Through The Eyes of
Alzheimer’s
Ali R. Rahimi,MD,FACP,AGSF
Professor of Medicine
Mercer University School of Medicine
Objectives
• Review the following in context to artistic ability:
– Typical Aging Process
– Effects of aging in selected artists
• Monet
• Rembrandt
– Process of Alzheimer’s Disease (AD)
– Effects of Alzheimer’s Disease in selected artists
• Carolus Horn
• William Utermohlen
– Review and Conclusions
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
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
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
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
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
Aging’s Effect on Art
• Decline of output during aging
• Peak productivity in 30’s and 40’s
• Productivity declines after 40’s
• Definite exceptions to this rule
– Grandma Moses started painting at age 78 and
completed works at age 101
– Rembrandt painting until death in 1669
Aging Related Impairments to
Creating Art
• Visual impairments
– ex. the aging eye
• Physical impairments
– ex. rheumatoid arthritis
• Changes in energy/drive
• General aging
Effects Seen From an Aging Eye
• Increased glare
• Decreased color
discrimination
• Decreased contrast
sensitivity
• Decreased acuity
• Decreased perception
of motion
• Decreased field of
view
Aging Related Disease Processes
of The Eye
• Cataracts
• Presbyopia
• Macular Degeneration
• Glaucoma
• Diabetic Retinopathy
• All have effect on an artist’s perception
Monet’s Bridge Through Cataracts
Aging Related Impairments to
Creating Art
• Visual impairments
– ex. the aging eye
• Physical impairments
– ex. rheumatoid arthritis
• Changes in energy/drive
• General aging
Pierre-Auguste Renoir (1841-1919)
•
•Afflicted with
rheumatoid
arthritis in 1894
•Produced almost
400 paintings
after diagnosis
•Adept skill even
with arthritis
Unbroken Spirit And Drive (1915)
•
•
Aging Related Impairments to
Creating Art
• Visual impairments
– ex. the aging eye
• Physical impairments
– ex. rheumatoid arthritis
• Changes in energy/drive
• General aging
Aging of an Artist
•
•Rembrandt (16061669)
•Famous for
detailed portraits
and visual acuity
•Chronicled his
aging with over
100 self-portraits
Rembrandt 1631 to 1661
Aging of Rembrandt (1669)
•
•Presbyopia caused
decreased detail
and clarity
•Final works
linked by broader
brush strokes, less
detail and
yellowish hue
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
Process of Alzheimer’s
• Typical aging process + disease process
• Most common neurodegenerative disease of the elderly
• Subtle, progressive changes
• Loss of synaptic connections
Alzheimer’s and The Brain
• General brain atrophy
• 4 classic changes:
–
–
–
–
Cortical atrophy
Degeneration of cholinergic neurons
Neurofibrillary tangles
Accumulation of amyloid plaques
Consequences of Alzheimer’s
• Brain related changes lead to many cognitive
impairments:
–
–
–
–
Memory impairment
Visuospatial disorientation
Language impairment
Constructional apraxia
Consequences of Alzheimer’s (Cont’d)
• Alzheimer’s 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
Brain’s 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
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
Alzheimer’s Scope of Damage
• Alzheimer’s 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
Cornerstones of Alzheimer’s Art
• Fewer angles
• Impaired perception
• Impaired spatial relationships
• Increased simplification
• Overall production impaired
• Severity of these changes correlates with severity
of disease
Contextual Criteria in
Alzheimer’s 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
Formal Criteria in Alzheimer’s 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
Formal Criteria in Alzheimer’s Art
• Transformation
– Anatomic features placed inappropriately
– Physiognomy (applying strange facial features
to humans and animals)
• Stereotype
– Repetition of a subject or object
Formal Criteria in Alzheimer’s Art
• Woodenness
– Enclosing pictures within frames
– Decreased depth (less shading)
– Increased rigidity (decreased movement/fluidity)
– More rigid geometric shapes
Formal Criteria in Alzheimer’s Art
• Disintegration
– Neglect of spatial relationships
– Loosening of physiognomy
•Animal and human qualities become even more
abstract
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
Carolus Horn
• Diagnosed with Alzheimer’s in 1984
• Diagnosed at age 63
• Disease presented with memory impairment,
difficulty recognizing people, impaired
reading and speaking abilities
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 Alzheimer’s caused in Horn
Rialto Bridge (1978)
Rialto Bridge (1978)
• Typical “leisure
painting”
• Detail and shading
are very precise
• Lots of movement
and fluidity
Rialto Bridge (Mid 1980’s)
•
Rialto Bridge (Mid 1980’s)
•
• Painted at beginning
of disease
• Ability to form smooth
arches and round
shapes still present
• Less movement and
shading
Rialto Bridge (1986)
•
Rialto Bridge (1986)
•
• 2 Years after diagnosis
• Mild to moderate
stage of AD
• Condensationincreased use of yellow
• Figures more
cartoonish
