Through The Eyes of Alzheimer

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Through The Eyes of Alzheimers

• Ali R. Rahimi,MD,FACP,AGSF
• Professor of Medicine
• Mercer University School of Medicine

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Objectives

• Review the following in context to artistic
  ability
• Typical Aging Process
• Effects of aging in selected artists
• Monet
• Rembrandt
• Process of Alzheimers Disease (AD)
• Effects of Alzheimers Disease in selected
  artists
• Carolus Horn
• William Utermohlen
• Review and Conclusions

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Aging of The Brain

• Steady decline of organ function and regulatory
  functions
• Atrophy of the brain
• Reduced blood flow to the brain
• Decreased number of nerve cells
• Reaction time to stimuli slows

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Aging of The Brain

• Above mentioned changes have effect on
  intelligence and cognition
• Declines in intelligence began at about age 60
• Difficulty with recall and accumulating new
  information also appear

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Aging of The Body

• Atrophy of all muscle systems
• Decreased muscle strength and endurance
• Disease processes, such as arthritis, impair
  mobility and limit fine movements
• Arthritis in about 50 of patients
• Decreased physical activity

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Aging of The Body

• Visual changes affect ability to see clearly and
  produce detailed work
• Depression
• Decreased self-confidence due to increasing
  limitations and decreasing amounts of freedom

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Results of Aging

• Decreased ability to achieve same level of work
  as previously possible
• Thinking processes and coordination decreased
• Physical ability to draw and paint decreased
• Motivation and energy to work is decreased

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Agings Effect on Art

• Decline of output during aging
• Peak productivity in 30s and 40s
• Productivity declines after 40s
• Definite exceptions to this rule
• Grandma Moses started painting at age 78 and
  completed works at age 101
• Rembrandt painting until death in 1669

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Aging Related Impairments to Creating Art

• Visual impairments
• ex. the aging eye
• Physical impairments
• ex. rheumatoid arthritis
• Changes in energy/drive
• General aging

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Effects Seen From an Aging Eye

• Increased glare
• Decreased color discrimination
• Decreased contrast sensitivity
• Decreased acuity

• Decreased perception of motion
• Decreased field of view

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Aging Related Disease Processes of The Eye

• Cataracts
• Presbyopia
• Macular Degeneration
• Glaucoma
• Diabetic Retinopathy
• All have effect on an artists perception

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Monets Bridge Through Cataracts
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Aging Related Impairments to Creating Art

• Visual impairments
• ex. the aging eye
• Physical impairments
• ex. rheumatoid arthritis
• Changes in energy/drive
• General aging

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Pierre-Auguste Renoir (1841-1919)

• Afflicted with rheumatoid arthritis in 1894
• Produced almost 400 paintings after diagnosis
• Adept skill even with arthritis

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Unbroken Spirit And Drive (1915)

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Aging Related Impairments to Creating Art

• Visual impairments
• ex. the aging eye
• Physical impairments
• ex. rheumatoid arthritis
• Changes in energy/drive
• General aging

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Aging of an Artist

• Rembrandt (1606-1669)
• Famous for detailed portraits and visual acuity
• Chronicled his aging with over 100 self-portraits

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Rembrandt 1631 to 1661

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Aging of Rembrandt (1669)

• Presbyopia caused decreased detail and clarity
• Final works linked by broader brush strokes, less
  detail and yellowish hue

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The Aging Artist

• Visual aging can decrease precision and cause
  color usage changes
• Decreased dexterity and mobility leads to broader
  strokes and less detail
• Decreased energy causes decreased production
• Overall, though, aging artist still able to
  produce works comparable to works they created
  when they were younger

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Process of Alzheimers

• Typical aging process disease process
• Most common neurodegenerative disease of the
  elderly
• Subtle, progressive changes
• Loss of synaptic connections

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Alzheimers and The Brain

• General brain atrophy
• 4 classic changes
• Cortical atrophy
• Degeneration of cholinergic neurons
• Neurofibrillary tangles
• Accumulation of amyloid plaques

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Consequences of Alzheimers

• Brain related changes lead to many cognitive
  impairments
• Memory impairment
• Visuospatial disorientation
• Language impairment
• Constructional apraxia

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Consequences of Alzheimers (Contd)

• Alzheimers patients do not benefit from clues
  or reminders
• Difficulty in finding words, drawing simple
  objects, and locating objects
• Decreased abstract thinking
• Have little insight into own disease

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Brains Influence in Art

• Anterior left hemisphere
• Coordinates limb and eye movements
• Occipital/Temporal cortical areas
• Perceive form and depth
• Parietal areas
• Influence perception of space
• Control movement in space and time

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Effects of Brain Damage in Art

• Right hemisphere damage
• Hemi spatial neglect
• Spatial relationships of parts of image incorrect
• Left hemisphere damage
• Less impaired spatial arrangement
• Oversimplification
• Tremulous quality to work

