What might architects learn from neuroscience that would help in designing better nursing homes and other facilities for the aging, particularly people with Alzheimer’s disease? When the brain is impaired, the environment can make it easier or harder to find one’s way, remember habits such as how to get dressed, interact socially, eat enough to be nourished, and even to walk safely outside.  Coupled with existing knowledge about the brain, answers to research questions identified by participants in a recent interdisciplinary workshop should one day guide the design of facilities that will improve life for  people with Alzheimer’s and perhaps for all of us as we age.

In Elegy for Iris, John Bayley’s poignant memoir chronicling life with his wife, Iris Murdoch, as she struggled with Alzheimer’s disease, the author writes, “Alzheimer’s is, in fact, like an insidious fog, barely noticeable until everything around has disappeared. After that, it is no longer possible to believe that a world outside the fog exists.”

Alzheimer’s disease, a progressive and irreversible neurodegenerative brain disorder, currently affects more than five million Americans. The disease causes formation of plaques in the brain’s cortex, and leads to degeneration of neurons, a reduction in key neurotransmitters such as acetylcholine, serotonin, and norepinephrine, and a loss of synaptic activity—the means by which neurons communicate. This brain atrophy causes symptoms that begin with simple memory loss and gradually advance to widespread, persistent cognitive impairment that may include problems with critical reasoning and sensory perception, general confusion, and social withdrawal. Because of this overwhelming loss of function, people with the disease will eventually need round-the-clock care, often provided by nursing homes or assisted-living facilities. Even the best of these facilities, however, can be a tremendous adjustment for people struggling with the disease, as well as for their families.

But what if we could create assisted-living spaces for people with Alzheimer’s that could make life easier despite the “insidious fog”? What if, by bringing together knowledge of architectural design and knowledge of what goes on inside the brain of the person with Alzheimer’s, we could design buildings and interiors that will help people stay more capable over longer stretches of time, remember the outside world, and successfully interact with it? Furthermore, what kind of brain research is needed as a basis for creating facilities that will make the adjustment from home to a care facility less stressful for the patient? To begin asking the questions that could jump-start this process, the Academy of Neuroscience for Architecture (ANFA) held an interdisciplinary workshop, “Neuroscience of Facilities for the Aging and People with Alzheimer’s” in late November 2006. (To read more about ANFA, see “Architecture with the Brain in Mind.”)

“Right now, not very much knowledge is available in neuroscience that is applicable to the design of facilities for people with Alzheimer’s,” says John P. Eberhard, FAIA, founding president of ANFA. “Ninety-nine percent of research in neuroscience is oriented towards disease and the ramifications of that disease. Practically no one looks at research that could be used to improve the facilities such people live in. We’re trying to encourage that to happen.”

Over three days in Washington, D.C., two dozen prominent neuroscientists, architects, and experts on Alzheimer’s disease and aging came together to discuss how to promote neuroscience research that will eventually have tangible application to designing nursing and  assisted-living facilities. In this article, we focus mainly on Alzheimer’s disease, but the lessons learned with this disease can be applied to the aging population as a whole.

“The purpose of the workshop was to create hypotheses that potentially can be tested in neuroscience laboratory conditions and eventually yield results that architects can use in design,” says Eberhard. To that end, participants formed small working groups focused on specific issues, among them physiology and physical ability, memory, sensory perception, and cognitive mapping. Each working group developed a series of hypotheses that, if tested, might have great impact on how architects and designers determine design criteria for assisted-living spaces in the future.