ro | en
ArgumentNo. 14/2022

Theraupeutic Architectural Tools in the Management of Perceptual Disorders in the Elderly with Alzheimer’s Disease

  • / lecturer PhD. arch., “Ion Mincu” University of Architecture and Urbanism, Bucharest, RO
  • / PhD scient. researcher III, biol., Medical Rehabilitation “Elias” Emergency Hospital, Bucharest, RO
  • / PhD cl. psych., Medical Rehabilitation “Elias” Emergency Hospital, Bucharest, RO
  • / assist. prof. PhD MD, „Carol Davila” University of Medicine and Pharmacy, Bucharest, RO


Perceptual disorders are common in patients with Alzheimer’s disease and include spatial disorientation, spatial visual deficits, movement perception disorders, three-dimensional non-recognition of objects, poor identification of facial emotional expressions, prosopagnosia, visual illusions and hallucinations. To these are added deficits that may occur due to other conditions commonly encountered in the elderly: narrowing of the visual field, decreased visual acuity and sensitivity to contrast and color recognition disorders.

The study is of the narrative review type and aims to explore the ways in which five specific architectural tools - light, form, color, texture and sound – can contribute to the management of perceptual disorders in order to increase the quality of life in Alzheimer’s disease, both for patients and for caregivers. Case studies are used.

Light, natural and artificial, can positively influence physical and mental health. It is recommended to increase the level of lighting for the older person, to use generous glazing, to have optimal orientation towards the cardinal points and to use zenithal lighting.

Form, in an honest relationship with function, supports correct spatial perception, alleviating distortions caused by neurocognitive disorders.

Color can help compensate for perceptual deficits by using contrasts. Studies recommend using colors from the warm, yellow-red spectrum.

Texture has influence especially on the biological aspect, i.e. on user safety, but it is also an excellent orientation tool for visually impaired people.

Sound can also prove to be a useful tool in ameliorating auditory perception disorders and increasing the quality of life for seniors with neurocognitive disorders by establishing a balance between the need for communication and the avoidance of auditory overstimulation.

The five architectural tools have both individual and synergistic action and contribute to: temporal-spatial orientation, amelioration of depressive symptoms, amelioration of sleep disorders, decrease of agitation, increase of appetite and of the degree of independence. Studies show a hierarchy in their compensatory use: shape is more recognizable than color and color more easily remembered than function. A multisensory approach is recommended.


Alzheimer’s disease, therapeutic architectural tool, dementia-friendly architecture, quality of life, interdisciplinarity



