How do you design for someone who is losing their mind? People with dementia experience visual, spatial, and perceptual symptoms, in a variety of combinations, that the rest of us can scarcely imagine. They often become less able to detect movement, differentiate between colors, and register contrast, such as between black and white. A blue floor surface may read as a body of water. A white porcelain toilet may be invisible against a backdrop of white tile. People with dementia see double, they lose depth perception, their field of vision narrows, and they have difficulty coping with visual stimuli, reflections, glare, and sudden changes in light level. They bump into things, get disoriented or lost easily, and have difficulty grasping objects such as door handles. They may lose the ability to recognize everyday objects. My father, who died of Alzheimer’s and Parkinson’s last month, and had a hearty appetite to the end, tried on separate occasions to eat a stick of deodorant, a rubber doorstop, and a Styrofoam cup. It’d be funny if it weren’t so very sad.

Perhaps these symptoms wouldn’t matter, architecturally, if dementia patients all conformed to the chairbound, somnolent stereotype. But many suffer from extreme restlessness and agitation, which compels them to roam wherever possible, and often at night. In the memory care facilities where he lived during the last year of life, Dad developed an alarming habit of walking into other people’s rooms uninvited.

Perhaps these symptoms wouldn’t matter if dementia patients remained out of sight and mind, where our fearful society habitually banishes them. The situation, however, is growing too big to ignore. The Alzheimer’s Association reports that 5.7 million Americans, including one in 10 over 65, suffers from Alzheimer’s, which is the most prevalent of the neurodegenerative diseases. More than 16 million provide (unpaid) care to loved ones with Alzheimer’s. An additional 2.2 million suffer from other forms of dementia such as vascular, frontotemporal, and Lewy body dementia. A 2017 study put the cost to the U.S. healthcare system of the nine most prevalent neurological diseases at $800 billion per year—more than the country’s entire annual military budget. These numbers will grow as the nation’s 76 million Baby Boomers progress into old age. A 2018 study estimated that by 2060, 9.3 million will be living with Alzheimer’s, and another 75 million will be in the early, undetectable stages of the disease. They deserve to live, and die, with dignity. Architecture must be ready to help them.

Unfortunately, design for dementia hardly registers as an area of academic or professional inquiry, compared to ostensibly glamorous project types like skyscrapers and museums. Health- and elder-care projects in general are red-headed stepchildren, receiving too little recognition from peers and the media (mea maxima culpa). The AIA/AAH Healthcare Design Awards are one welcome exception, another is the interest and research of firms such as Nord Architects and Perkins Eastman [PDF] and of innovative younger practitioners such as Matthias Hollwich, AIA, Jack Sardeson, and Deane Simpson. Given the scope of the issue in terms of both human and economic cost, design for our aging population and for people with dementia in particular deserves a more central place in the collective architectural consciousness.

Author's note: Several commenters have rightly brought up AIA's highly active Design for Aging Knowledge Community, which deserves a shout out (as do many other groups and individuals, of course). The knowledge community's leadership was an invaluable source for our June 29 report: "Getting Better with Age: Design for Senior and Assisted Living Facilities."