Questions

1. How does the human mind create an understanding of space?

Our hypothesis is that, if architects learn more about the cognitive processes at play in dementia, this knowledge may then be used to advance dementia design. Moreover, a more scientifically informed and nuanced understanding of how the brain comprehends space should prove invaluable to all aspects of architectural design.

There is a profound link between place and memory as evidenced by research on the hippocampal structure and function of the brain. Within the hippocampus, and its neighbouring structures, neurons exist that lay down memories in their connections while allowing us to map space and navigate it. This internal representation of space is essentially a ‘cognitive map’: we have ‘grid cells’ that create lasting matrices with the longitude and latitude of the spaces we experience; ‘place cells’ that highlight our position in these matrices, helping us to understand where we are; and ‘head-direction cells’ that work like compasses to signal the direction we are facing (Moser 2014).

Alzheimer’s disease is caused by the build-up of plaques and tangles disrupting synaptic connections in the brain. This has a disproportionate impact on the higher synthetic functions of human cognition, including but not limited to, the suite of faculties that deal with navigation in time. When neural activity in the regions around the hippocampus weakens, memory retention declines. Tragically, one of the things we can then forget is where we are. Becoming lost and having no sense of place is common in Alzheimer’s disease and is an immense challenge for architecture generally and in producing buildings for the care of these patients specifically.

8 Monitored activity of the hippocampal neurons, showing place cells and grid cells. Image from the Jeffery Lab, UCL.

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2. What findings from neuroscience, anthropology, art and healthcare can help architects design for people living with dementia and, more broadly, for all of us?

It is important to note that there is not a single consensus on how places are perceived, on an individual and collective level, and that sometimes our experts did not agree on the conceptualisation of how memory works. In terms of understanding the specific challenges architects face in designing for people with dementia, the findings of Sebastian Crutch of the Dementia Research Centre, UCL, were helpful in elucidating both the difficulties of the task and the ways we might overcome these. Crutch noted that human experience is fundamentally personal and affected by ‘a huge number of distinct, and individually damageable, processes’ that transform over time (Crutch 2016). The difficulty for designing for dementia is precisely that the effects of the condition are so inherently individual and constantly changing. We put it to Crutch that designing a ‘daisy chain’ of spatial conditions can help people interlink situations in their minds in order to recall them as remembered experiences later on, a strategy that Crutch agreed seemed promising. The metaphor of a ‘daisy chain’ seemed suitable for describing an interconnected set of memorable scenes that allow people to thread together longer navigational sequences.

In addition to defining space through an understanding of personal history, we were interested in how a place can be comprehended communally. Here we found our engagement with social anthropologist Tim Ingold particularly insightful. In our dialogue with Ingold, we recalled geographer Doreen Massey’s social definition of space ‘as the simultaneity of stories so far’ (Massey 2005), that is, our way of situating ourselves in the world, and of remembering it, is greatly

9 William Utermohlen, Self Portrait with Saw, 1997.

10 William Utermohlen, Self Portrait – Head 1, 2000.

influenced by both personal and shared history. In this conception, mind, body and environment are a shared continuum: a complete system in which perception is the achievement of a whole organism rather than only the mind in a body or the body in an environment. This holistic or ecological view stands in contrast to the views of neuroscientists, and Ingold, for one, rejects their idea that the brain is ‘a central control system’. Ingold sees the brain as a part of a broader ‘circuit’ processed by human action: ‘one is continually creating and re-creating one’s knowledge through the process of going about in it [our knowledge], rather than having it stored away somewhere’ (Ingold 2016). What contributes to this process is the human capacity for story-making. Dementia, according to Ingold, disrupts and confuses a narrative. This was a notable remark that we took from this dialogue as we agreed with Ingold’s position on the significance of story-making.