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Alzheimers Scope of Damage

• Alzheimers generally causes global deterioration
• Will see combination of right and left sided
  impairments due to global effect
• Position of plaques and lesions plays a role in
  changes seen
• Usually do not see hemi spatial neglect or
  tremulous quality

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Cornerstones of Alzheimers Art

• Fewer angles
• Impaired perception
• Impaired spatial relationships
• Increased simplification
• Overall production impaired
• Severity of these changes correlates with
  severity of disease

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Contextual Criteria in Alzheimers Art

• Impaired ability to draw squares and houses
• Subject matter more abstract
• Magical subjects increasingly popular
• Ornamentation more prevalent
• Increased scribbling
• More geometric, linear shapes used

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Formal Criteria in Alzheimers Art

• Regression
• Lack of perspective
• Primitive, child-like qualities
• Distortion
• Increasing comic or grotesque quality
• Cartoon-like quality to work
• Condensation
• Overfilling/overflowing of space

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Formal Criteria in Alzheimers Art

• Transformation
• Anatomic features placed inappropriately
• Physiognomy (applying strange facial features to
  humans and animals)
• Stereotype
• Repetition of a subject or object

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Formal Criteria in Alzheimers Art

• Woodenness
• Enclosing pictures within frames
• Decreased depth (less shading)
• Increased rigidity (decreased movement/fluidity)
• More rigid geometric shapes

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Formal Criteria in Alzheimers Art

• Disintegration
• Neglect of spatial relationships
• Loosening of physiognomy
• Animal and human qualities become even more
  abstract

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Carolus Horn (1921-1992)

• Designer for advertising company (clients
  included Coca-Cola)
• Completed leisure paintings in his free time
• Enjoyed drawing animals
• Enjoyed capturing the Rialto Bridge in Venice,
  Italy

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Carolus Horn

• Diagnosed with Alzheimers in 1984
• Diagnosed at age 63
• Disease presented with memory impairment,
  difficulty recognizing people, impaired reading
  and speaking abilities

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Carolus Horn

• Progression of disease can be seen through
  paintings
• Painted Rialto Bridge at least five times from
  1978 to 1988
• Allows visualization of the artistic changes that
  Alzheimers caused in Horn

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Rialto Bridge (1978)

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Rialto Bridge (1978)

• Typical leisure painting
• Detail and shading are very precise
• Lots of movement and fluidity

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Rialto Bridge (Mid 1980s)

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Rialto Bridge (Mid 1980s)

• Painted at beginning of disease
• Ability to form smooth arches and round shapes
  still present
• Less movement and shading

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Rialto Bridge (1986)

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Rialto Bridge (1986)

• 2 Years after diagnosis
• Mild to moderate stage of AD
• Condensation-increased use of yellow
• Figures more cartoonish
• Ability to round shapes decreasing

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Rialto Bridge (1988)

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Rialto Bridge (1988)

• 4 years after diagnosis
• Moderate to severe stage of AD
• Unable to form smooth arch
• Predominance of yellow increased
• Less detailed clouds and cartoonish figures

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1988
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Painting From 1988

• Woodenness-enclosed within a frame
• Stereotype-repetition of symbols/shapes
• Magical themed subject matter
• Increased ornamentation

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Late 1980s
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Painting From Late 1980s

• Increasing simplicity and lack of details
• Ability to square windows impaired
• Altered physiognomy-animals with human features

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Art From End Stage Ad

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Art From End Stage Ad

• Condensation-red only color used
• Total disintegration-loss of ability to form
  realistic image
• Unable to form squares
• Regression to child-like quality

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Last Attempts at Art

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Last Attempts at Art

• Drive to create art still present days before
  death
• Unable to create a realistic image
• Loss of artistic talent at this point

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William Utermohlen (1936-Present)

• Artist from Philadelphia who moved to England in
  1957
• Known for detailed figurative work, portraits,
  and murals
• Self-motivated to produce self portraits that
  showed effect of Alzheimers on his artistic
  ability

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William Utermohlen

• No family history of Alzheimers
• Car accident at age 55 left him unconscious for
  30 minutes
• Diagnosis of Alzheimers made at age 61
• MMSE 22/30, depressed, lapses in memory, spatial
  impairment in all aspects of life

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William Utermohlen

• Increasing difficulty reproducing his image as
  disease progressed
• Was aware of problems present in his work, but
  was unable to fix them
• Verbal impairment declined quickly, found that
  painting helped him to express things more easily

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Utermohlen at Age 60

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Utermohlen at Age 60

• Painted before diagnosis
• Figure gripping table overpowered by room and
  skylight
• Meant to show fear and isolation of surroundings

