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Published on: January 4, 2013
by Richard C. Senelick, MD, for The Atlantic:
Depending which part of the brain is affected, different skills will be preserved or impaired in various types of cognitive decline and dementia. This gradual reformation is what may allow the emergence of new artistic abilities.
I always wished l had true musical or artistic talent. There being none, I became a physician. Five years ago, I starting taking guitar lessons and hoped that I would be amazed by some “hidden” talent that would reveal itself to me and the rest of the world. Although I continue to practice every day and enjoy my musical adventure, the talent part remains elusive, if not totally hidden. But this is not the case for everyone. There are people who start to paint or play a musical instrument later in life and become very accomplished — often only when their brain begins to deteriorate.
As some people age and begin to lose cognitive abilities, they start to express previously hidden artistic talents. In my previous article, “Maintaining Connection and Saving Face,” I described Lester Potts, who became an acclaimed water colorist as his dementia progressed and he lost his verbal abilities. Here, we’ll look at what leads to this and similar phenomena.
The school of pop psychology pretends that the right brain-left brain divide is clear-cut, but we are much more complex than that. The “simple” task of looking at a picture of a cat and saying its name out loud involves large areas of the brain. The image of the cat must strike the back of both eyes and travels over the optic nerves where they then cross and enter the brain. The signal travels to the very back of the brain, and then the information on the right side of the brain must cross to the left side where both sets of information are combined and compared to a “database” of previously stored images.
Our brains store everything we have seen and remembered for just such a moment. Is there anything there that looks like the cat? Fur, claws, a meow, fond memories, a nasty scratch. Once identified, the information travels forward to the part of the left side of the brain that controls speech production. The muscles that control our breathing, tongue and lips all have to be coordinated to say the simple one syllable word, “cat.” This all happens in less than a second.
Our brain is packed with pathways that carry very specific information. A stroke may be highly selective and attack just one specific part of the brain. However, aging and dementia are processes that slowly cause the deterioration of nerve cells throughout the brain.
But dementia and aging do not affect all parts of the brain equally. Alzheimer’s disease, especially, does not affect the entire brain at once but starts in the part of the brain that creates new memories. Most people know that as we age we can remember with vivid clarity things from the past, while the events of a few hours earlier may be a total blur. Depending on which part of the brain is affected, different skills will be preserved or impaired in different types of dementia. This gradual reformation is what may allow the emergence of artistic abilities.
Our ability to communicate relies primarily on the use of verbal and writing skills, which are then lost when cognitive skills decline. But, creative arts like music or painting can bypass the “verbal pathways” and access other pathways that become available for communication. Dr. Bruce Miller, Clinical Director of the Memory and Aging Center at the UCSF has studied how the brain functions in patients with newly acquired abilities. Dementia preferentially attacks the frontal and temporal parts of the brain at first, only involving the “artistic” parietal and occipital lobes later in the disease.
What a person sees and where they have seen it over their entire lifetime – the same process as remembering “cat” — is stored in these “artistic parts of the brain. Painting is predominantly a visual process that involves the parts of the brain that are spared for most of the course of dementia. As a result, the people with dementia will often express these visual memories through painting.
Miller and colleagues described an interesting series of 12 patients with dementia who “acquired, or sustained, new musical or visual abilities despite progression of their dementia.” One patient was a 68-year-old man who began to compose classical music in the face of progressive dementia. “His mind was ‘taken over’ during composition,” notes the study. This led to the theory that, in the healthy brain, one part of the brain “suppresses” or is dominant over another part of the brain. In this case, the gentleman had musical abilities that were suppressed by another part of his brain. When the dominant part of the brain deteriorated, the “musical part” was released to express itself. The same theory may hold true for artists like Lester Potts, who started to paint after losing his verbal abilities. Alternative channels of communication have opened. Dementia patients’ artwork reveals the ability to communicate in people who were previously thought to lack even self-awareness.
The majority of the time we assume that we have lost our loved ones to another world, where we cannot reach them. Like I stressed in my previous piece, our challenge is to take the time and make the effort to meet them in “their now,” which is still rich with emotion. This requires that we view them through a new prism, one that embraces what emerges from their alternative channels.
For the majority of our lives we define ourselves by our abilities: how well we perform in school, catch a football, teach algebra or raise our children. Unfortunately, as we age or after we develop a chronic illness, we focus more on what we cannot do- our disabilities. We are suddenly the person in the wheelchair or the one who cannot remember where they parked their car. As time goes on, we feel marginalized and isolated from social interactions and stimulation. We become the person in the corner of the room.
But, even those with significant dementia and cognitive disabilities have a reservoir of abilities. We find ourselves mistakenly believing that our relative who suffers from Alzheimer’s is no longer capable of experiencing joy or communicating their emotions, so we define them by their disease rather than by who they are in their now.
Expressive arts therapies incorporate a wide range of opportunities for people to communicate, including music, art, drama, poetry, and storytelling. The expressive arts offer a new channel of communication and increase people’s ability to tell their story.
Isak Dinesen, the Danish author who wrote Out of Africa, tells us that, “To be a person, is to have a story to tell,” and telling that story helps to heal us.
The story of art and dementia is told in the documentary I Remember Better When I Paint , narrated by Olivia de Havilland. It shows how the creative arts can change the quality of life for people with Alzheimer’s disease. The co-director of the film, Berna Huebner, visited her mother in a nursing home in Chicago and asked her, “Wouldn’t you like to paint again?” Her mother, a once highly successful painter responded, “Yes, I remember better when I paint.”
Berna enlisted art students to work with her mother, and after many months she emerged from a state of apathy and once again began to paint. The use of art opened a “dialogue” of communication that had been closed for years. In memory of her mother Hilda (Hilgos) Gorenstein, Berna founded the Hilgos Foundation, which provides grants to art students who work with Alzheimer’s patients.
My mother is 96 years old and resides in a Texas nursing home. Although she is quite forgetful, she can still work a crossword puzzle, engage in a dialogue and visit with the couple that she joins for every meal. However, as I look around the hallways, I see scores of recliner-bound residents staring aimlessly at the ceiling, turning only slightly when someone walks past them. The immediate assumption is that they are no longer quite “there.”
John Zeisel, author of the book I’m Still Here remarks in the documentary that many relatives and friends maintain “negative attitudes that the person is not (still) there. We need to shift them into an attitude that the person is always there. If I help them paint they will remember better … If families understand they are still there they treat them with greater respect and dignity.”
But who will do the work?
Hilda Gorenstein had a tireless advocate in her daughter, who organized students from the Art Institute of Chicago. Those students didn’t give up on their elderly friends, even when there didn’t seem to be much progress. They waited for a breakthrough and it paid off. But, who will advocate for the people lining the halls of my mother’s nursing home? The government recently cut reimbursement to nursing homes by 14% and they will struggle to meet the basic needs of their residents. It will be impossible to convince them that they need to supply additional services that enrich the lives of the elderly and disabled. This is also at a time when the US Senate just failed to ratify the United Nations treaty for disabled rights, a remarkable slap in the face to all people with disabilities.
It is easy to disenfranchise the disabled and elderly, for they do not have a powerful voice. Their outer voice has been silenced by age and disease while society fails to recognize their “inner voice” and meet their emotional needs.
In the end we must be the ones to create a life worth living for those with Alzheimers and cognitive decline. Everyone grows older — for many, it will one day be our life.
Picture: Lester Potts
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