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Objective: This publication
intend to show the presence of artistic creativity in dement patient’s
non-artists, according to my experience of 20 years in art workshops for people
with neurodegenerative disorders.
Background: Some authors
underline the impairment of the abilities in Alzheimer’s patients with
decreasing of visuospatial capacities and loss of motricity. Others note that
almost disease creates a technic failure; the products keep a real artistic
status. Such creativity can appear with « ingenuous » patients as seen in
art-therapy productions.
Method: 70 patients with
neurodegenerative disease, participants of an art therapy workshop (45 women/25
men) were selected. 42% of patients suffered of an Alzheimer’s disease, 30% of
a vascular one, 14% of an ethylic one and 14% of other dementia. The MMSE score
was 13.5 ± 6.2 on 30 and the “House Drawing Test” score was 9.5 ± 7.8 on 25.
The weekly sessions of 2 h are livened up by an art therapist and a team
leader. The study is illustrated by the case report of a 90 years old woman,
affected by an Alzheimer’s disease at advanced stage.
Results and
discussion: The results show a decrease of breakdown and behavioral troubles,
stabilization of knowledge functions and apparition of a surprising creativity
for regular attenders.
Conclusion: The pictorial
creativity may be emerging even during advanced stage of disease and among
“ingenuous” patients. So, it is therefore important to give a different status
for them and that their production becomes a rising value as street art, tags
or graffiti. This creativity has a therapeutically impact in affective,
cognitive and social functioning of patients.
Keywords: Alzheimer’s disease,
Art therapy, Creativity, MMSE, House drawing test
INTRODUCTION
The emergence of artistic skills has been
documented in patients with frontotemporal dementia [1]. Some authors underline
the impairment of these abilities in Alzheimer’s patients with decreasing of
visuospatial capacities and loss of motricity [2]. Others note that almost
disease creates a technic failure, the products keep a real artistic status: it
is the case for artists like Espinel [3], Maurer and Prvulovic [4], Crutch et
al. [5] and Fornazzari [6]. However, such creativity can appear with « ingenuous
» patients as seen in art-therapy productions [7]. This publication intends to
show the presence of artistic creativity in dement patient’s non-artists,
according to my experience in workshops for people with neurodegenerative
disorders [8]. The participants were enrolled in Arpajon Hospital, not very far
from Paris, in Dr. Philippe Barboux geriatric setting. The workshop received
190 participants hospitalized between 1991 and 2012 with various pathologies.
For the study the selected 70 patients showed a cognitive deterioration
following the criteria of DSM-IVR [9]. They were 81.5 ± 8.4 years. 42% of these
patients had Alzheimer’s disease, 30% had vascular dementia, 14% had
alcohol-related dementia and 4% presented other forms of dementia. The weekly sessions of 2 h are
livened up by an art-therapist and a team leader.
RESULTS
Stakeholders have seen progress on several levels:
·
A decrease of breakdown and behavioral
troubles, stabilization of cognitive functions, significant improved relations
with family and environment, mood and physical state.
·
Technical progress in about 50% of
patients and apparition of a surprising personnel creativity and personal style
for 30% of regular attenders.
CASE REPORT
Among 18 cases of creative patients, presented in my recent book [8], I
chose this one because it seems to me very reveling concerning art therapy
power, even in case of severe dementia. The patient was a 90 years old,
right-handed woman, retired secretary at the post office. As documented by her
sister, she played the piano and attended museums and exhibitions but without painting.
She enters to the hospital for « fall and confusion ». During her stay in
hospital she received Prozac 20 mg in the morning and Melleril 10 mg in the
evening. The patient shows a deterioration of memory, temporal and spatial
disorientation, language abnormality, poor judgment, wondering and a diagnosis
of probable Alzheimer’s disease was made. The patient scored 6 on the MMSE and
54 on the ADAS-cog. Her coping of intersecting pentagons was normal but house
drawing failed: instead of drawing she writes scrawl « drawing ». The Cornell
Depression Scale shows the score of 23 out 38, with suicidal thoughts,
psychomotor slowing, frozen mimic and sad faces of crying as well as frequent
psychosomatic complaints.
If during the first sessions the patient does not do anything,
inconsistent and disoriented, in a few sessions, stimulated by art therapist,
she is a little more autonomous: asked to make a spontaneous drawing she
sketches very quickly 4 trees on a road after taking a quick look out the
window. Her works are sketched quickly in pencil and then ironed with felt or
gouache, causing astonishment and admiration of animators. During a year of her
participation in the workshop she performed thirty productions in a series of
wooded road painted with little colors, between figuration and abstraction. Her
mood improves, the behavior is more suitable, and her sister contacted by me to
show her drawing board, surprised by these changes will decide her return at
home.
DISCUSSION
This one year involvement in the art workshop had an impact on her
emotional and behavioral state: a decrease of depression, of neuropsychiatric
symptoms and emergence of creativity, surprising in 90 years old woman, no
previous artistic experience, with an advanced stage of Alzheimer’s disease.
This proves that even in a factual state of cognitive deterioration, there is
always a small expressive flame that just awaits a tutor to accompany the
creative act. If patients with mild diseases may be able to work independently,
those with severe dementia likely require greater structure and creation of a
comfortable, stimulating, encouraging environment. Is creativity possible in
dementia? Even if judgments on the level of creativity are still relative and
temporary, about 30% of regular participants suffering from different types of
dementia were considered creative by the animators and training students in
visual arts at workshop. If healing is not possible, evolution of the disease
through this stimulating activity will be more moderate and slower. Creativity
could be considered here as a factor of resilience.
It is therefore necessary to give a different status to the “memory
patient” and that their production becomes a rising value as street art, tags
or graffiti. Our experience of over 20 years of geriatric art workshop
animation allows us to see that pictorial creativity may be emerging even
during elderly life of patients: this creativity have a therapeutically impact
in their affective, cognitive, social functioning and in their self-esteem.
DISCLOSURE
The author reports no conflicts of interest.
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DB, Kluger BM, et al. (2006) What’s inside the art? The influence of
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workmen can blame their tools: Artistic change in an individual with
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creativity in an artist with Alzheimer’s disease. Eur J Neurol 12: 419-424.
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Art therapy for Alzheimer’s disease and other dementias. J Alzheimers Dis 39:
1-11.
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d’Alzheimer. Soigner autrement les maladies de mémoire. Lyon. Chronique
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Diagnostic and statistical manual of mental disorders. Washington, DC.
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