  1. (2018). Dementia Friendly Products, accesat în 8 Mai 2022 la dementia-friendly-products/
  2. Brown, M. J., & Jacobs, D. E. (May 01, 2011). Residential Light and Risk for Depression and Falls: Results from the LARES Study of Eight European Cities. Public Health Reports (1974-), 126, 131-140.
  3. Calkins, M. P. (2018). From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia. The Gerontologist, v58 nsuppl_1 (20180118): S114-S128.
  4. (n.d.) Caddington Grove, accesat în 8 Mai 2022 la caddington-grove-in-dunstable-bedfordshire/
  5. Chapman, N. J., Hazen, T., & Noell-Waggoner, E. (2007). Gardens for People with Dementia: Increasing Access to the Natural Environment for Residents with Alzheimer's. Journal of Housing for the Elderly, 21, 249-264.
  6. Collier, L. & Jakob, A. (2017). The Multisensory Environment (MSE) in Dementia Care: Examining Its Role and Quality From a User Perspective. HERD, Oct;10(5):39-51.
  7. Dalke, H. & Matheson, M. (2007). Colour design schemes for long-term healthcare environments. Kingston upon Thames, UK.
  8. Divo, M. J., Martinez, C. H., & Mannino, D. M. (2014). Ageing and the epidemiology of multimorbidity. The European Respiratory Journal, 44, 4, 1055-1068.
  9. Dunne, T. E., Neargarder, S. A., Cipolloni, P. B., et al. (2004). Visual contrast enhances food and liquid intake in advanced Alzheimer's disease. Clinical Nutrition, 23, 4, 533-538. (n.d.a). Garden Design Principles, accesat în 08 Mai 2022 la https://www.
  10. (n.d.b). Colour and Pattern, accesat în 08 Mai 2022 la https://www.enablingenvironments.
  11. (n.d.c). Sound, accesat în 08 Mai 2022 la sound.html
  12. Fleming, R., Crookes, P.A., & Sum, S. (2008). A review of the empirical literature on the design of physical environments for people with dementia. Research Online.
  13. Harrad, R. & Sulla, F. (2018). Factors associated with and impact of burnout in nursing and residential home care workers for the elderly. Acta Bio-Medica : Atenei Parmensis, 89, 60-69.
  14. Hayne, M.J & Fleming, R. (2014). Acoustic design guidelines for dementia care facilities. Research Online.
  15. Iachini, T., Iavarone, A., Senese, V.P., et al. (2009). Visuospatial Memory in Healthy Elderly, AD and MCI: A Review. Current Aging Science, 2, 1, 43-59.
  16. Illuminating Engineering Society of North America. (2016). Lighting and the visual environment for seniors and the low vision population. New York: ANSI/IES.
  17. Janata P.  (2012) Effects of widespread and frequent personlized music programming on agiation and depression in assisted living facility residents with Alzheimer-type dementia. Music and Medicine. 4(1):8–15.
  18. Jensen, L. & Padilla, R. (2017). Effectiveness of Environment-Based Interventions That Address Behavior, Perception, and Falls in People With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review. American Journal of Occupational Therapy, 71, 5.
  19. Jheng, S.-S. & Pai, M.-C. (2009). Cognitive map in patients with mild Alzheimer's disease: a computer-generated arena study. Behavioural Brain Research, 200, 1, 42-7.
  20. Johnson, J.K., & Chow, M. L. (2015). Hearing and music in dementia. (Handbook of Clinical Neurology.) eScholarship, University of California.
  21. Juda, M., Liu-Ambrose, T., Feldman, F., et al. (2020). Light in the Senior Home: Effects of Dynamic and Individual Light Exposure on Sleep, Cognition, and Well-Being. Clocks & Sleep, 2, 4, 557-576.
  22. Khachiyants, N., Trinkle, D., Son, S.J., et al. (2011). Sundown Syndrome in Persons with Dementia: An Update. Psychiatry Investigation, 8, 4, 275.
  23. Lenham, J. (2013). Colour, contrast and comfort: interior design in dementia. Nursing & Residential Care, 15, 9, 616-618 Lloyd-Jones, T. J. (2005). The role of color in the implicit memory performance of healthy older adults and individuals with Alzheimer's disease. Neuropsychology, 19, 1, 44-53.
  24. Marquardt, G., & Schmieg, P. (2009). Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. American Journal of Alzheimer's Disease and Other Dementias, 24, 4, 333-40.
  25. McAdam, K. & Williams, S. (2017). Dementia Friendly Design Features for Walking Paths: A Focused Practice Question. Brampton, ON, CA
  26. McLaughlin, N. (2018). WANDERING ROUTES, accesat în 08 Mai 2022 la McManus, D. (2020). Ellesmere Nursing Home Chelsea, London, accesat în 08 Mai 2022 la london/ellesmere-nursing-home
