From Chapter One:
"Building for the Shattered Mind: Partnering Brain Science and Architecture" by Kayt Sukel and Russell Epstein, Ph.D.
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 5 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 would 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 would 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.
“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, DC, 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.
From Chapter 2:
"Remembering the Past to Imagine the Future" by Karl K. Szpunar and Kathleen B. McDermott, Ph.D.
Evidence from Damaged Brains
Consider the patient known in the scientific literature as KC. KC, who has been studied extensively by Tulving and his colleagues at the University of Toronto,1 has global amnesia caused by diffuse brain damage that he sustained in a motorcycle accident. Many of KC’s cognitive abilities are intact, but he can neither remember any single episode from his past nor project himself mentally into the future. When asked to do either, he states that his mind is “blank”; when asked to compare the kinds of blankness in the two situations, he says it is the “same kind of blankness.” DB, another brain-injured patient who has been studied by Stanley Klein, Ph.D., and his colleagues at the University of California at Santa Barbara, exhibits a similar profile.
Following DB’s cardiac arrest, his brain sustained damage due to lack of oxygen. DB can no longer recollect his past, nor can he project himself into the future.2 Both KC and DB have self-concepts consistent with descriptions of their personalities given by others who know them well. Although they cannot remember specific events from their own pasts, their overall self-knowledge (for example, “I am generally comfortable in social settings”) is reliable and can even be changed by new experiences. Moreover, both patients understand the concept of time: they know that there is a future and a past, they can tell time with an analog clock, and they know about their past and their future in a vague sense. What they lack is the ability to perform mental time travel.
Eleanor Maguire, Ph.D., and her colleagues at University College, London, have recently replicated what was observed with KC and DB and extended the observations in a more systematic fashion.3 Five amnesic patients were tested for their ability to form mental images of novel experiences that might take place in the future in a familiar setting, such as a possible event in their lives over the next weekend. These patients were markedly impaired in their ability to do this—their mental images were vague and highly fragmented when compared to those reported by a control group of people of the same average age and level of education but without amnesia.
Another example can be found in people with severe depression. Researchers have known for some time that such individuals have difficulty in bringing to mind personal details from their past. Mark Williams, Ph.D., and his colleagues at the University of Wales showed in 1996 that people with clinical depression are also impaired in their ability to engage in episodic future thought, a discovery that may have important implications for understanding how prolonged depressive states are maintained. For example, an inability to envision a “brighter future” may contribute to sustaining depression.