Cultural expression through art in alzheimer's disease: a psychological analysis of painting-based engagement, identity, meaning-making, and affective regulation.

Alzheimer's disease is usually described through progressive decline in memory, language, executive function, and autobiographical continuity. However, this clinical framing does not fully explain how individuals with Alzheimer's disease may continue to respond to visual form, aesthetic atmosphere, image-based cues, symbolic materials, and shared artistic encounters. This narrative review examines visual art engagement, particularly painting, as a psychologically meaningful field in which perception, affect, identity, agency, and relational presence may remain partially accessible despite cognitive decline. Rather than treating art as simple recreation or as direct evidence of hidden mental content, the review positions artistic engagement as an aesthetic and psychological process shaped by visual attention, sensory salience, material choice, emotional tone, cultural familiarity, and interpersonal witnessing. Painting is emphasized as an active medium through which color, gesture, rhythm, spatial arrangement, and material interaction may support non-verbal expression and momentary authorship. At the same time, photography, visual images, collage, and familiar artworks are considered as complementary modalities that can scaffold recognition, emotional orientation, biographical resonance, and shared attention without requiring accurate memory retrieval. The review highlights that art-based engagement may support dignity, mood regulation, social recognition, and person-centered care, but its interpretation must remain cautious. Artistic products cannot independently prove memory, trauma, desire, depression, insight, or clinical improvement. Their value lies in process-based observation, aesthetic responsiveness, contextual interpretation, and ethical care. Future research should further distinguish the psychological effects of artistic creation, aesthetic viewing, photography-based reminiscence, sensory stimulation, and social contact in Alzheimer's disease.