Creative Expression, Communication and Dementia

A creative look at dementia

Karen Gram, Vancouver Sun

Published: Wednesday, May 28, 2008

Vancouver dementia expert Dahlia Gottlieb-Tanaka has seen the glimmer of life return in people with dementia. So has Australian occupational therapist Hilary Lee, Montreal neurologist Remi Quirion and UBC psychology professor Peter Graf.

At an international conference this weekend, each of them will take a stab at busting long-held assumptions about the abilities of people living with dementia.

"Everybody is saying people with dementia have no attention span and can't learn new things," says Gottlieb-Tanaka, who founded the Society for the Arts in Dementia Care. But she and others have seen that given the right stimuli, people with dementia can attend and learn new things.

"All we need to do is give them an opportunity and do it in the right way. Understand they need time to digest the information and time to respond and if you really genuinely care and still believe there is a thinking brain in there you will be amazed what you will get in return," she says.

For 10 years, Gottlieb-Tanaka has been offering creative experiences to with people with dementia. She'll bring in a topic - say, good vs. bad - and they'll talk about it for half an hour and then the seniors make their own artistic rendition of the concepts.

"These are difficult concepts for anyone, not just those with cognitive impairment," she says. But the residents rise to the challenge and stay totally engaged for the 90-minute sessions.

For good vs. bad, one man used a white crayon to draw a glass of water on white paper. Unless you held it to the window, you couldn't see the image. Gottlieb-Tanaka thought the paper was blank, but he explained that water is so pure, you can't see it. On black paper, he used the white crayon to make a lot of dots symbolizing disease.

"How fantastic," she says of his interpretation, noting he died a few months later of dementia.

When she introduced the topic of friendship, one woman painted a bouquet of flowers but left one incomplete. When asked if she wanted to finish it, she sadly said no, that it represented the lack of friendship in her life.

Part of the conference, which is open to the public, is an exhibit at Emily Carr Institute of Art and Design of art done by people around the world with dementia.

The range of ability is fascinating with some showing elements of the disease. For example, one artist has what is called right neglect which means she can not perceive anything on her right side. All her images start at the centre of the page and work left.

In Australia, Hilary Lee an occupational therapist and artist, has been able to elicit beautiful art from her seniors. She agrees that dementia is not a limiting factor when it comes to attention. In fact, she was able to demonstrate that people with dementia can still learn new things.

She is bringing copies of tapestries to the Vancouver conference that her seniors made using tools and techniques none had used before.

"Every single person learned how to do this," she says.

This suggests that even though brain cells are dying in one area, the brain still has the capacity to make new connections in other areas, says Gottlieb-Tanaka.

Lee and Gottlieb-Tanaka emphasize that the art they do with the seniors is not art therapy.

"We don't go in with the intention to cure," says Gottlieb-Tanaka. "We are facilitating a situation where we give people a safe framework to express themselves. Sometimes, it's a song, sometimes a poem or a dance or drawing or just telling a story."

Dr. Remi Quirion, a neuro-scientist and Scientific Director of the Institute of Neurosciences, Mental Health and Addiction in Montreal, says he has seen more and more evidence that artistic expression is beneficial to people with dementia.

"It seems that even if the brain is quite affected by the disease process of dementia, there is still a lot of sparkle of creativity in the Alzheimer brain," he says. "I don't personally call it art therapy. I don't know if we can go that far, but certainly in terms of quality of life and the well being of the person, it seems to be a big plus."

While a small group of experts now see this phenomenon, few long term care facilities offer art programs to their residents with dementia because of the long-standing belief that they aren't capable of doing anything. Many facilities still care for their dementia residents with medication and television. It's no wonder they show a lack of attention, says Quirion.

Frustrated by the lack of understanding so many people have of the condition, Gottlieb-Tanaka partnered with Dr. Peter Graf, a psychology professor at UBC to develop a tool to measure ability in people with dementia.

The tool they gradually developed with the help of Lee in Australia measures seven domains including memory, verbal and body language skills, attention and psycho-social skills.

"We used the instrument to make observations of the residents when they were engaged in a creative activity and when not," he says.

"It was like night and day." When they were not doing anything creative, they were apathetic, he says. They didn't reminisce, or pay attention to what was going on.

"As soon as they were in a program, they came alive." Graf said this area of research is new to him and that he too held many of the old assumptions about people with dementia. But not any more.

"Today I am convinced there is so much that is there and is possible."

The Multi-disciplinary Conference of Arts and Sciences Creative Expression, Communication and Dementia occurs May 30-31, 2008 at the Emily Carr, Institute of Art and Design.

The art show, Mindscapes 2008 will open June 2-14.