Cognitive decline refers to a gradual loss of thinking abilities such as memory, attention, and problem-solving, often seen in conditions like Alzheimer’s disease.
Drawing tasks can reveal early signs of this decline, as they require coordination of motor skills, spatial awareness, and executive function.
Changes in drawing quality—such as missing details or disorganization—may reflect underlying cognitive impairment before it becomes obvious in daily life.
Goldner, L., Pery, A., Jaroenkajornkij, A. N., Avraham, G., & Binson, B. (2025). Drawing the mind: Assessing cognitive decline through self-figure drawings. Frontiers in Psychology, 16, 1558675. https://doi.org/10.3389/fpsyg.2025.1558675
Key Points
- Focus: The study investigates how self-figure drawings can be used to assess cognitive decline in older adults with Alzheimer’s Disease (AD), Mild Cognitive Impairment (MCI), and normative cognitive functioning.
- Method: Researchers conducted a cross-cultural, correlational study with 496 older adults from Israel and Thailand using the MoCA-5 and a self-drawing task. Drawings were coded into eight categories and statistically analyzed.
- Findings: Detailed and realistic self-figure drawings were associated with better cognitive functioning, while disorganized or unusual drawings indicated cognitive impairment.
- Implications: Self-figure drawings may serve as a culturally sensitive, low-cost, non-invasive tool to detect cognitive decline in aging populations.
Rationale
Drawing integrates cognitive, visuospatial, and motor abilities, all of which decline in AD and MCI.
While traditional tools like the MoCA are validated, they may overlook early signs of decline in non-Western or low-resource settings.
Previous research links human figure drawings to cognitive development and impairment, but few studies have explored their diagnostic value in elderly populations or across cultures.
This study aims to fill that gap, highlighting both cognitive and emotional dimensions of self-representation through drawing.
The next step is to validate self-figure drawing as a standardized screening method, with adjustments for cultural expression.
Method
A correlational, cross-sectional design was used to examine associations between cognitive functioning (via MoCA-5 scores) and the characteristics of self-figure drawings.
Participants were recruited from community centers and elderly care settings in Israel and Thailand.
Drawings were independently coded and categorized, and results were analyzed with MANCOVA, t-tests, and Chi-square tests.
Procedure
- Participants gave informed consent.
- They completed a demographic questionnaire.
- Each participant took the Montreal Cognitive Assessment (MoCA-5).
- Participants were asked to draw a self-portrait on A4 paper using pencil (no eraser allowed), with no time limit.
- Drawings were categorized into eight types based on features like completeness, realism, and distortion.
- Data were statistically analyzed to compare drawing type with MoCA-5 scores and cognitive categories.
Sample
- Size: 496 older adults
- Age: Mean age = 73.97 years (SD = 9.26)
- Gender: 70.2% women (n = 347)
- Geography: 77% Israeli, 23% Thai
- Education: Over half had junior/high school education; 23.5% had college degrees
- Living Arrangements: 67.6% lived with a partner; 25.3% lived alone; 7.1% in nursing homes
Measures
- Montreal Cognitive Assessment (MoCA-5): A brief screening tool measuring attention, memory, executive function, and orientation.
- Self-Figure Drawing Task: Participants were instructed to draw themselves. Drawings were categorized based on complexity, proportion, and realism.
- Drawing Categories: Adapted face/full body, exaggerated, schematic, disjointed, strange, and non-figure (e.g., object) drawings.
Statistical Measures
- t-tests: Compared MoCA scores by culture.
- Chi-square tests: Assessed associations between drawing types, culture, and MoCA categories.
- MANCOVA: Compared MoCA scores across drawing categories while controlling for culture.
- Tukey post hoc tests: Analyzed pairwise differences in MoCA scores between drawing groups.
Results
- Participants who produced adapted face and full-body portraits had the highest MoCA scores.
- Those who created schematic, strange, or object-based drawings scored significantly lower.
- Cultural differences were observed: Thai participants had higher MoCA scores and a different distribution of drawing types compared to Israelis.
- Drawings were significantly associated with cognitive status categories (normal, mild, moderate-to-severe impairment).
- Israeli participants with cognitive impairment were more likely to produce “strange” drawings, while Thais with impairment produced more “exaggerated face” portraits.
Insight
This study shows that self-figure drawings may reflect not only cognitive but also emotional and identity-related processes in older adults.
Realistic drawings signal preserved cognitive function, while disorganized or missing features suggest decline.
The integration of artistic and clinical data offers a broader, more nuanced lens for dementia screening.
Unlike conventional neuropsychological tools, drawings reveal subtleties in self-perception, visuospatial coordination, and cultural expression.
This approach extends previous research by providing cross-cultural validation and demonstrating the potential utility of visual data in clinical diagnostics.
Clinical Implications
- Screening Tool: Clinicians can use self-figure drawings as an accessible way to flag early cognitive decline, especially where resources are limited.
- Culturally Adaptive: Drawing tasks can be adapted across cultures, offering a more inclusive method of assessment.
- Early Detection: Visual characteristics in drawings may signal preclinical cognitive changes not captured by standard tests.
- Multidisciplinary Use: Art therapists, psychologists, and geriatricians can collaborate in interpreting drawings to inform treatment planning.
- Recommendations: Include self-figure drawing in dementia screenings, especially for diverse or underserved populations. Train clinicians to interpret drawings systematically.
Strengths
This study had several methodological strengths, including:
- The study had a large, cross-cultural sample, enhancing generalizability.
- Use of both qualitative (drawing) and quantitative (MoCA) data provided a multidimensional assessment.
- The coding of drawings was conducted collaboratively by trained art therapists, increasing reliability.
- Inter-rater reliability was high (Kappa = 0.88).
- The use of validated tools (e.g., MoCA-5) ensures measurement accuracy.
Limitations
This study also had several limitations, including:
- The study’s correlational design prevents causal conclusions.
- Unequal representation between Israeli and Thai participants may affect cross-cultural generalizations.
- Drawing ability and prior art experience were not controlled for and may have influenced outcomes.
- Some statistical tests (e.g., Chi-square) had cells with low expected frequencies, reducing reliability for subgroup analyses.
- The drawing categorization relied partly on subjective judgment despite coder consensus.
Socratic Questions
- What assumptions does the study make about the link between artistic ability and cognitive function?
- How might cultural norms around art and self-expression influence the drawing outcomes?
- Could the emotional state of participants (e.g., depression) impact the drawings independently of cognitive decline?
- In what ways might drawing assessments complement or challenge traditional neuropsychological testing?
- How would you adapt this method for younger populations or individuals with different educational backgrounds?
- What are the ethical considerations in interpreting personal drawings in clinical contexts?
- Could this method be misused or overinterpreted in diagnosing dementia?
- How would including qualitative interviews about the drawing process deepen the analysis?