The ecological view is significant to architecture because one of its main tasks is to nurture this interconnected reality between environment and embodied construction, but architects do not yet know how to capture it. The work of artists who live with dementia, however, shows us ways in which this might be represented. The paintings of the artist William Utermohlen, who was diagnosed with Alzheimer’s disease and continued to paint as the condition took effect until his death, give us unique insights (Crutch 2001). As time progressed and Utermohlen’s cognitive abilities gradually declined, his self-portraits showed spaces that increasingly collided, fragmented and multiplied (9–12). ‘Profiles in Paint’, a more recent project conducted at the UCL Dementia Research Centre, asked artists with and without dementia to paint the exact same group of objects (13–6). It showed that the artists with dementia created profound distortions in their representations, one of which was an inability to represent accurate relations between objects (Harrison 2017). We saw these paintings as works of art in their own right manifesting the artists’ world views rather than as mere diagnostic tools showing evidence of loss. We also took into account healthcare research that highlights the emotional benefits of the experience of music, dance and touch for people living with Alzheimer’s disease. Notably, key areas of the brain linked to musical memory are relatively unaffected by dementia.

These dialogues and explorations persuaded us that a main aim of Losing Myself should be to redefine architectural representation based on such findings that centre on experience. Human experience is not picture-like.

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11 William Utermohlen, Blue Skies, 1995.

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12 William Utermohlen, Conversation Pieces – Snow, 1990.

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13–6 Profiles in Paint, 2015. These paintings were made by people with posterior cortical atrophy and other rare forms of dementia. The project was a collaboration between artist Charlie Harrison and Professor Sebastian Crutch at UCL Dementia Research Centre, with research assistants Amelia Carton, Emilie Brotherhood and Chris Hardy.

3. In what ways can we advance architectural representation to reflect these findings?

A common limitation of the architectural plan is that it represents the building as a static and whole object, neutrally and equally demarcated, from the all-seeing and singular position of the architect. Questioning this position, we investigated a novel method of architectural representation originating from the multiple and overlapping perspectives of occupants.

In discussion with Crutch, we identified the ‘egocentric’ and ‘allocentric’ functions occurring in the human brain (Crutch 2016) and realised that these had not been considered by architects before in the process of drawing. Allocentric spatial referencing in humans requires a sophisticated form of mental manipulation whereby the world is understood by assessing and imagining relationships between objects. It is characterised by an advanced ability to retain a mental image of the whole. In egocentric spatial referencing, however, the brain makes simpler self-to-object connections rather than the more complex and relational object-toobject correlations of allocentric functioning. Architects constantly ferry between plans and perspective drawings that can be loosely associated with aspects of allocentric and egocentric processing respectively, but it is unclear how these forms of drawing enable them to consider fully the degraded allocentric capacities of people with dementia when they design for them.

In our interdisciplinary dialogues, we came to realise that the problem for us, as architects, is that the architectural plan, as a primary tool of our discipline, is mainly allocentric: ‘based on a totalizing map-like view, disconnected from the circumstantial self-dependent ways in which we live in the world’ (Manolopoulou 2020). In response to this challenge, Losing Myself invents a method of drawing that combines and reveals allocentric and egocentric spatial referencing introducing this neurobiological concept in architectural drawing for the first time. Eventually, Losing Myself demonstrates that the architectural plan, although certainly allocentric, embodies a mode of spatial thinking that includes egocentric aspects.

17 The first set-up for drawing experimentation. A glass surface is set on trestle legs while a video camera is placed underneath the glass in order to capture the process of drawing on tracing paper.

18 The first sketch that captured the idea of a single flowing line (seen in black) in an attempt to represent the inhabitant’s mind ‘wandering’ to form spatial perceptions. Drawing by Yeoryia Manolopoulou.

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19 Video still of an early drawing filmed from below the glass top. It captures both drafter and drawing ‘inhabiting’ the surface simultaneously. Drawing by Yeoryia Manolopoulou.

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20 Drawing from above, filming from below, one of the bedrooms from the perspective of its occupant. The method of the single flowing line is used to describe self-to-object visual connections in a continuum. The completed drawing can be seen on p. 4. Drawing by Michiko Sumi.

