SECAB’S

MALIK SANDAL INSTITUTE OF ART AND ARCHITECTURE

VIJAYAPURA - 586109

DEPARTMENT OF ARCHITECTURE
Thesis Synopsis On

THE DEMENTIA VILLAGE

( Dementia Care And Resource Facility )

BACHELOR OF ARCHITECTURE ( 2023 - 2024 )

Submitted By :- POOJA . N
2MB19AT006 VIII SEM

THESIS SEMINAR - 18ARC83

Under the guidance of

PROF. SARALA SIRASAGI

 CONTEXT
1. Preface……………………………………………………………………01

2. Abstract …………………………………………………………………..02

3. Overview, What Is Dementia ………………………………………..…03

4. Types Of Dementia …………………………………………………..…05

.
5. Aim, Objective …………………………………………………………..09

6. Methodology And Need For Study ………………………………...…10

7. Limitations And Constraints …………………………………….……..11

8. What Is Alzheimer’s Disease? ………………………………………..12

A. Symptoms Of Alzheimer’s

9. Dementia And Alzheimer’s Overview ………………………..….…....15

10. Symptoms, Signs And Causes Of Dementia ……………….……..…16

11. Dementia Treatment And Care ………………………………..…..….17

12. Dementia Stages …………………………………………………..…..24

13. Characteristics Of Dementia ……………………………………….....27

14. Global Scenario ……………………………………………………......28

15. Indian Scenario ………………………………………………...…...…33

16. Resources Necessary For Dementia Care ………………………….42

17. Types Of Dementia, Diagnosis And Treatment ……………………..46

18. Literature Case Studies (Internation, Indian)

1. Alzheimer’s Respite Centre, Dublin …………………………...53

2. The Hogeweyk - Dementia Village, Netherlands ……………..59
3. Jagruti Rehabilitation Centre, Pune …………………….……...64
4. Carpe Diem Dementia Village ……………………….……….....66
PREFACE :-

SHARING IDEAS WITH DON DE VLAMING

I Have Alzheimer’s Disease, And I’m Still Here. I Attend A Support Group At The Alzheimer
Society Of Manitoba For People With Dementia. We Share Ideas And Relate To Each Other
Beautifully By Talking About People’s Interests. When I Look Around The Room, It Doesn’t Seem
Like Anyone Has Dementia Because We Are All Just Friends Talking.

But Out In Society, Sometimes People Have Expectations That We Can’t Meet, And We Are Treated
Differently. They Don’t Realize That While We Live In The Same World, Our World Is Not Quite The
Same As Theirs, Even Though We Are Still The Same People Inside.

In Reality, In Our Group, We Have More Ability To Communicate Amongst Each Other Than Many
Families. The Reason Is That In Families, People Can Take Things For Granted. In Our Group, We
Can’t. We Have To Work On Things And We Have To Be Good Listeners. We Are All Still
Functioning – Maybe Not In The Same Way As The Rest Of Society, But We Are Enjoying The
Socialization.

The Biggest Killer For Us Is Loneliness. We Are All Friends In Our Support Group, But My Hope Is
That People Out There Will Include Us And Encourage Us. If You Find Topics We Are Informed
About, We’ll Talk About Them. If You Ask Us About Our Talents, We’ll Share Them. Just Like
Anyone Else, We Want To Be Included And Respected.

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ABSTRACT :-

We spend our lives making memories, going over them again and again till they have been
hardwired into our minds. they are the measure of our lives. what are we without the aid of our
memories? they help us to learn, to laugh and to remember. so imagine waking up one day to have
completely forgotten these events. imagine seeing the world through a foggy window that you cannot
quite rub away. imagine not being able to remember the people you love, the life you have lived up
to that point. if just the thought of it is scary enough, imagine living with a chronic and psychosomatic
condition like dementia.

Our minds automatically jump to our grandparents the minute we start thinking about the silver years
of our lives which are yet to come. the role of grandparents or the elderly has always been significant
in our lives especially here, in india where a lot of young adults prefer staying with their parents.
The role of grandparents is becoming more and more central to family life in the 21st century as the
world is marching forward with dual employment in houses, where the job of looking after the
children is generally taken up by grandparents as it takes off a lot of burden off of the parents
shoulders as they feel safe knowing that their child is looked after by their own parents rather than
unknown people at the children day care facilities. but what happens if your grandfather fails to
recognise you one day?
What if he suddenly becomes vociferous and aggressive? do you stop loving him? do you just
overlook it as a natural part of ageing? would you be comfortable enrolling them into a regular old
age home? will you be willing to take out time from your work or will either member of your family
sacrifice their jobs at the expense of reduced income which would, in turn, affect the care of the
concerned family member? dementia is a very sensitive issue- right from taking care of the person at
home to making a decision of enrolling the loved one into a special facility because that, in turn,
affects each and every person in the family knowing or unknowingly

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As far as members of the family are concerned, there is no greater disappointment than their
favourite elderly being unable to recognise them, especially when they might have connected and
related particularly well to them while growing up.

