A photographic treatment for people with dementia

One of the first dementia patients Laurence Aëgerter met was in the later stages of the illness. She visite...

Posted: Aug 20, 2018 12:05 PM
Updated: Aug 20, 2018 12:05 PM

One of the first dementia patients Laurence Aëgerter met was in the later stages of the illness. She visited the man at a care facility in Switzerland to note his reactions to photographs she had brought along. As she showed him pictures and asked him to remark on them, he fluttered in and out of awareness, like a lamp flickering on and off, she said. For 10 minutes, the patient hardly said anything, struggling to articulate basic sentences.

Then, Aëgerter showed him a photograph of a cat with her kitten, and something amazing happened.

Aging and health

Alzheimer's disease

Chronic diseases

Dementia

Demographic groups

Diseases and disorders

Geriatric medicine

Health and health care (by demographic group)

Health and medical

Medical fields and specialties

Neurological disorders and injuries

Population and demographics

Senior citizens

Society

Law and legal system

Trial and procedure

Arts and entertainment

Visual arts

"He was able to speak for five minutes in a row," said Aëgerter, a French visual artist based in Amsterdam. "That image triggered something very deep in him, a very deep memory that made him feel so strong. In those minutes, it was like he had no disease at all."

The photographs Aëgerter brought to show the dementia patient were part of the early stages of a project she calls "Photographic Treatment." The premise was simple: Improve the quality of life of elderly people with dementia by staging "photo interventions." They're individual or group sessions that focus conversations on images she curated over the span of three years.

The photos are available as diptychs in a book series, on top of wooden blocks and by free download from the project's website. In June, the book series received the Author Book Award in July at the Recontres D'Arles, a prestigious international photography festival.

Aëgerter undertook the project in 2015 to add levity and humor -- through unexpected pairings, like the face of a child next to one of a seal -- to the lives of patients with dementia and Alzheimer's as well as their families. According to the Alzheimer's Association, up to 40% of people with the disease struggle with "significant depression." And too often, Aëgerter said, dementia patients are infantilized by caretakers and family members, which can add to their frustration and sadness.

"Sometimes, people don't know what's possible and what's not possible, and that makes them very cautious," she said of family members and caretakers. "I realized we should never underestimate people who are sick."

Reconnecting with people with dementia

Dementia is a broad term for a loss of cognitive abilities, such as thinking, remembering and reasoning, that interfere with one's life. Alzheimer's disease accounts for roughly 60% to 80% of dementia cases. According to the National Institute on Aging, up to half of people 85 or older might have some form of dementia.

So why did the man Aëgerter visited have such a strong reaction to the image of the kitten and its mother? He might have connected it with a memory from his childhood and early adolescence. Researchers call this phenomenon, in which elderly people recall events that occurred when they were 15 to 25 years old, the reminiscence bump.

Frans Hoogeveen, a lecturer in psychogeriatrics at the Haagse Hogeschool and one of the scientific advisers for "Photographic Treatment," said that this phenomenon is seen in all elderly people but that it is augmented for those with dementia due to the simultaneous loss of their short-term memory. Failure has been shown to increase stress levels and decrease the overall well-being of those with dementia, so questions based on recollection can often set dementia patients up for failure, Hoogeveen said.

"A mistake often made by spouses of people of dementia is asking them things they cannot reply to because of their illness," he said. Asking about a party that happened a day ago, for example, would rely on a person's memory and would not be a good question, he added.

Because of these limitations, people might not know where to begin when trying to engage and connect with those with dementia, said Ruth Drew, director of information and support services at the Alzheimer's Association. Activities such as discussing a photograph can help both patients and their family members, she said.

"Using these photographs may also help the person who wants to connect with a family member with Alzheimer's to have a jumping-off point that can help engage that person," she said.

Aëgerter's first inklings of "Photographic Treatment" came on the heels of another project, "Cathédrales," which she published as an artist's book in 2014 and from which she spun off a sequel and multiple gallery exhibitions. The book consists of photographs she took of a 1949 catalog of the cathedrals and churches of France that she lay on her windowsill to capture how sunlight revealed and covered up pages from the book at different parts of the day.

The shadows evoked memory for Aëgerter, she said, and after watching videos about dementia patients and reading studies about the benefit of photo interventions, she resolved to create a photo series to benefit them.

Aëgerter worked with experts on dementia and dementia patients to create guidelines for the photos. She found 90% of the photos online by searching copyright-free images; the other 10%, she took herself when she could find no suitable alternative. A photo of a young girl is actually a photo of Aëgerter when she was a child.

Building the books

It took more than 60 hours of work to find and edit the photographs, not counting time spent creating pairs from the more than 300 images. The photos are presented as black and white verticals and focus on one main subject using a shallow depth of field; this photographic technique limits what appears in focus, helping to reduce unnecessary stimuli in the image, which, according to Hoogeveen, people with dementia often have a hard time disregarding.

Aëgerter discovered early on that people with dementia preferred photographs of natural smiles, rather than posed or doctored ones.

"People with dementia have kind of a sixth sense for what is authentic or not," she said.

