If learning is not in your
body, you haven’t learned it… Those who believe that the mind trains the
body have it backwards, it is the body that trains the mind.
Ever since Alois Alzheimer first described the disorder that bears his
name, researchers are on a quest to find the cure and stop the rampage
of this decimating illness. The syndrome characteristic to Alzheimer's and other neurodegenerative diseases is commonly referred to as Dementia. Dementia is, therefore, a group of symptoms specific to illneses which cause irreversible decline of cognitive functions. These brain deseases can affect memory, language, orientation, visual-spatial processing, attention, judgement, planning, behaviour, emotional control and personality.
Neurodegenerative diseases are also called “progressive diseases”, due to their
irreversibility. Dementia is commonly associated with Alzheimer’s disease which is accounting for 50-75% of cases (ABS, 2015) and it occurs most
commonly in the elderly. According to Australian Bureau of Statistics
there are 342,800 people living with dementia (2015) in Australia and
the number is expected to grow.
The causes of neurodegenerative diseases, including Alzheimer's, remain a mystery. Despite decades of research, Alzheimer’s disease remains largely untreatable and incurable; even with billions of dollars invested
and more than 200 anti-Alzheimer’s drugs developed no major
breakthrough in its treatment had been developed. All current drugs are oriented on treating symptoms and have only modest effects.
The hope is that any breakthrough in understanding Alzheimer's will help us understand all other major neurodegenerative diseases.
What research tells us, so far, is that there are two toxic proteins
involved in Alzheimer’s – amyloid and tau, with amyloid being the
trigger and tau doing the most of the damage.
Over time these proteins build up in the brain – initially in the medial
temporal lobes and then in other brain regions. The human brain can
tolerate a certain amount of amyloid, but once tau is activated the
symptoms of Alzheimer’s start to appear. Presence of beta amyloid
(markers for Alzheimers) in spinal fluid, in combination with mental
status exam, may be used to increase the accuracy of a diagnosis.
However, there are many factors that influence the onset and development
of this disease. Research suggests that complex interactions take place,
with many factors influencing its development; from relations between
amyloids and the sleep disturbances , to association between estrogen and dementia , or evidence of relation between metal
toxicity and inflammation. Some research provide stronger evidence than others,
and sometimes these studies could even be contradictory, as Maki and
Henderson study show, contrary to belief, giving women estrogen with
progestin (Prempo) would increase their risk of Alzheimer’s disease.
However, what we now do understand is that our gene-inherited tendencies
may reveal our vulnerability towards certain diseases but it is the
gene-environment interactions which determines their onset. Beneficial
factors, such as mental and social involvement when integrated with
physical activity can decrease the rate of cognitive decline in someone
with dementia and improve their quality of life dramatically. Our brains
are so plastic that even everyday same practices produce slightly
different neural connections. This brain’s ability to change itself
through creation of new and strengthening of already existing neural
pathways is called neuroplasticity. In rehabilitation after stroke
procedure, it is demonstrated that environmental influences (CI Therapy)
can cause plastic change in the injured brain
It seems that the best cure may be achieved by prevention. Deseases that cause dementia begin many years before any symptoms become apparent. We do know that being aware and attentive, active, mentally and socially engaged helps with the prevention of many neurodegenerative diseases and may even slow their progression.
Art as a way of retaining cognitive capabilities
Nowadays some of the more successful artists do not even produce their
own work themselves. They have an army of elves doing the "production”. In history of Western metaphysics concept was traditionally separated from physical action. By following same tradition contemporary fine art students are, even at
universities, encouraged to write about what they would do
in "conceptual" terms where the planning is often the end in itself. However, what would be the point of artistic
endeavour when a mounting research, from different scientific fields,
demonstrates that the real benefits of artistic activity come from the
artistic creative process defined by the physical action itself?
Here, however, we shall not dwell on the mysterious
depths of art, nor shall we discuss the fundamentals of what constitutes
art. In this instance, we shall consider the benefits of an artistic
process from a neurological point of view. More specifically, the
benefits of what is considered as a traditional, representative visual
art practice - drawing, in relation to therapeutical treatments of many
In our time many would argue that, due to the fact that representational art is concerned with appearances
it, apparently, lacks the depth of modern art which is concerned with ideas.
