brain injury

Sit down, close your eyes, and try to remember how you got to where you are.

How easy is it for you to visualize the path you took today? How did you remember where to go? Maybe you know to always turn at an important landmark — the tree your mom planted, for example. Maybe there was a sign telling you the right direction.

Photo from iStock.

For people living with dementia, these navigational clues can be hard to read.

According to the Alzheimer's Association, about 5 million Americans live with some form of dementia. Dementia isn't a single disease — rather, it's a broad category of cognitive and neurological symptoms. The most common cause of dementia is Alzheimer's disease, but there are many others, including strokes or Parkinson's disease.

Dementia can interfere with many of the brain's mental processes, including spatial memory — the part of the brain that deals with navigation. This is why many people living with dementia may sometimes find it hard to get around, even in familiar places.

Part of our ability to navigate lies in the hippocampus; dementia can interfere with processes in this region. Image from Henry Gray/Wikimedia Commons.

Getting lost can be especially dangerous for people who live with advanced forms of dementia — it can mean forgetting how to get home and being exposed to the cold or rain or running into dangerous situations like wandering across a highway.

A possible solution for this problem lies in the designs of the very buildings we live in.

Woodside Place is an assisted-living community in Pittsburgh, Pennsylvania, that was built by Presbyterian SeniorCare in 1991.

Photo by Presbyterian SeniorCare, used with permission.

Though not as common today, in the 1980s, many facilities used physical or chemical restraints to prevent their residents from moving around.

Woodside, on the other hand, was specifically built and decorated to accommodate the natural wandering tendencies of people living with dementia.

Clever design decisions — like the use of color — help reinforce and strengthen the residents' spatial memory.

Many care spaces are designed like hospitals, fairly sterile and visually repetitive, white hallway after white hallway. By making the space more colorful, Woodside provides a quick intuitive reminder for residents to identify where they are.

Photo by Presbyterian SeniorCare, used with permission.

At Woodside, even the staff's uniforms are color-coded based on which wing they work in.

"[Patients] may not remember my name, but they remember she's green, she belongs to me," Carrie Chiusano, executive director of Presbyterian SeniorCare's dementia care center, explained.

Staff uniforms are color-coded. Photo by Presbyterian SeniorCare, used with permission.

Another strategy Woodside uses is to have decorations and signs that are meaningful and packed with emotional relevance.

Outside Woodside's green treehouse-themed wing is a large tree decoration. These cueing devices are more than just props; they serve as subtle visual reminders and landmarks for residents.

Woodside has also invested in signs and decorations that have personal significance to the residents. For example, many residents have decorated their doors and living spaces with photographs of themselves, family, and friends, so that they can more easily identify which room is theirs.

This can apply to more than just personal pictures; it can apply to meaningful symbols as well. Mary O'Malley, a Ph.D. student at Bournemouth University in England, told Upworthy of a care facility she visited where one area was decorated with generic pictures of water lilies and another was decorated with a painting of the city's history.

Water lilies vs. New York City. Which means more to you? Images from iStock.

Though the lilies were very pretty, O'Malley said the residents' emotional connection with their home city ultimately seemed to be a more useful navigation tool.

Researchers like O'Malley are constantly looking for ways to design living spaces specifically for people living with dementia.

Along with her supervisors, O'Malley is studying how people learn and remember routes and directions. She's taking a multidisciplinary approach, using psychology, neuroscience, sociology, and perhaps most importantly, direct conversations and feedback from people living with dementia.

Mary O'Malley conducting research at Bournemouth University. Photo from Philip Hartley/Bournemouth University.

O'Malley is interested in what type of spatial memory is most susceptible to memory loss.

For instance, we know that most older adults seem to work better with landmarks ("head toward the church") rather than plain directions ("turn right at the church"). O'Malley wants to see if this pattern holds true in people living with dementia as well. She's also studying the way our brains read maps to see if maps can be more user-friendly.

As we learn more about these designs, we can incorporate them not just into care facilities and hospitals, but into community spaces too.

While care facilities can be designed for residents with specific needs, it's estimated that about 60% of people living with Alzheimer's live within the larger community, rather than in assisted-living facilities.

"If you want to support people so that they remain in the community, then you should be making these changes to the community," O'Malley said.

These design decisions, such as the use of visual reinforcement and meaningful decoration, could be easily incorporated into the spaces we see around us every day. Next time you find yourself stuck trying to navigate, think about all the little visual cues you take for granted and how easy it would be to make them better for everyone.