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21 Drawing of a bedroom to describe another occupant’s perspective. The process was performed and recorded multiple times by different drafters. Drawing by Emma Guy. 22 Drawing of one of the shared spaces in The Orchard Centre, focusing on the corridor and bathrooms. Drawing by Michiko Sumi.

4. How can specialist design knowledge support all stages of building or redesign?

Research on dementia design is relatively new, and as the body of knowledge on human cognition grows, inevitably older studies are quickly superseded. For example, whilst the benefits of abundant daylight with minimum confusion of glare and shadows are unquestionable, new research on improving navigation calls for replacing previous guidance on colour-coding interiors, as this has been found to be reductive. We now know that visual landmarks play an important role in guiding spatial navigation: they act as visual beacons, offer orientation and associative cues, and create reference frames for navigation (Chan et al. 2012). A spatial sequence of meaningful objects and vivid situations can act as a thread of navigational markers to prompt a person’s memory and assist their movement more effectively and enjoyably. This evolving nature of design guidance suggests that it is more important for architects to seek to understand the cognitive processes and perceptual implications of dementia, and reflect on this when designing, than to draft and abide by a didactic list of reductive instructions.

Learning from existing dementia care facilities by examining how they are experienced in the everyday is also crucial. Losing Myself took as a starting point The Orchard Centre, a model respite facility designed by McLaughlin, completed in 2009. The Orchard Centre was a test case for future developments for the Alzheimer’s Society of Ireland, ‘both in its successes and its failures’ (McLaughlin 2013). Conceived as a walled garden building, it was designed to create a sense of ease and freedom amongst the occupants who could safely wander within a network of linked rooms, courtyards and pathways. Routes were created through gardens and social spaces to avoid corridors and cul-de-sacs; clerestory windows were designed to provide abundant natural light.

We revisited this building seven years after it was built to understand how it is used and the changes that might have had happened in it over time. Through our visits and conversations with carers and families of the people being cared for in the centre, we realised disparities between the architects’ intentions and the building as a lived reality.

Our research shows that in dementia care settings tensions frequently emerge between the management of health, hygiene and safety, intended to protect the individual, and the building’s own affordances that enable greater degrees of freedom and personalisation to users. A continuous and empathetic relationship between architect and client at all stages of the building, before and during occupation, is essential and can help users – from managers and carers to patients – to overcome such difficulties. This is important for all projects but particularly acute for dementia care facilities that care for occupants with unique environmental sensitivities and need to adapt themselves as research on dementia evolves.

5. How can we build dementia-friendly cities from the outset?

Cities and landscapes should be designed or adapted with a full understanding of the spatial difficulties that people with dementia face in their lives. Given that research has repeatedly shown that the home environment is best for ageing and living with dementia, the entire cityscape should be designed to allow people to continue to stay at home and in their communities for as long as possible. We need to provide engaging and accessible connections between the home, the neighbourhood and the broader city.

Taken as a whole, all public buildings and the urban realm in its totality need to be conceived as dementia-friendly from the outset. Design clarity, signage, accessibility and the reduction of physical barriers as well as minimising noise and air pollution are crucial. Landmarks can play a meaningful role in easing navigation and green spaces can enhance the wellbeing of all dwellers.

Beyond the physical attributes of the urban environment, attention must be paid to cultural change through cultivating a compassionate and informed community. Broadening a strong awareness of the condition amongst the public can contribute positively to forming and maintaining inclusive and age-friendly communities.

23 23 The Orchard Alzheimer’s Respite Centre, architectural plan by Níall McLaughlin Architects.

24 24 Adjusting the plan of The Orchard Centre, after revisiting it in 2016, in order to make the base for redrawing the building from the imagined perspectives of 16 inhabitants.

25 25 Structuring the plan of The Orchard Centre according to its patterns of inhabitation. Different colour frame sequences stand for representations of the experiences of different inhabitants as they would move from place to place in the building. Overlapped frames indicate areas of social interaction where occupants meet. Score by Yeoryia Manolopoulou.

26 (overleaf) Still view of the new animated plan of the building, composed of hundreds of filmed drawings, stitched together to make an animated composite of allocentric and egocentric line structures.