  27. Nagahata, K., Fukushima, T., Ishibashi, N., et al. (2004). A soundscape study: What kinds of sounds can elderly people affected by dementia recollect?. Noise & Health, 6, 24, 63-73.
  28. ORIENTATION SIGNAGE, accesat     în       08 Mai 2022 la orientation-signage?variant=32067005907004
  29. Park, N.-K., & Farr, C. A. (2007). Retail Store Lighting for Elderly Consumers: An Experimental Approach. Family and Consumer Sciences Research Journal, 35, 4, 316-337.
  30. Pollock, A., & Fuggle, L. (June 01, 2013). Designing for dementia: creating a therapeutic environment. Nursing & Residential Care, 15, 6, 438-442.
  31. Reisberg, B., Ferris, S.H., de Leon, M.J., & Crook, T. (September 01, 1982). The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 9, 1136-9. (n.d.) THE USE OF COLOR IN DEMENTIA PATIENTS, accessed on 08 May 2022 at the-use-of-color-in-demantia-patients.html
  32. Rhodus, E.K., Hunter, E.G., Rowles, G.D., et al. (2022). Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study. Gerontology & Geriatric Medicine, 8.
  33. Rodiek, S. & Schwarz, B. (2012). Outdoor environments for people with dementia. Routledge.
  34. Savazzi, F., Isernia, S., Farina, E., et al. (2020). Art, Colors, and Emotions Treatment (ACE-t): A Pilot Study on the Efficacy of an Art-Based Intervention for People With Alzheimer’s Disease. Frontiers in Psychology, 11.
  35. Shih, Y.-H., Pai, M.-C., Lin, H.-S., et al. (2020). Effects of walking on sundown syndrome in community-dwelling people with Alzheimer's disease. International Journal of Older People Nursing, 15, 2.
  36. Sung, H., Chang, A. M., & Abbey, J. (2006). The effects of preferred music on agitation of older people with dementia in Taiwan. International Journal of Geriatric Psychiatry, 21, 10, 999.
  37. Talebzadeh, A., & Botteldooren, D. (2021). Soundscape design for people with dementia; The correlation between psychoacoustic parameter and human perception of safety and mood. The Journal of the Acoustical Society of America, 149, 4.
  38. Trojano, L. & Conson, M. (2008). Visuospatial and visuoconstructive deficits. In G. Goldenberg, M. Miller. (Eds.), Neuropsychology and Behavioral Neurology (pp. 373-391), Edinburgh: Elsevier.
  39. Utton, D. (2009). The design of housing for people with dementia. Journal of Care Services Management, 3, 4, 380-390.
  40. Walker, C. (2017). Toilet humour far from funny for people with dementia, accesat în 08 Mai 2021 la https://www.carehome.
  41. Weintraub, S., Wicklund, A.H., & Salmon, D.P. (2012). The neuropsychological profile of Alzheimer disease. Cold Spring Harbor Perspectives in Medicine, 2, 4.
  42. Wiener, J.M., & Pazzaglia, F. (2021). Ageing- and dementia-friendly design: theory and evidence from cognitive psychology, neuropsychology and environmental psychology can contribute to design guidelines that minimise spatial disorientation. Cognitive Processing, 22, 4, 715-730.
  43. Wijk, H., Berg, S., Sivik, L., et al. (1999). Color discrimination, color naming and color preferences in 80-year olds. Aging (Milan, Italy), 11, 3, 176-85.
  44. Zamfir, M., Ciobanu, I., Marin, A., et al. (2020). Spaces for prevention of staff burn-out syndrome in elderly-care institutions. Eur Geriatr Med, 11, 194-195.
  45. Zamfir, M., Ciobanu, I., Marin, A., et al. (2021). Ancore de memorie în arhitectura dementia-friendly si limitele verstatilității spațiale în contextul pandemiei de Covid-19. Argument, 13/2021.

Related articles

Mihaela Zamfir, Ileana Ciobanu, Andreea Georgiana Marin, Mihai-Viorel Zamfir
Memory Anchors in Dementia-Friendly Architecture and the Limits of Spatial Versatility in the Context of the Covid-19 Pandemic (2021)

Mihaela Zamfir, Ileana Ciobanu, Andreea Georgiana Marin, Mihai-Viorel Zamfir
Memory Anchors in Dementia-Friendly Architecture and the Limits of Spatial Versatility in the Context of the Covid-19 Pandemic (2021)

Mihaela Zamfir, Ileana Ciobanu, Andreea Georgiana Marin, Mihai-Viorel Zamfir
Memory Anchors in Dementia-Friendly Architecture and the Limits of Spatial Versatility in the Context of the Covid-19 Pandemic (2021)

Mihaela Zamfir, Ileana Ciobanu, Andreea Georgiana Marin, Mihai-Viorel Zamfir
Memory Anchors in Dementia-Friendly Architecture and the Limits of Spatial Versatility in the Context of the Covid-19 Pandemic (2021)