• Ability to round
shapes decreasing
Rialto Bridge (1988)
•
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
1988
Painting From 1988
•
• Woodenness-enclosed
within a frame
• Stereotype-repetition
of symbols/shapes
• Magical themed
subject matter
• Increased
ornamentation
Late 1980’s
Painting From Late 1980’s
•
• Increasing simplicity
and lack of details
• Ability to square
windows impaired
• Altered physiognomyanimals with human
features
Art From End Stage Ad
•
Art From End Stage Ad
•
• Condensation-red only
color used
• Total disintegrationloss of ability to form
realistic image
• Unable to form
squares
• Regression to childlike quality
Last Attempts at Art
•
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
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 Alzheimer’s on his artistic ability
William Utermohlen
• No family history of Alzheimer’s
• Car accident at age 55 left him unconscious
for 30 minutes
• Diagnosis of Alzheimer’s made at age 61
– MMSE: 22/30, depressed, lapses in memory,
spatial impairment in all aspects of life
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
Utermohlen at Age 60
Utermohlen at Age 60
• Painted before
diagnosis
• Figure gripping table
overpowered by room
and skylight
• Meant to show fear
and isolation of
surroundings
Utermohlen at Age 60
•
Utermohlen at Age 60
• Typical self-portrait
• Serves as reference
point for style and
artistic ability
• Anatomically correct
• Appropriate
perspective
Utermohlen at Age 62
Utermohlen at Age 62
•
• Earliest signs of
decreasing ability to
form realistic selfimage
• Conveys increasing
sense of anxiety
• Decreasing ability to
define features
Utermohlen at Age 63
Utermohlen at Age 63
•
• Changes becoming
more pronounced
• Sense of proportion
altered
• No background
present
Utermohlen at Age 64
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
Utermohlen at Age 65
Utermohlen at Age 65
•
•
•
•
•
•
• More abstract style of
self-portrait
• Primitive, child-like
style of work
• Loss of realism
Utermohlen at Age 66
Utermohlen at Age 66
•
• Attempt at more
realistic style
• No close resemblance
to human form
• Perspective and
anatomic placement
incorrect
The Artist with Alzheimer’s
• Horn and Utermohlen serve as first artists to
document the effect of Alzheimer’s 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 Alzheimer’s as previously mentioned
Art and Alzheimer’s
• Producing art may also benefit Alzheimer’s
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
Final Conclusion
• Aging artists and those afflicted with Alzheimer’s
Disease prove that no matter the obstacles life
places in front of you the drive and determination
to create refuses to be destroyed.
References
• “A portrait of Alzheimer’s.” BBC News Online: Health.
22 Apr 2003
http://news.bbc.co.uk/2/hi/health/1412428.stm.
• Crutch S, Isaacs K, Rossor M. Some workmen can blame
their tools: artistic change in an individual with
Alzheimer’s disease. Lancet 2001;357:2129-33.
• Cummings J and Zarit J. Probable Alzheimer’s Disease in
an Artist. JAMA 1987;258(19):2731-34.
• Derbyshire D. “Artist Charts His Slide into Dementia.”
Telegraph Online. 29 June 2001. 22 Apr
2003<http://www.telegraph.co.uk/news/main.jhtml.
References
• Dipiro J, et al. Pharmacotherapy: A pathiophysiologic
approach. New York:McGraw-Hill, 1999.
• Espinel C. de Kooning’s late colours and forms: dementia,
creativity, and the healing power of art. Lancet
1996;347:1096-98.
• Galasko D, ed. Clinics in Geriatric Medicine: Alzheimer’s
Disease and Dementia. Vol.17 No. 2. Philadelphia: W.B.
Saunders Co., 2001.
• “Grasping Creativity.” 22 Apr 2003
<http://arttech.about.com/library/weekly/aa02/401a.htm.
References
• Kane R, Ouslander J, Abrass I. Essentials of Clinical
Geriatrics. 3rd ed. New York:McGraw-Hill, 1994.
• Kirk A and Kerteza A. On Drawing Impairment in
Alzheimer’s Disease. Arch Neurol 1991;48:73-77.
• Maurer K and Frölich L. “Paintings of an artist with
progressive Alzheimer’s Disease.” Alzheimer’s Insights
Online. 22 Apr 2003http://www.alzheimerinsights.com/insights/vol6no2/vol6no2a.htm.
• Meulenberg F. de Koonings dementia. Lancet
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References
• Miller B. “Alzheimer’s and Artistic Abilities.” Alzheimer’s
Association of Northern California and Northern Nevada
Newsletter. Winter 2003:pg 1 and 6.
• Morley J. “Aging through the Eye of the Artist.” Aging
Successfully. Fall 1999; Vol. IX, No. 3:1-3, 22.
• “Rembrandt.” Webmuseum, Paris. 22 Apr
2003<http://www.ibiblio.org/wm/paint/auth/rembrandt/.>
• Scharlach A and Robinson B. Cirriculum Module on The
Aging Process. 22 Apr 2003<http://1stsocrates.berkeley.edu/~aging/ModuleProcess.html.>
References
• “The Self-Portrait as Self-Study.” 22 Apr 2003
http://www.research.umbc.edu/~ivy/selfportrait/study.h
tml.
• “Van Rijn, Rembrandt Harmensz (1606-1669).” 22 Apr
2003<http://www.psych.ucalgary.ca/pace/valab/AVDE_Website/rembrandt.html.
• “Visual Aging.” 22 Apr 2003
http://www.psych.ucalgary.ca/pace/va-lab/AVDEWebsite/visualaging.html.
• Williams M. Complete Guide to Aging and Health. New
York:Harmony Books, 1995.