John Hunter

An Analysis of an Art-based Approach to Treating Cognitive

Dysfunction
Article analyzed: Art Galleries, Episodic memory and Verbal Fluency in
Dementia: An Exploratory Study

Dementia is mental/cognitive affliction that has no known cure, and impacts the daily
lives of those who suffer from it and those who care for them. Previous research into cognitive
dysfunction indicated a possible positive effect for dementia patients in the overall categories of
sociability and psychological health from art-based interaction. The authors of the article felt
this warranted further investigation and attempted refine, quantify and measure the
understanding of the cognitive process that is affected and engaged during art-based experiences.
The authors selected participants meeting several criteria: over fifty years of age, in early
to mid stages of dementia (as determined by a standardized mental state examination), capable of
basic verbal communication and having a willing family caregiver to accompany them to the
interactions (experiments). Six participants, three male, three female, with an average age of
seventy-eight, were selected. An individual baseline for episodic memory (frequency and
immediacy of accessing long, mid and short-term and contextual memory) and verbal fluency
(frequency of using the correct word selection and placement) was established for each
participant though an interview utilizing open-ended questions, as standardized written
questionnaires had proven unreliable and problematic for dementia patients in the past. The
interviews were audio recorded and specific memory markers and verbal cluster patterns noted,
analyzed and assigned a numerical designation to quantitatively provide each patient's initial
aptitude with memory and verbal fluency. The family caregivers were also interviewed and
recorded for anecdotal qualitative comparative purposes.
The patients and their caregivers attended three weekly ninety minute sessions in an art
gallery, led by professional art educators. The first thirty minutes of each session was devoted to
viewing and discussing, as a group, selected 17th and 18th century paintings from Western
European artists. The remaining sixty minutes was spent in a hands-on art-making period, for
both patients and caregivers, supervised and aided by art instructors, with paints, pencils,
charcoals, etc available, as well as reproductions of the paintings previously viewed. The
participants and their caregivers were interviewed immediately after each gallery session, and
were recorded, as were any conversations occurring during the art-making period. The authors
then followed up with recorded interviews with the participants and their caregivers four weeks
after the last session, bringing along reproductions of the painting viewed during the gallery
sessions.
The results of the content analysis of the pre-session, post-session and four week followup interviews indicated a distinct overall gain (in comparison to the baseline) in episodic
memory and a slight increase in verbal fluency. Memory made a significant gain during the
post-session interview and showed less gain in the four week follow-up. Verbal Fluency showed
a modest gain during the post-session interview and virtually no gain in the four week follow-up,
even falling below the baseline in a few instances.
The interviews with the caregivers reflected their belief in noticeable positive changes in
the affability, sociability and capability of their respective relatives. The caregivers maintained
that the changes seemed strongest during the duration of the experiment, with the effect
subsiding somewhat as time passed. They also expressed the belief that the art-making session
of the experiment (in which they directly participated with their family members/ patients) gave
them a new and effective way of interacting with their relatives.
1

The authors incorporated several key features to facilitate a greater in-depth exploration
of the subject than previous research: use of a non-clinical location (art gallery), having both
verbal (viewing discussions) and tactile (art-making) components to the experiment, use of
recorded verbal interviews (as opposed to standardized written questionnaires) and
accompaniment by, and participation of, each patients individual caregiver.
The challenges or drawbacks of this particular experiments parameters were readily
acknowledged by the authors. They address the small sample size, relatively brief duration, lack
of a control group for comparative purposes, the biased, emotional feedback of the family
caregivers, and the possibility of the results being specific to the location (the art gallery). They
also refer to the future possibility of using larger groups, a control group, a longer time frame and
transportation of the experiment to patients homes or care facilities, to ensure more
comprehensive data.
The authors, based on the quantitative data gathered from the memory/verbal analysis
and qualitative feedback from the caregivers infer a possible art interaction-cognitive activity
correlation and conclude that further investigation is warranted, although specifically stating that
the study was exploratory and that they attribute their findings to no specific part of the
experiment. Along with future studies, the authors encourage the development of organized,
goal-based interactions between art educators, art therapists and cognitive researchers to create
community style support groups for dementia patients and their caregivers.
I found this article to be multidisciplinary, rather than truly interdisciplinary, in nature.
The authors approach a Behavioral Science problem (cognitive dysfunction in dementia patients)
in a scientific manner, using art education and art-making (Humanities) as an adjunct, a stimulus
component in a research method. The authors dont view or interact with the patients from any
art-making or art-creating perspective, nor do they actively participate in art discussion or artmaking in the gallery sessions. Nor do the authors view their results through the prism of art, in
any way. Using the exact same research methods, the stimulus in the experiment could have
been a Botany discussion accompanied by planting a garden, or an Astronomy discussion
followed by charting a star map. The results may have been different using other stimuli, and
previous research of this nature (Humanities-based stimuli such as song or dance as well as art)
may have been what inspired the authors to use art as their stimulus. The subjects of art
education and creation was subsidiary to the scientific process, not truly integrated into it or used
in its final presentation.