As such it is habitually diminished in the eyes of the artworld due to its
imperative of copying reality or relation to "just" gaining the skill of copying reality.
The popular assumption is that representational art is forever
entrapped into competing battle with photography, while, in fact, anyone who has ever drawn or painted anything
knows that the process of art, even the one we call representative art,
has nothing to do with the ability to recreate more or less accurate illusions of reality.
Drawing as Neuroplastic Awareness Drawing Therapy
In his famous 1871 lecture, Helmholtz, a German physicist, emphasised
two capabilities of artists: advanced observational capabilities and
enhanced memory for the observed images. While the ﬁrst part of his
claim is often mentioned, the second, memory related, has been widely
Drawing, nowadays almost forgotten as an artistic medium, may seem simple but is an
extremely complex activity that requires harmonisation of multiple brain
mechanisms, such as perceptual processing, memory, precise motor
planning and motor control, spatial transformations, emotion control,
and involvement, among many other high cognitive functions
We know that to learn a language we need to follow and adopt certain
rules to acquire it; It is similar with music and visual arts. By learning how to draw we are learning the rules of the medium and aquiring specific skills. Working memory and attention are two central pillars of cognition.
Drawing reveals concurrent visual-motor selections, as it engages visual
and motor brain areas at the same time. Items in visual working memory
can invoke multiple, item-specific, action plans to be accessed while
visual representations is assuring the guided behaviour. Praxis is the ability to perform meaningful or coordinated movements
under voluntary control, which involves left parietal lobe, the one which is often
effected by Alzheimer’s disease.
Some studies suggest that a simple tool use, such as a stick as an
extension of limb movements, involves sensorimotor integration
in the dorsal stream of visual processing for action controlOn the other hand, complex tool use involves a modification of
hand movements into new motor actions; therefore, requiring the semantic
knowledge about the tool and its function, which implies the role of
ventral stream, mostly neural networks in the left temporal, frontal and
parietal cortices Hodges and
collegues demonstrated that patients with semantic dementia function
well in everyday life and sometimes show striking preservation of the
ability to use objects suggesting the interconnectivity between
gesture, movement planning and semantic knowledge. Furthermore, many
studies that combine visual or gesture (drawing) with verbal treatment
showed significant effectiveness
Drawing is not just any physical activity, even though any physical
activity has been proven to be beneficial in treatments for many
diseases. To use a pencil as a tool and to engage in drawing demands:
awareness of movements, direction, concentration, planning and
implementation and so much more. The process of sensory analysis of the
world involves mental processing and presents available action
opportunities. Decision-making, underlying voluntary behaviour, can then
be viewed as the process of selection of motor options that will be
As Cisek and Kalaska note, eye connects perceptual, decisional, and
motor processes, and we can assume similar association exist for the
arm, whose main role is physical interaction with the world Studies of tactile perceptual decisions suggest a similar functional architecture for the limb motor system Schelegel and
colleagues (2014) conducted a study in which they investigated
differences between art students and students who did not study art in
relation to creative cognition, perception and perception to action.
They found that art students’ creativity was proliferated through the
reorganisation of prefrontal white matter. Furthermore, sketching from
observation involved multivariate patterns of cortical and cerebellar
activity in art students most prominently (Fig.3.). Plasticity in neural
pathways that enable creative cognition and mediate perceptuomotor
integration supported and was highly correlated with the appearance of
these visual artistic skills.
From Visual Imput to Affirming Neural Pathways
As optic nerve leaves the eyeball, it carries the information to the
various sites in the brain. Most of the fibres go first to lateral
geniculate nucleus (LGN) in the thalamus, and from there information is
transmitted to the primary projection area for vision, in the occipital
lobe. Most astonishingly, the cells that link retina to the brain are
already involved in the process of analysing the visual input. Further,
LGN reaches to other parts of the brain, such as many areas of the
occipital lobe (V1,V2,V3,V4, PO and MT) but also parietal cortex and
inferotemporal cortex, with each of them having their own differentiated
This brain specialisation allows parallel processing (different steps of
visual processing going at the same time). Within optic nerve itself,
two types of cells are distinguished, - P cells and M cells. P cells are
specialised for spatial analysis and detailed analysis of form. M cells
– for detection of motion and perception of depth. From the occipital
lobe signal is transmitted to the cortex of the temporal lobe. This
pathway (referred to as - What system) is used for identification of
objects. Second pathway carries information to the parietal cortex
(Where system) and guides our action based on our perception.
