Posted on Tuesday, March 05, 2013
Assistant Professor of Psychology Daniel Graham spreads out eight images on the desk in front of him - sweeping vistas, secluded forests, a stone bridge - images of varying landscapes. These photographs, used in a recent study completed by Graham and his colleagues and published in the open-access journal Frontiers in Psychology, are key to a rather puzzling - and amazing - discovery: despite having no memory for images, people with Alzheimer's retain a stable sense of aesthetics.
Prior to exploring the subject of Alzheimer's disease, Graham had worked studying the art produced by patients suffering from schizophrenia, exploring possible connections with the disorder and its effects on art as caused by alterations to one's vision.
Although vastly different diseases, Alzheimer's then presented an interesting subject for Graham; people with Alzheimer's have often lost significant semantic and memory capabilities, and may be freer to evaluate images on a more elemental aesthetic level.
In the study, Graham and his colleagues presented participants with a series of very simple tasks: rank sets of images in order of preference. Alzheimer’s patients and controls were shown paintings and natural images matched in content by design – painted landscapes, neutral images of landscapes, portraits and photographs of faces.
The paintings are vivid images - Van Goghs, Cézannes - presenting scenes of fields and flowers, bridges and houses. Graham says that on average, people with dementia – regardless of the stage of the disease – as well as healthy elderly control participants could consistently rank the images in order of preference at the beginning and end of the two-week study.
When presented with photographs of landscapes, the results were the same - despite obvious loss of mental capabilities, Alzheimer's patients continued to like the same images. However, Graham and his colleagues were struck with the question: does it make a difference what type of images they use?
"We wanted to compare paintings of a scene with photographs of the same scene, and match images in terms of subject matter to see if that makes a difference," explains Graham, pointing to Van Gogh's famous "Langlois Bridge at Arles," and then to a photo of the actual bridge in Southern France. "In terms of landscape, it turns out it didn't make any difference. People with dementia - at any stage - can complete the task with landscapes, photographed or painted, indistinguishably from the way people without dementia can do it."
Then came the surprising finding: "We did the same thing with faces," says Graham. Photographs of men and women, young and old were presented; next, painted portraits of these same faces. "We saw the stability, the similarity in the ordering, for the paintings of the faces, but not for the photographs of the faces."
What makes this finding so puzzling is that it seems to suggest that it is not simply the case that faces in general present a problem - and it's also not the case that making a painting of a subject changes matters. Those with Alzheimer’s could not remember the images in any of the groups – portrait or landscape, painting or photo – over two weeks, while the controls could.
"What we think it might be, when you see a face - especially in the earlier phases of the disease - ostensibly you're doing the task of ordering the faces in order of how much you like them, but it's hard to look at a photograph of a face and not think ‘Who is that? Do I know that person? Am I supposed to know who that person is?' We think that there is some kind of conflict or distraction there."
When delving into the world of Alzheimer's, the concept of face perception is a particularly interesting one: there is some evidence that face perception deficits may have later onset than deficits in scene perception. "You might not remember a name, but you might think that that person looks familiar - in that sense your face recognition system may retain some features that are similar to those in a person without Alzheimer's," explains Graham.
However, this fact coupled with the finding of the study is an unexpected finding. "It's especially puzzling that we can do this aesthetic task, this preference test because a lot of areas of the brain that seem to be involved with aesthetic judgment task are affected by the disease," says Graham. "How are people able to make these consistent judgments if they have what is essentially brain damage in areas involved in higher thought?”
Graham speculates that perhaps there are subcortical mechanisms - mechanisms not using the cortical hemispheres, but perhaps subcortical pathways that could take over some functions of cortex - that might be spared in the progression of the disease.
"We can't prove that someone with dementia is going about the task in the same way as someone without dementia - in terms of what their brain is doing," says Graham. "But the results are almost identical. Either the brain is somehow compensating, or fewer things are damaged than we thought."
When closely examined, the seemingly simple task of liking something is quite a complex decision. "Liking something means evaluating what is there, trying to make some sense of it, reflecting within yourself, introspecting and considering - do I like this? Or do I not like this?" Graham explains. "It requires some level of conscious thought - and you might expect that people with Alzheimer 's disease wouldn't give it a whole lot of conscious thought and would just order images in any old order, but that is not what we've found."
Of course, the study has presented Graham and his colleagues with deeper questions about aesthetics: How stable is our sense of aesthetics, our "likings"? When is your aesthetic sense no longer changeable? How might these findings apply to other things - the food you eat, creativity, how you think of new ideas?
"In some sense, these Alzheimer's patients could be making a pure aesthetic judgment - not colored by past or experience, which tells us we don't know when – or if – aesthetic sense crystallizes," says Graham. Currently, Graham is working with psychology major Amy Gallop '13 on an independent study, which is looking into this second question empirically for people at different ages.
The implications of this finding could be important not only for the study of aesthetics, but for art therapy and the care of Alzheimer's patients. Although the results of this study will not provide a cure for the disease, they could lead to therapies that lessen its severity. Through art exposure therapy, those suffering from Alzheimer's could have their aesthetic sense excited.
"The idea is to reduce stress and present people with things they will have a positive attitude towards - which is remarkably difficult, as pictures of family and friends can be frustrating," hopes Graham. "If we can expose them to more to the things they like - and avoid the things that they don't like, it might make the lives of people with Alzheimer 's disease better."
The paper is currently published in provisional form here, and is available to all:
Graham joined the Hobart and William Smith faculty in the fall of 2012. He earned his B.A. in physics from Middlebury College. Graham went on to study at Cornell University, where he received his M.S. in physics and his Ph.D. in psychology.