Article researched
Eekelaar, Catherine, Paul M. Camic, and Neil Springham. "Art Galleries, Episodic Memory
And Verbal Fluency In Dementia: An Exploratory Study." Psychology Of Aesthetics,
Creativity, And The Arts 6.3 (2012): 262-272. PsycARTICLES. Web. 30 Nov. 2012.
Annotated Bibliography
A Blair, et al. "An Art Gallery Access Programme For People With Dementia: 'You Do It For The
Moment'." Aging & Mental Health 13.5 (2009): 744-752. CINAHL Plus with Full Text.
Web. 25 Nov. 2012. http://sfx.fcla.edu.ezproxy.lib.ucf.edu/ucf/ucf?
genre=article&atitle=An+art+gallery+access+programme+for+people+with+dementia
%3a+%E2%80%9CYou+do+it+for+the+moment&title=Aging+
%26+Mental+Health&issn=&isbn=&volume=13&issue=&date=20090101&aulast=Mac
Pherson
%2c+S.&spage=744&pages=&rft.sid=EBSCO:PsycARTICLES+References:AMH.AC.G
DD.MACPHERSON.AGAPPD>
The authors are employed in the Department of Psychology, Australian National
University, Canberra, Australia at the Aged Care Evaluation Unit, NSW Greater Southern
Area Health Service, Australia. The authors approached this study with the perspective of
engaging dementia patients in a higher level cognitive activity than they had been
exposed to previously, due to caregivers lowered expectations of the patients aptitudes.
This study centered on patients with distinct behavioral/social markers as assessed by the
authors based on pre-experiment interviews and extensive history from the patients
caregivers. The authors refined these markers into 4 categories of behavior: Negative,
Neutral, Engaged, and Highly Engaged. Each patient was given a baseline based on
these categories. 7 patients then attended hour-long art education sessions (viewing and
discussion led by an art educator at a gallery) once a week over 6 weeks. The patients
were assessed weekly after each session. Results indicated a consistent rise in High
Engagement for 4 of the 7 patents, with mixed results for the other 3. A 6 week follow up
assessment did not show that rise, suggesting that, as the other studies had indicated, the
cognitive/social effects of artistic stimulation are not permanent. I felt this study
approached the subject of art interaction and dementia patients from a standpoint that
patients who were traditionally viewed as mentally/socially inept were in fact capable of
more than was expected of them. Their notation of the attentive nature of the patients
during the discussions and copious positive anecdotal data from the caregivers suggest, to
me, that the authors were pulling for art interaction to reveal a depth and capability in
these patients not previously suspected. Its a compassionate point of view, and the
follow up interview the authors conducted with the gallery educators about what the
educators learned show that the authors were thorough in assessing the effects of the
study on different people involved with it. They conclude that the study was worthwhile

even if it indicated no long-lasting effects because it provided temporary boost for both
the patients and caregivers, and such programs could be of use in the future.
Crawford, MJ and H Killaspy. Group Art Therapy as an Adjunctive Treatment for People with
Schizophrenia: A Randomized Controlled Trial. National Institute for Health
research /Health Technology Assessment 2012; Vol. 16: No. 8. n.pag. Web. 17 Nov. 2012.
<http://www.hta.ac.uk/execsumm/summ1608.shtml>

