Spontaneous drawings of 38 patients, diagnosed by the National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria as "probable Alzheimer's disease," and of 39 normal control subjects were analyzed by two independent observers using a standardized scoring system. Drawings of patients with Alzheimer's disease displayed fewer angles, impaired perspective and spatial relations, simplification, and overall impairment compared with those of the control subjects. This represents a combination of the deficits seen following right- and left-hemisphere lesions. Neglect, tremor, and perseveration were not prominent. Drawing impairment was relatively independent of language or memory impairment, but drawing performance was related to perceptual and executive dysfunction in the visuospatial domain. Deterioration was followed up for up to 3 years.