Drew said this is a common observation in those with Alzheimer's. They can read facial expressions, tone of voice and body language even as they struggle with language and memory, which may have to do with the fact that we learn these things before we learn language.

Once she had collected and edited the images, Aëgerter's next step was to make pairings to create the diptychs in the series, which she did based on instinct. So she lay out hundreds of photographs on the floor of her studio and invited assistants, friends and family to stop by as she rolled around in a swivel chair and taped photographs side by side, creating a pile of images about whose pairing she was certain and relegating some other pairs to her corridor, which she termed "the corridor of doubt."

"It was a long process of choosing but very, very spontaneous, very joyful," she said. "Actually, it was the best of the whole project" for her, both as an artist and a human.

'Everybody was very touched by the book'

As soon as the jury at Arles saw "Photographic Treatment," the winner of the festival's Auhtor Book Award was clear, said Marloes Krijnen, the director of the international photographic organization Foam and president of the jury that selected "Photographic Treatment" for the award,

"Everybody was very touched by the book, and the fact that photography has the ability to help people with dementia, help them use their fantasy, help them feel much more happy and healthy, is something amazing," she said.

She said the series also fit in well with Aëgerter's oeuvre and remarked that it was beautifully printed, clear and fresh.

The jury's decision also related to the fact "Photographic Treatment" is available in multiple formats, Krijnen said.

Aëgerter said she decided to make the photos available as free downloads so that the cost is not an obstacle for anyone who thinks they or a loved one will benefit from the project.

She said she is grateful for the project's recognition in the art world, although she did not set out with the intent of making it a critical hit.

"What would make this project a real success for me is that it would be implemented in as many residential care facilities as possible, because I think it really addresses people in a profound, authentic and adult way," she said.

Mississippi Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 117617

Reported Deaths: 3302
CountyConfirmedDeaths
Hinds8011179
DeSoto721079
Harrison539884
Jackson469387
Rankin401686
Madison384394
Lee364082
Forrest309478
Jones296184
Washington260399
Lafayette253143
Lauderdale2499135
Lamar229138
Oktibbeha203755
Bolivar202877
Neshoba1861111
Lowndes181262
Panola170640
Leflore169188
Sunflower164049
Warren156056
Monroe153073
Pontotoc149020
Marshall147330
Lincoln142959
Pike140456
Copiah138736
Scott126229
Coahoma125537
Yazoo122734
Grenada122639
Simpson122349
Union119725
Tate119339
Itawamba115926
Leake115842
Pearl River115060
Holmes114960
Adams109344
Prentiss108320
Wayne102722
Alcorn102112
George101419
Covington98529
Marion95443
Tippah93123
Newton86827
Chickasaw86226
Hancock85928
Tallahatchie84626
Winston84621
Tishomingo82241
Attala80526
Clarke76353
Clay70522
Jasper69217
Walthall64127
Calhoun62713
Noxubee60117
Smith59816
Yalobusha55614
Montgomery55423
Claiborne53916
Tunica53617
Lawrence53414
Perry51223
Carroll49712
Stone48614
Greene47918
Humphreys44916
Amite42713
Quitman4216
Jefferson Davis41711
Webster37813
Benton3608
Wilkinson33820
Kemper32715
Sharkey28715
Jefferson27710
Franklin2483
Choctaw2086
Issaquena1074
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 160380

Reported Deaths: 2713
CountyConfirmedDeaths
Jefferson23573377
Mobile16994316
Tuscaloosa10462140
Montgomery10352198
Madison942298
Shelby750465
Baldwin671269
Lee657165
Calhoun464761
Marshall442651
Etowah434151
Morgan422335
Houston419334
DeKalb349228
Elmore324653
St. Clair304042
Limestone293631
Walker283793
Talladega271437
Cullman255725
Lauderdale233842
Jackson219417
Autauga208231
Franklin206432
Colbert206032
Blount197225
Russell19603
Chilton190432
Dallas188127
Coffee180711
Dale178952
Covington175929
Escambia174931
Chambers136847
Clarke136617
Pike134514
Tallapoosa133987
Marion110331
Barbour10429
Marengo102622
Butler101241
Winston94013
Geneva9217
Lawrence86933
Pickens86918
Bibb85015
Randolph83516
Hale77730
Cherokee75614
Clay75312
Washington75112
Henry7236
Lowndes71628
Monroe65510
Bullock65017
Crenshaw60930
Perry5956
Fayette58913
Cleburne5739
Wilcox57012
Conecuh56513
Macon53920
Lamar5085
Sumter47421
Choctaw39312
Greene34616
Coosa2093
Out of AL00
Unassigned00
Tupelo
Overcast
75° wxIcon
Hi: 76° Lo: 60°
Feels Like: 75°
Columbus
Overcast
73° wxIcon
Hi: 76° Lo: 62°
Feels Like: 73°
Oxford
Overcast
72° wxIcon
Hi: 70° Lo: 54°
Feels Like: 72°
Starkville
Overcast
70° wxIcon
Hi: 75° Lo: 57°
Feels Like: 70°
WTVA Radar
WTVA Temperatures
WTVA Severe Weather