People diagnosed with Alzheimer’s disease are urged to stay active. They’re told that engaging in physical and mental exercise may be their current best hope to slow the effects of the plaque, tangles, and cell degeneration the disease causes in their brains. Yet perversely, there are few activities designed to meet their special needs and changing capabilities. But a creative couple of practitioners have recently hit upon one offering that is already showing great promise: improv theater performances.

In the interest of full disclosure, I admit to being skeptical about the idea initially. Some years ago, I took improv acting classes in which a teacher encouraged a roomful of us wannabe thespians to perform spontaneously, without a script. I hoped it would help make me think faster. Our teacher, a non-divalike actress, promised more: that improv would “unleash our inner creativity.” Also that the “collaborative imaginations” of the class members would somehow converge to produce a “one-of-a-kind theatre experience.” For six weeks, we were urged to take center stage and perform solo exercises such as demonstrating fifty things to do with a piece of rope to the audience of supportive class members. Mostly, it was terrifying; my mind went completely blank after showing off a snake, necklace, and sidewalk crack — wildly searching for forty-seven more. But the exercise did underscore the need to be present and to let go of old ways of thinking.

Curtains Up: The Memory Ensemble

Christine Dunford, an ensemble member of the Chicago-based Lookingglass Theater Company says that being present and innovative are precisely the strengths that people with Alzheimer’s and other forms of dementia can bring to a stage. She collaborated with Darby Morhardt, research associate professor at Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center to found The Memory Ensemble. Its mission is to improve the quality of life for people in the early and moderate stages of Alzheimer’s disease and other dementias, to investigate the efficacy of this drugfree approach, and to translate any positive effects into other aspects of the participants’ lives.

Dunford and Morhardt took their early inspiration from settled evidence showing that older adults involved in arts programs report they have a positive effect on their social functioning as well as their physical and mental health. The researchers hoped to prove that older adults with dementia would experience similar uplifting benefits.

Their carefully crafted pilot program outlined a specific design: seven to nine 90-minute sessions staffed by teaching artists, a social worker, note taker, volunteers and a teaching artist in training. Participants, referred from Northwestern University’s memory clinic, were required to have a clinical diagnosis of Alzheimer’s and sufficient ability to follow directions; those with psychotic disabilities or who needed assistance with activities of daily living were excluded.

The researchers also emphasized the need to keep the setting and experience consistent — held in the same room with the same welcoming signs, sign-in sheets, and nametags in the same place, as well as the same cohort of people throughout all sessions. To measure participants’ affects, they were asked to rate their moods on the five-point Smiley Face Scale as they arrived for class and again at the end of each session.

After a brief check-in, participants were led through gentle breathing and stretching exercises before delving in to the harder core exercises, such as improv’s signature “Yes, and . . .” in which actors are required to accept their classmates’ ideas and build on them.

For those new to the improv stage, the technique is illustrated as follows:

• Character #1: “What a hot and miserable day to be a ranch hand! ” (Following the “Yes, and . . .” method, the second character will accept the premise and add to the situation.)
• Character #2: “Yep, and it’s made me think about leaving behind this cowboy life and headin’ off for San Francisco.”

This helps affirm the first actor and helps to develop a scene, as opposed to what would happen if Character #2 responded, for example: “No it’s not. And we’re not ranch hands either.”

Why Improv?

Dunford explains that it’s that period of anxiety, which could last a split second or several minutes, in which the second actor searches for a response that is key. It’s the breakthrough that cultivates success and helps build confidence — especially in people with Alzheimer’s. “This actually helps people develop skills they can maintain despite memory loss,” she says.

And because improv students are strongly urged to support one another, the exercises also help foster a sense of community which can help overcome the sense of isolation that many people with dementia report feeling.

“The more enlightened person-centered care principles emerging to treat Alzheimer’s patients are very close to the improv principles,” Dunford explains, citing the need to treat all with respect, to be supportive, and to work in partnership. She says improv also builds on skills that most people retain despite memory loss — such as the abilities to observe, listen, be spontaneous, and trust others.

Expanding upon the current program, Dunford and Morhardt plan to do more outreach to African American and Latino artists in the future. Most research statistics show African Americans are 2 ½ to 3 times as likely to get Alzheimer’s as whites; Latinos are about 1 ½ times as likely. They also plan to produce a manual and training materials so that the classes can be easily replicated in other locations.

And while they are quick to acknowledge that improv does not offer a cure for dementia, they proudly point to the documented results that Memory Ensemble sessions have delivered to participants — including feelings of success, optimism, hope, normalcy, confidence, connection, and a sense of empowerment.

Concluded one Memory Ensemble member: “It’s a no-brainer; excuse the pun.”