MJ Crawford is the Director of the Centre for Mental Health, Imperial College London,
London, UK, and H Killaspy is a consultant and professor at the Department of Mental
Health Sciences, University College London, UK. They conducted a similar study to
Eekelar-Camic but the participants were suffering from schizophrenia, not dementia.
However, both conditions share similar frontal and temporal brain abnormalities and are
characterized by confusion, anxiety, and difficulty differentiating reality, among other
symptoms. The authors also conducted the study on a much larger scale with a much
longer time limit and follow up, although with less direct interaction with the art
educators and participants, and no discussion component to the art sessions, only art
creation, unlike Eekelar-Camic. The authors recruited 417 participants aged 18 and up
and used standardized tests to establish cognitive awareness baselines for all of them.
The authors also recruited a similar sized control group who attended weekly non-art
focused activity sessions, and established baselines for these participants in the same
manner. The art participants attended a 90 minute weekly art session, in groups of eight
participants, for a span of one year. The art educator encouraged them to make art as they
saw fit, with no specific guidance, unless requested. Testing both groups weekly
throughout the course of the one year study, the authors found no significant difference in
any changes in the groups cognitive awareness measurements. In a follow-up test for
385 of the art participants two years later, the authors found no evidence of any long-term
positive gain from the art group. So, some conclusions about the effectiveness of art
interaction for cognitively challenged patients may be drawn from this study, but since its
focus was a different area of brain activity than the Eekelar-Camic study (Reality
recognition and sociability vs. memory and verbal fluency) it doesnt necessarily negate
the optimistic tone of the Eekelar-Camic study. Plus, one of the goals of this study was
also assessing the cost-effectiveness of art therapy for schizophrenics, which is an
economic factor not present in the Eekelar-Camic study, and which may have affected the
overall assessment of its authors.

Hass-Cohen, Noah. Art Therapy and Clinical Neuroscience in Action. Global Association for
Interpersonal Neurobiology Studies Community Newsletter. Spring 2006. 10-12. Web.
17 Nov. 2012. <http://noahhasscohen.com/uploads/2/9/0/0/2900945/hass-cohenarttherapyclinicalneurosciencein_action2006_article.pdf>
Noah Hass-Cohen, M.A, ATR-BC, LMFT is the founder and director of the art therapy
program at Phillips Graduate Institute, with a masters degree in psychology. The
program focus is on the integration of art therapy with clinical neuroscience and marriage
family therapy theories. In this article, she examines the neurological areas pertinent to
dementia, specifically, the subcortical, right-brain hemisphere responses for dealing with
stress and fear. Hass-Cohen found that the same brain region was also stimulated during
the creation of, and integration with, colors and forms. She posits that the subcorticalinduced, relaxed mental state created by the art interaction then facilitates the processing
of new or repressed (often traumatic) information or
memories by the hippocampus region of the brain. While repressed memories or
emotional trauma are not the focus of the Eekelar-Camic study, the inducement of the
right hemisphere calming response created by art interaction could be applicable in
treatment of the confused and anxious mental states which characterize dementia.
Kinney, Jenifer and Clarissa Rentz. Observed well-being among individuals
with dementia: Memories in the Making, an art program, versus other
structured activity. National Center for Creative Aging. n.pag. Web. 21
Nov. 2012. <http://www.creativeaging.org/publicationsresearch/resources?field_resource_type_tid=1123>

Jennifer Kinney is a PhD in the Department of Sociology and Gerontology; Miami

University, Oxford, Ohio and Clarissa A. Rentz, is an MSN, APRN Alzheimer's
Association of Greater Cincinnati, Cincinnati, Ohio. In this study, for a baseline the
authors used an observational table assessing seven emotional/social categories in 12
dementia patients: identity, growth, autonomy, security, connectedness, meaning and joy.
Over a 12 week period the patients participated in an art teacher-facilitated program
called which encouraged them to paint any type of picture they wanted, name their
painting and relate the story they felt it held. A weekly assessment was performed after
each session. The same patients were then enrolled in a weekly activity session, not
pertaining to art in any particular manner, with weekly assents held after each activity
session. The results indicated that the patients scored significantly higher identity,
connectedness and joy during the art session weeks than the other activity weeks. I found
this study to be interesting because, rather than a control group consisting of different
individuals, the authors tested the same patients under two different conditions: artstimulated and non-art stimulated. They reported similar results to the other studies, but
5