Patients with damaged occipital- temporal pathway often manifest visual
agnosia – inability to recognise visually presented objects but have no
problem in recognising visual orientation; while those who suffer from
damage to occipital-parietal pathway have difficulty in detecting motion
but not in identifying objects.
Visual attention is a process of selection and is significantly related
to memory. Early hypothesis suggests that things we do not consider
important we fail to process from the start. Late hypothesis, on the
hand, indicates that all input is analysed but just attended is
remembered. Some research demonstrate that attended input was privileged
from the very start Furthermore, attention and awareness modulates neural pathways even as early as it reaches LGN, hence, attention changes our memory but it also
literally changes our perception
Body Knowledge - Cognitive Kinaesthetic Therapy, CI (Constraint Induced
In recent years, there has been a push to understand how movement
affects cognitive functioning. Jensen presented multiple reasons for why movement has an influence on
cognitive function. As we have mentioned before, brain regions are
extremely interrelated. Areas of the brain that control both gross and
fine motor skills include the cerebral cortex, basal ganglia, and
cerebellum. The cerebral cortex controls the movements of the muscles,
while the basal ganglia control position and voluntary movement.
Anatomically, the area of the brain associated with motor coordination
is the cerebellum. It monitors muscles during movement but is also
involved in memory, attention, and spatial perception suggesting a link
between cognitive functioning and movement.
Jensen (2005) demonstrated that there is a functional evidence which
shows improvement of cognitive functioning through movement. Enhanced
blood flow due to increased movement escalates the amount of oxygen
being delivered to the brain, influencing higher cognitive abilities and
affecting attention. Furthemore, Eliassen, Souza and Sanes demonstrated
an increased activation in the brain during movement while investigating explicit learning mechanism.
As Jensen has eloquently summarised: “ If learning is not in your
body, you haven’t learned it… Those who believe that the mind trains the
body have it backwards, it is the body that trains the mind”
Having the object in front of your eyes or in your thoughts alone will
not improve your memory. Learning is not a passive process. Our visual
memory, motor skills and cognition are dependent on interrelation of
different brain regions. Awareness, the intention to memorise, activity
we chose in order to personalise the information, together with
rehearsal, leads to deep processing. Visual memory evolves through
connections between nerve cells and builds memory connections that serve
as retrieval paths, which in return helps us improve memory in general
and retain brain plasticity well into old age.
Therefore, drawing presents a unique activity that integrates different
brain regions and enhances perceptual, cognitive, and motor abilities.
It may look like a passive activity but its physicality is very
specific. Life drawing is particularly demanding. It involves looking at
objects in the world and then presenting them graphically (visual
realism or view-based depiction).
Furthermore, drawing strengthens the resolve and feelings of
achievement, as its exercises do not only rely upon “enjoyment of
creative action” alone, where everything is “equally beautiful”,
although it may be true. The emphasis is on achieving a certain set of
skills, which are not easy to gain, and on awareness of each movement
presented as a possibility. Planning, implementation, coordination,
memory and focus are, among many, important factors, which make these
drawing extremely useful activity in the fight against cognitive decline.
People who suffer from neurodegenerative diseases are often not willing
to engage with their environment. They feel ostracised and with little
hope to ever contribute to community. There are not enough places for
them to challenge themselves or have any possibility of improvement.
Equaly, there are not enough places for their carers or those who are
willing to do all they can to prevent the onset of neurodegenerative
diseases. Therefore, there is a growing interest in developing tailored
Our aim is to help individuals in delaying and preventing the onset of
neurodegenerative diseases by devising appropriate treatments and doing
lifestyle interventions which may reduce the impact (and delay the
onset), but also those who are already affected to continue to actively
participate in their living environments.