avaliados semanalmente num estudo quase experimento e seguidos por 125 sessões de arte terapia durante um período de 31 meses. Os pacientes receberam diagnóstico de doença de Alzheimer (N=11) de acordo com os critérios padronizados internacionais. O Mini Exame do Estado Mental e uma bateria de testes cognitivos foram usados para avaliar o déficit cognitivo.

Resultados:

Tipos diferentes de produtos artísticos foram observados durante as sessões para a maioria dos pacientes. A seleção de desenho ou modelagem mostrou associação significativa com gravidade do déficit cognitivo. Tipo de material bem como qualidade do produto artístico também apresentaram associação similar com gravidade do déficit cognitivo.

Conclusão:

A associação significativa entre tipo de produto artístico, desenho ou modelagem, com gravidade do comprometimento cognitivo pode ser influenciada pela variedade de funções cognitivas comprometidas (incluindo a função viso-espacial) e acabar levando à percepção inadequada dos elementos gráficos.

Palavras-chave:
terapia da arte; demência; doença de Alzheimer.

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References

¹
Cummings JL. Drug Therapy: Alzheimer's Disease. N Engl J Med 2004;351:56-67.
²
Miller BL, Hou CE. Portraits of artists: emergence of visual creativity in dementia. Arch Neurol 2004;61:842-844.
³
Cummings JL, Zarit JM. Probable Alzheimer's disease in an artist. JAMA 1987;258:2731-2734.
⁴
Espinel CH. de Kooning's late colours and forms: dementia, creativity, and the healing power of art. Lancet 1996;347:1096-1098.
⁵
About art therapy - American Art Therapy Association, Inc. http://www.arttherapy.org/about.html accessed April 10th; 2007.
» http://www.arttherapy.org/about.html
⁶
Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Rikkert MG. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ 2006;333:1196-1201.
⁷
Farina E, Mantovani F, Fioravanti R, et al. Efficacy of Recreational and Occupational Activities Associated to Psychologic Support in Mild to Moderate Alzheimer Disease. A Multicenter Controlled Study. Alzheimer Dis Assoc Disord 2006;20:275-282.
⁸
American Psychiatric Association. Diagnostics and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.
⁹
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDAWork Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
¹⁰
Chaves ML and Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.
¹¹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹²
Chaves ML, Ilha D, Maia AL, Motta E, Lehmen R, Oliveira LM. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Braz J Med Biol Res 1999;32:1133-1143.
¹³
Cooper LA. Varieties of Visual Representations: How Are We To Analyze The Concept of Mental Image? Neuropsychologia 1995;33:1575-1582.
¹⁴
Kosslyn SM. Seeing and imagining in the cerebral hemispheres: A computational approach. Psychol Rev 1987;94:148-175.
¹⁵
Bartolomeo P. The relationship between visual perception and visual mental imagery?: a reappraisal of the neuropsychological evidence. Cortex 2002;38:357-378.
¹⁶
Giles GM, Clark WJ. Brain Injury Rehabilitation: A neurofuntional approach. London: Chapman & Hall; 1993.
¹⁷
Podgorny P, Shepard RN. Functional representations common to visual perception and imagination. J Exp Psychol Hum Percept Perform 1978;4:21-35.
¹⁸
Foucault M. História da sexualidade II - O uso dos prazeres. Rio de Janeiro: Edições Graal Ltda; 1984.
¹⁹
Hallowell AI. Culture and experience. Philadelphia: University of Pensylvania Press; 1955.
²⁰
Miller BL, Cummings J, Mishkin F, et al. Emergence of artistic talent in frontotemporal dementia. Neurology 1998;51:978-82.

Publication Dates

Publication in this collection
Apr-Jun 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Cummings JL. Drug Therapy: Alzheimer's Disease. N Engl J Med 2004;351:56-67.

[2] ²
Miller BL, Hou CE. Portraits of artists: emergence of visual creativity in dementia. Arch Neurol 2004;61:842-844.

[3] ³
Cummings JL, Zarit JM. Probable Alzheimer's disease in an artist. JAMA 1987;258:2731-2734.

[4] ⁴
Espinel CH. de Kooning's late colours and forms: dementia, creativity, and the healing power of art. Lancet 1996;347:1096-1098.

[5] ⁵
About art therapy - American Art Therapy Association, Inc. http://www.arttherapy.org/about.html accessed April 10th; 2007.
» http://www.arttherapy.org/about.html

[6] ⁶
Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Rikkert MG. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ 2006;333:1196-1201.

[7] ⁷
Farina E, Mantovani F, Fioravanti R, et al. Efficacy of Recreational and Occupational Activities Associated to Psychologic Support in Mild to Moderate Alzheimer Disease. A Multicenter Controlled Study. Alzheimer Dis Assoc Disord 2006;20:275-282.

[8] ⁸
American Psychiatric Association. Diagnostics and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.

[9] ⁹
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDAWork Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[10] ¹⁰
Chaves ML and Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.

[11] ¹¹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[12] ¹²
Chaves ML, Ilha D, Maia AL, Motta E, Lehmen R, Oliveira LM. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Braz J Med Biol Res 1999;32:1133-1143.

[13] ¹³
Cooper LA. Varieties of Visual Representations: How Are We To Analyze The Concept of Mental Image? Neuropsychologia 1995;33:1575-1582.

[14] ¹⁴
Kosslyn SM. Seeing and imagining in the cerebral hemispheres: A computational approach. Psychol Rev 1987;94:148-175.

[15] ¹⁵
Bartolomeo P. The relationship between visual perception and visual mental imagery?: a reappraisal of the neuropsychological evidence. Cortex 2002;38:357-378.

[16] ¹⁶
Giles GM, Clark WJ. Brain Injury Rehabilitation: A neurofuntional approach. London: Chapman & Hall; 1993.

[17] ¹⁷
Podgorny P, Shepard RN. Functional representations common to visual perception and imagination. J Exp Psychol Hum Percept Perform 1978;4:21-35.

[18] ¹⁸
Foucault M. História da sexualidade II - O uso dos prazeres. Rio de Janeiro: Edições Graal Ltda; 1984.

[19] ¹⁹
Hallowell AI. Culture and experience. Philadelphia: University of Pensylvania Press; 1955.

[20] ²⁰
Miller BL, Cummings J, Mishkin F, et al. Emergence of artistic talent in frontotemporal dementia. Neurology 1998;51:978-82.

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