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Utermohlen at Age 60

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Utermohlen at Age 60

• Typical self-portrait
• Serves as reference point for style and artistic
  ability
• Anatomically correct
• Appropriate perspective

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Utermohlen at Age 62

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Utermohlen at Age 62

• Earliest signs of decreasing ability to form
  realistic self-image
• Conveys increasing sense of anxiety
• Decreasing ability to define features

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Utermohlen at Age 63

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Utermohlen at Age 63

• Changes becoming more pronounced
• Sense of proportion altered
• No background present

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Utermohlen at Age 64

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Utermohlen at Age 64

• Facial features blurred and disjointed
• Took 2 months to complete
• Would regularly rub out work when unhappy and try
  to redo
• Unrealistic self-image

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Utermohlen at Age 65

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Utermohlen at Age 65

• More abstract style of self-portrait
• Primitive, child-like style of work
• Loss of realism

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Utermohlen at Age 66
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Utermohlen at Age 66

• Attempt at more realistic style
• No close resemblance to human form
• Perspective and anatomic placement incorrect

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The Artist with Alzheimers

• Horn and Utermohlen serve as first artists to
  document the effect of Alzheimers on artistic
  ability
• Their paintings clearly show decline in ability
  in relationship to progression of the disease
• Both artists show the classic signs of impairment
  of Alzheimers as previously mentioned

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Art and Alzheimers

• Producing art may also benefit Alzheimers
  patients because it serves as an outlet and
  expression for their feelings when other ways of
  expression may be impaired
• It also allows the patient control over a
  creative process when the disease has taken
  control away from them

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Final Conclusion

• Aging artists and those afflicted with
  Alzheimers Disease prove that no matter the
  obstacles life places in front of you the drive
  and determination to create refuses to be
  destroyed.

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References

• A portrait of Alzheimers. BBC News Online
  Health. 22 Apr 2003 http//news.bbc.co.uk/2/hi/h
  ealth/1412428.stm.
• Crutch S, Isaacs K, Rossor M. Some workmen can
  blame their tools artistic change in an
  individual with Alzheimers disease. Lancet
  20013572129-33.
• Cummings J and Zarit J. Probable Alzheimers
  Disease in an Artist. JAMA 1987258(19)2731-34.
• Derbyshire D. Artist Charts His Slide into
  Dementia. Telegraph Online. 29 June 2001. 22 Apr
  2003lthttp//www.telegraph.co.uk/news/main.jhtml.

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References

• Dipiro J, et al. Pharmacotherapy A
  pathiophysiologic approach. New YorkMcGraw-Hill,
  1999.
• Espinel C. de Koonings late colours and forms
  dementia, creativity, and the healing power of
  art. Lancet 19963471096-98.
• Galasko D, ed. Clinics in Geriatric Medicine
  Alzheimers Disease and Dementia. Vol.17 No. 2.
  Philadelphia W.B. Saunders Co., 2001.
• Grasping Creativity. 22 Apr 2003
  lthttp//arttech.about.com/library/weekly/aa02/401a
  .htm.

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References

• Kane R, Ouslander J, Abrass I. Essentials of
  Clinical Geriatrics. 3rd ed. New
  YorkMcGraw-Hill, 1994.
• Kirk A and Kerteza A. On Drawing Impairment in
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• Maurer K and Frölich L. Paintings of an artist
  with progressive Alzheimers Disease.
  Alzheimers Insights Online. 22 Apr
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  6no2/vol6no2a.htm.
• Meulenberg F. de Koonings dementia. Lancet
  19963471838.

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References

• Miller B. Alzheimers and Artistic Abilities.
  Alzheimers Association of Northern California
  and Northern Nevada Newsletter. Winter 2003pg 1
  and 6.
• Morley J. Aging through the Eye of the Artist.
  Aging Successfully. Fall 1999 Vol. IX, No.
  31-3, 22.
• Rembrandt. Webmuseum, Paris. 22 Apr
  2003lthttp//www.ibiblio.org/wm/paint/auth/rembrand
  t/.gt
• Scharlach A and Robinson B. Cirriculum Module on
  The Aging Process. 22 Apr 2003lthttp//1st-socrates
  .berkeley.edu/aging/ModuleProcess.html.gt

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References

• The Self-Portrait as Self-Study. 22 Apr 2003
  http//www.research.umbc.edu/ivy/selfportrait/stu
  dy.html.
• Van Rijn, Rembrandt Harmensz (1606-1669). 22
  Apr 2003lthttp//www.psych.ucalgary.ca/pace/va-lab/
  AVDE_Website/rembrandt.html.
• Visual Aging. 22 Apr 2003 http//www.psych.ucalg
  ary.ca/pace/va-lab/AVDE-Website/visualaging.html.
• Williams M. Complete Guide to Aging and Health.
  New YorkHarmony Books, 1995.