Abstract
In Transcending Dementia Through the TTAP Method: A New Psychology of Art, the Brain, and Cognition, Dr Linda Levine Madori promotes her proprietary approach of using creative expression to enhance the lives of those stricken with Alzheimer’s dementia. According to the author, use of the TTAP (Therapeutic Thematic Arts Programming) Method promotes both emotional and cognitive improvement in its clientele. In addition, Levine Madori claims that implementation of the method eases the work of skilled nursing facility employees and reduces the cost of care for Alzheimer’s patients in such facilities.
The book begins with a cursory overview of Alzheimer’s disease. Levine Madori’s presumed attempt to be both terse and comprehensive, however, ultimately makes the first chapter difficult to follow. For example, given the simplicity of the summary, the page dedicated to neurophysiology and histopathology either overreaches in scope or risks overwhelming the uninitiated reader with technical terminology. Explanations of the disease are intermingled with epidemiological data that, although important, do not further the reader’s understanding of the disease itself. Annoyingly, the author also peppers the text with interjections regarding the utility of the TTAP Method, softening the chapter’s focus on Alzheimer’s disease itself. The chapter does end, however, with a useful appendix focusing on the abilities retained rather than lost during each stage of Alzheimer’s. This reframing is not merely semantic and is likely to be useful to all who care for those with Alzheimer’s disease.
The second chapter provides an overview of the TTAP Method itself. Unfortunately, it is poorly organized. Dr Levine Madori frequently jumps from descriptions of the method to the theories that underlie it and the benefits it promises to bestow. At best, this chapter is conceptually muddled and barely provides any understanding of Levine Madori’s program. The reader is likely to be better served by skipping this overview and diving into the subsequent chapters in which the TTAP Method, its theoretical underpinnings, and its benefits are more thoroughly explored.
The book’s third chapter provides a comprehensive description of the TTAP Method itself and its application to the Alzheimer’s population. The author’s prose is generally clear and forthright making her explanations easily understandable, even to those otherwise unfamiliar with art and recreation therapy.
Dr Levine Madori’s discussion of the neuroscientific underpinnings for the TTAP Method concentrates on supporting the premise the deterioration of cognitive function can be achieved by stimulating the brain to grow new neurons, encouraging the formation of new neural connections, and decreasing stress, anxiety, and depression. The literature cited in the text certainly backs this claim, but the author often generously interprets the primary literature to add punch to her argument. Since the book is not intended for experts in neuroscience it might be assumed that scientific accuracy is merely a casualty of simplicity, but her summaries of several studies expose a superficial understanding of the primary literature.
Transcending Dementia then proceeds to discuss how the different steps of the TTAP Method stimulate different regions of the brain. Levine Madori states, for example, that step 1 (conversation) stimulates Broca’s area whereas step 6 (writing experience) stimulates Wernicke’s area of the brain. Although this is not explicitly incorrect, there is no reason for one to suppose that Broca’s area is less stimulated when writing or that Wernicke’s area is less stimulated when conversing. One cannot (at least a priori and the author provides no evidence) assume that conversation and writing preferentially stimulate one region over the other. Similar arguments can be made for each of the 12 steps in the TTAP Method. Given the current understanding of the brain, it is arguably tautological to state that people engaging in different activities are engaging different parts of their brains. Similarly, there is no doubt that engaging in the arts and recreational activities engages discrete and often specific regions of the brain. This begs the question, however, of whether the activities of TTAP are better or worse than other methods for stimulating the brain and slowing the progression of cognitive deterioration.
The final chapter of the book attempts to address the specific benefits of the TTAP Method. Dr Levine Madori states that 11 studies (8 published) have specifically evaluated the TTAP Method. Unfortunately, the author only describes 4 of those studies in greater detail and 3 of the 4 had 8 or fewer subjects and no controls. The evidence the author provides to support the clinical efficacy of the TTAP Method is flimsy. Levine Madori does conclude, however, by discussing the 2 most promising features of her method: structure and documentation. To better understand how art therapy can ameliorate the lives of those diagnosed with dementia studies need to be performed. Any method that provides a solid framework for its implementation and explicitly documents the therapy provided can be studied better than a system that does not.
The arts are a promising avenue through which to enrich the lives of those afflicted with cognitive impairment. Art and recreation therapy warrant further study and already deserve greater acceptance in the care and rehabilitation of people stricken by a wide range of pathologies. Transcending Dementia, which reads like a marketing pamphlet, does little to support this.