A revolutionary approach combining neurological insights with ethical principles to transform dementia care environments
Imagine standing in your own kitchen, a room you've occupied for decades, and suddenly finding it unfamiliar. The cupboard doors seem to be in the wrong places, the lighting creates confusing shadows, and you can't remember how to make your morning tea. This disorienting experience is a daily reality for many of the 55 million people worldwide living with dementia, a number projected to triple to 153 million by 2050 1 .
People currently living with dementia worldwide
Projected cases by 2050
Countries participating in COSMIC research 1
For too long, our approach to designing spaces for people with cognitive decline has been purely clinical—focused on safety at the expense of humanity. But a revolutionary shift is occurring where neuroscience meets philosophy, creating environments that don't just minimize risks but maximize human potential. This isn't just about building better nursing homes; it's about reimagining how design can support personhood, dignity, and connection even as memory fades.
To understand why design matters so much for dementia, we need to look at what's happening inside the brain. Dementia isn't just about memory loss—it affects visual processing, spatial awareness, and sensory integration in ways that fundamentally change how a person interacts with their environment.
These neurological changes explain why traditional environments can become terrifying places for people with dementia. A patterned carpet might appear to be crawling with insects. A dark bathroom threshold might look like an impassable chasm. The hum of a refrigerator might drown out important conversation.
Neuroscience teaches us that the dementia-affected brain processes information differently, but philosophy asks the crucial follow-up question: How then should we design environments that work with this different way of experiencing the world?
The philosophical foundation of modern dementia design rests on two pillars: ethics and aesthetics. Ethics emphasizes justice, advocates for inclusive, person-centered practices, and challenges societal stigmas. Aesthetics, beyond mere beauty, focuses on sensory and emotional engagement, which becomes increasingly significant as dementia progresses 2 .
This represents a radical departure from the sterile, hospital-like environments of the past. Instead of asking "How do we prevent accidents?" the new approach asks "How do we create an environment that supports identity, connection, and meaning?"
This philosophical shift recognizes that good design for dementia isn't universal—it must respect cultural, personal, and individual differences in what feels familiar, comforting, and engaging.
Professor Perminder Sachdev, leader of the COSMIC international research consortium, emphasizes this need for tailored approaches: "If we want to reduce the future burden of dementia globally, we need to understand how risk factors play out in diverse settings. What works for high-income countries may not apply in low- and middle-income regions. We need solutions that fit local realities" 1 .
So what does this neuroscience-philosophy fusion look like in practice? Organizations like Dementia Australia have developed evidence-based principles that translate these concepts into tangible design features 4 .
These principles come to life in simple but profound ways. An ensuite bathroom might feature:
The COSMIC (Cohort Studies of Memory in an International Consortium) research collaboration has revealed a crucial insight: dementia risk factors don't affect all populations equally. By bringing together data from more than 60 cohort studies across 38 countries, COSMIC has identified important cultural and regional variations that must inform design approaches 1 .
| Region/Population | Key Risk Factor Patterns | Design Implications |
|---|---|---|
| Asian populations | Stronger effects of cardiovascular risk factors; social factors more protective | Environments supporting physical health; spaces facilitating family interaction |
| Western populations | Moderate cardiovascular risk impact; varying social protection | Balance between independence and community engagement |
| All populations | Education protective but impact varies; genetic factors differ | Need for culturally tailored cognitive engagement approaches |
These findings demonstrate why importing design solutions from one culture to another often fails. As Dr. Darren Lipnicki, CHeBA Research Fellow notes, "If we want to reduce the future burden of dementia globally, we need to understand how risk factors play out in diverse settings" 1 . A design that works in a Canadian suburb might be entirely inappropriate in urban Japan or rural India.
While physical environments are crucial, technological advances are opening new possibilities for supporting people with dementia. The most exciting developments focus on extending independence while maintaining connection.
At the 2025 Alzheimer's Association International Conference, researchers announced remarkable progress in home-based treatments and diagnostic tools 3 :
An injectable version of the Alzheimer's drug that can be administered at home, reducing the need for regular hospital visits. Clinical trials showed weekly injections proved just as effective as IV infusions at removing amyloid from the brain, with most people and carers able to use the auto-injector device successfully at home 3 .
These tests, which can detect Alzheimer's-related changes in the blood, have moved from research settings into the clinic. Researchers are now working to understand how these tests work in everyday practice across people with different ethnic backgrounds or health conditions 3 .
| Technology | Function | Stage of Development |
|---|---|---|
| Trontinemab | Uses 'brain shuttle' technology to cross brain's protective barrier more effectively | Early clinical trials showing rapid amyloid removal |
| Blood biomarker tests | Detects Alzheimer's-related changes through simple blood test | Moving to clinical implementation; goal of NHS use by 2029 |
| AI diagnostic tools | Analyzes speech patterns, movement to detect cognitive changes | Research and development phase |
The philosophical question with all these technologies is the same: How do we leverage innovation to support, rather than replace, human connection and dignity?
Creating environments for people with dementia requires both specific materials and an underlying approach. Here are the key components:
| Element | Function | Implementation Examples |
|---|---|---|
| Color Contrast | Helps distinguish objects and surfaces | Contrasting toilet seat, wall color different from doors |
| Clear Sight Lines | Reduces disorientation and supports wayfinding | Open sight lines to key areas, unobstructed pathways |
| Appropriate Lighting | Minimizes shadows and glare that cause confusion | Even, natural light where possible; careful artificial lighting |
| Familiar Objects | Supports memory and personal identity | Personal photographs, culturally relevant furnishings |
| Sensory Cues | Provides navigation assistance without institutional signs | Visual landmarks, distinctive scents, textured wayfinding |
| Safety Features | Prevents harm without restraint | Unobtrusive monitoring, graduated security measures |
Beyond these physical elements, the most important tool is the co-design process that actively involves people with dementia, their loved ones, and caregivers in creating environments 2 . This participatory approach ensures that spaces reflect the actual needs and preferences of those who will use them, rather than just the assumptions of designers.
The revolution in designing for dementia represents more than just technical innovation—it signals a profound shift in how we view cognitive decline and aging. By combining insights from neuroscience with philosophical principles of ethics and aesthetics, we're learning to create environments that honor personhood throughout life's entire journey.
The progress of COSMIC helping us understand diverse needs 1
Being implemented in care homes and private residences 4
Bringing treatment and diagnosis into the home 3
What unites these developments is a commitment to creating environments where people with dementia can continue to grow, connect, and find meaning.
As research continues, the future promises even more personalized approaches—environments that adapt to changing needs, technologies that support specific cognitive challenges, and communities that naturally integrate people across the cognitive spectrum. The goal is not just better facilities for people with dementia, but a world where design reflects the fundamental truth that human dignity exists independent of cognitive ability.
The kitchens, living rooms, and neighborhoods we create today will determine whether a dementia diagnosis means withdrawal from the world or continued participation in life's rich tapestry. The evidence from both neuroscience and philosophy suggests we're finally learning to build environments where people with dementia can still feel at home—in the fullest sense of the word.