When Lester Potts began succumbing to Alzheimer's disease at age 70, the changes in his demeanor hit his family "like a cyclone," his son Daniel recalls. In some ways the situation was especially hard on the younger Potts because he is a neurologist, and he blamed himself for not spotting the disease sooner: "I thought myself a poor excuse for a dementia doctor and inadequate as a son."
Lester's condition worsened until finally he couldn't safely stay at home. Fortunately, the family found an opening at a nearby adult daycare center, and Lester felt comfortable there-one of the few bright spots in a harrowing decline. Then a volunteer art teacher encouraged Lester to try painting with watercolors. He began bringing home dozens of still lifes, landscapes, pictures of flowers, birds, and holiday scenes-painted in bright colors that were sometimes more vibrant than his real-life subjects.
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The breakthrough was nothing short of a miracle, says Daniel, a Tuscaloosa physician and a former resident at the UAB School of Medicine. "Dad no longer had the ability to communicate through words, but somebody cared enough to unlock a hidden talent," he says. "There's something primal about art; it can form connections in the brain even when the mind is fading away. He realized what he was achieving. He was proud of the paintings he brought home, and he'd show them to us again and again."
Art can often be a window to bypass the constrictions of dementia, says UAB geriatrician Andrew Duxbury, M.D. "Art is one of the most basic impulses people have, and it's been acted upon as long as modern human beings have lived," he says. "We see it in archaeological digs, the famous cave paintings, and even at primitive sites before that, where bits of shell made into necklaces have been found."
Visions of the Past
Creating is just something humans need to do, Duxbury says, and the process involves many different parts of the brain. "The kind of ‘crystalline' memory that's usually attacked first in these diseases is not the kind of memory involved in creation," he says. "So even in a brain that's starting to experience damage from Alzheimer's disease or another related dementia, the artistic impulse is not usually impacted in that way. Also, art tends to calm people who are agitated. It's a task they can focus on, because there are not a lot of rules that govern the process."
The allure of art makes more sense when we view dementia as a reversal of developmental processes from early childhood, Duxbury adds. "From the time young people can hold a crayon, they're driven to draw. They start with scribbles, and then learn about color and form. It's usually something kids enjoy. It's a way they can express what's going on in their minds, even though they may not have the language abilities yet." And the same is true for Alzheimer's patients, he says. "Their brains may be damaged so that they've lost some crystalline-fact abilities, but the qualities present in children that allow them to express themselves are still there. It's a way for them to express what they're thinking and feeling."
Many of Lester Potts's nature images were clearly based on memories of the Alabama Gulf Coast and his childhood in Pickens County: landscapes with piers and lighthouses and seagulls, a beached rowboat, a pair of baby opossums on a tree limb. Others were more mysterious, with objects subtly transformed from their real-world counterparts. What first appear to be rocks in one painting are shaped somewhat like leaves, but with a grain pattern resembling wood.
"He grew up in the Great Depression, and my grandfather had a sawmill," Daniel says. "That's how they survived, how they put food on the table. My dad grew up sawing. It was a metaphor for who he was. He was a tough, steely, tenacious soul. Wood and lumber were very important to him. Throughout his life he built birdhouses for people and gave them away. And he built sets for a community theater."
Fade to Blue
After his father's death, Daniel collected about 30 of these late-life paintings into a book he titled The Broken Jar, accompanied by a series of poems he wrote about his family and childhood. Seeing the progression of Lester Potts's images within a few dozen pages showed them in a new light, he found: "My dad loved colors, but eventually the colors left." By the end, a somber blue and green dominate the pictures, and one of the last ones shows a leaf-strewn ground with the odd combination of a boot, a Christian cross, and a crosscut saw, all items that were familiar in his life. "When I saw the cross coming from the boot," Daniel remembers, "I realized my dad was no longer there."
The final picture in the book is a stark, black-and-white drawing of an apparent saw blade. The saw has no handle, and the blade is shaped somewhat like a jawbone. "I asked him about the picture, but he just cried and shook his head," Daniel recalls. "He never painted anything else after that. He doodled some, but he couldn't put the elements of a picture together any more."
One of the most striking examples of the "twilight" of dementia is found in the work of a 20th-century Swiss illustrator named Carolus Horn, which Duxbury uses for presentations to audiences about the power of art in dementia. "Horn took annual vacations to Venice," Duxbury says, "and one of his favorite subjects to sketch was the Rialto Bridge. So we just happen to have many different views of that bridge that he painted over the years. He came from a family with a familial Alzheimer's trait, so he developed his disease relatively early in his life—in his 50s and 60s, when he was still a relatively healthy and vigorous person. He continued to make these trips to Venice with his family, even when he was not cognitively as intact, so we can see in his art the very specific changes that seem to happen through time."
A monochromatic drawing of the Rialto Bridge from 1978, made before the onset of Horn's disease, has the charm of an antique woodcut. The bridge and its surrounding brick buildings are depicted in fine detail and with a realistic perspective, as is a boatman steering a gondola in the foreground canal. A 1982 version, during the beginning of the disease, is bolder than his earlier work and more cartoonlike, less three-dimensional. A 1986 illustration continues the move toward simplicity, but adds subtle touches of color in the background.
Horn's 1988 artwork, during the later stages of his struggle with Alzheimer's, is completely transformed: All bold lines and exaggerated bright colors, it is like a landscape painted by a child. The people are little more than cartoons, and the clouds are simplistic, hard-edged ovals in a blue sky. By 1992, the bridge and the other buildings have lost their shapes and are now barely recognizable blobs, arranged geometrically within a rectangular border.
The progression to bright primary colors and a flattening of dimensions is typical in Alzheimer's art, Duxbury says. "It's a more simplistic rendering of the world. Detail goes away. In the very late stages, the ability to differentiate color goes away, and there's often a choice of a single color. Sometimes just red. Sometimes just blue. By that time, people are no longer verbal; they only express themselves through shapes."