the use of the same patents for comparison purposes would seem to address a concern
inherent in the other studies control groups, namely, that a few outlier individuals (who
werent a part of the art group) in that control group could skew the results.
Rusted, Jenifer, Linda Sheppard and Diane Waller. A Multi-centre Randomized Control Group
Trial on the Use of Art Therapy for Older People with Dementia. Group Analysis 16
Dec. 2006. 517536. Web 15 Nov. 2012. <http://gaq.sagepub.com/content/39/4/517>
Jennifer Rusted is a professor in Experimental Psychology at the University of Sussex,
Brighton. Linda Sheppard is currently Deputy Director of the Child and Family Research
Group in the Department of Psychology, University of Sheffield. Diane Waller is
Professor of Art Psychotherapy/Group Analyst, Area of Group and Intercultural
Psychotherapy Training at Goldsmiths College. The authors conducted a similar study to
that done by Eekelar and Camic, but on a larger scale with more scientific controls and a
longer time frame. 45 participants experienced weekly art interactive sessions once a
week over 40 weeks. Using standardized tests, a pre-experiment baseline for mood,
cognition, depression and sociability was established for each participant. A control
group of similar size and mental state (as established by baseline testing) participated in a
weekly activity session (for 40 weeks) that did not involve art or emotional expression.
Mental state tests were then conducted for both groups at 10 and 20 week intervals, again
at the end of the experiment, again one week after the experiment and again 12
weeks after the experiment. Overall, the authors found a steady, measureable rise in
mood and sociability in the art group up to the 20th week, then leveling off after that.
They found a return to the baseline by the last week of the experiment and a decline in
the depression baseline at the on week follow-up, which had returned to normal baseline
at the 12 week follow-up. They found no significant change throughout the control
groups tests. The authors of this study supervised and guided the art educators much
more closely than the authors of the Eekelar-Comic study did, and include much less
anecdotal feedback from participants caregivers. The data would indicate that art
interactions for dementia patients is helpful up to a point, then diminishes; however the
focus of this study was mood, sociability and overall cognitive awareness, as opposed to
the Eekelar-Camic study which focused more specifically on memory retrieval and verbal
fluency. Since this report preceded the Eekelar-Camic study, its reasonable to assume
that its findings possibly influenced the latter researchers to continue the exploration and
further refine the aims of such research and how to quantify them.
Wandell, Brian. Neuroeducation: Learning, Arts, and the Brain; Summary of Neuroscience
Research. Findings and Challenges for Educators and Researchers from the 2009 Johns
Hopkins University Summit. 2009. 21-23. Web. 15 November 2012. http://steamnotstem.com/wp-content/uploads/2010/11/Neuroeducation.pdf 2009.
Brian A. Wandell, Ph.D., Stanford University. Dr. Wandell is the chair of the department
of psychology and a member of the electrical engineering and radiology departments.
Dr. Wandells research projects center on visual disorders, reading development in
children, digital imaging devices, and algorithms. His work in visual neuroscience uses f
6

functional and structural MRI, along with behavior testing and modeling, to understand
the action of visual and speech portions of the brain. His research also includes studies of
the organization of the visual field maps in the human brain, color and motion processing
within these maps, and the potential for treatment of developmental disorders. Dr.
Wandells use of magnetic resonance imaging techniques allowed him to trace the axon
pathways in the corpus collosum (which connects the brain hemispheres) that engage
when processing images and color, such as we do when viewing a painting. He found
that these same axon pathways were also involved in the effective production and
manipulation of speech, raising the possibility of a visual processing-speech effectiveness
correlation. Dr Wandells studies involved children, so the parallel to the axon activity of
an older dementia patent isnt implicit, but the connection of visual processing and ability
to manipulate words would seem to be neurologically hardwired to some extent, until
injury or decay (as in dementia) would alter it.