The world's population is ageing and with all the new medical revelations and breakthroughs, the life
expectancy has increased, resulting in a gradual increase in the overall population. however, this
increase in life expectancy coupled with the change in lifestyle has also resulted

In an increase in the number of people being diagnosed with dementia, especially alzheimer's. so
much so that dementia is emerging as a major public health crisis affecting each and every part of the
world.

Increased prevalence of diabetes, hypertension, and stroke due to changes in lifestyle has started
affecting people younger than 65 years of age resulting in an early onset of dementia making
dementia a growing concern which will affect each of us directly or indirectly at some point in our
lifetime.

Alzheimer's is an enemy that attacks from the shadows. it snatches every little bit of
everything that makes you, you. it scratches at a person's dignity till every last bit of it has
been chipped away. unfortunately, we as of now are not sufficiently prepared to tackle this
enemy

OVERVIEW :-
This chapter being the most crucial part of this book attempts to throw light on what is dementia ,
what is alzheimer’s disease and the difference between them through in-depth study and research.
the subtopics covered in this book are as follows:

WHAT IS DEMENTIA :-
Dementia is not a single disease; it’s an overall term — like heart disease — that covers a wide
range of specific medical conditions, including alzheimer’s disease. disorders grouped under the
general term “dementia” are caused by abnormal brain changes. these changes trigger a decline in
thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent
function. they also affect behavior, feelings and relationships.

Alzheimer's disease accounts for 60-80% of cases. vascular dementia, which occurs because of
microscopic bleeding and blood vessel blockage in the brain, is the second most common cause of
dementia. those who experience the brain changes of multiple types of dementia simultaneously
have mixed dementia. there are many other conditions that can cause symptoms of dementia,
including some that are reversible, such as thyroid problems and vitamin deficiencies.
Ddementia is often incorrectly referred to as "senility" or "senile dementia," which reflects the
formerly widespread but incorrect belief that serious mental decline is a normal part of aging.

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4
 TYPES OF DEMENTIA

Dementia is a general term for loss of memory and other mental abilities severe enough to
interfere with daily life. it is caused by physical changes in the brain. alzheimer's is the most
common type of dementia, but there are many kinds.

1. CREUTZFELDT-JAKOB DISEASE :-

Creutzfeldt-jakob disease (cjd) is the most common human form of a group of rare, fatal brain
disorders known as prion diseases.

Prion diseases, such as creutzfeldt-jakob disease, occur when prion protein, which is found
throughout the body but whose normal function isn't yet known, begins folding into an abnormal
three-dimensional shape. this shape change gradually triggers prion protein in the brain to fold into
the same abnormal shape.

Creutzfeldt-jakob disease causes a type of dementia that gets worse unusually fast. more common
causes of dementia, such as alzheimer's, dementia with lewy bodies and frontotemporal dementia,
typically progress more slowly.

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2. DEMENTIA WITH LEWY BODIES :-

Dementia with lewy bodies (dlb) is a type of progressive dementia that leads to a decline in
thinking, reasoning and independent function. its features may include spontaneous changes in
attention and alertness, recurrent visual hallucinations, rem sleep behavior disorder, and slow
movement, tremors or rigidity.

3. DOWN SYNDROME AND ALZHEIMER'S DISEASE :-

As they age, those affected by down syndrome have a greatly increased risk of developing a type
of dementia that's either the same as or very similar to alzheimer's disease.

Down syndrome — also known as trisomy 21 — is a condition in which a person is born with
extra genetic material from chromosome 21, one of the 23 human chromosomes. all human
chromosomes usually occur in pairs, with one copy inherited from a person’s mother and one
from the father. most people with down syndrome have a full extra copy of chromosome 21, and
so they have three copies instead of the usual two. scientists think the extra copy results from a
random error in the specialized cell division that produces eggs and sperm.

Advances in function, well-being and life span for people with down syndrome have revealed
an additional health risk: as they age, individuals affected by down syndrome have a greatly
increased risk of developing a type of dementia that’s either the same as or very similar to
alzheimer’s disease.

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4. FRONTOTEMPORAL DEMENTIA :-

Frontotemporal dementia (ftd) or frontotemporal degeneration refers to a group of disorders caused

by progressive nerve cell loss in the brain's frontal lobes (the areas behind your forehead) or its
temporal lobes (the regions behind your ears).

The nerve cell damage caused by frontotemporal dementia leads to loss of function in these brain
regions, which variably cause deterioration in behavior, personality and/or difficulty with producing or
comprehending language.

There are a number of different diseases that cause frontotemporal degeneration. the two most
prominent are :-
1) a group of brain disorders involving the protein tau
2) a group of brain disorders involving the protein called tdp4

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5. HUNTINGTON'S DISEASE :-

Huntington's disease (hd) is a progressive brain disorder caused by a defective gene. this disease
causes changes in the central area of the brain, which affect movement, mood and thinking skills.

Huntington's disease is a progressive brain disorder caused by a single defective gene on

chromosome 4 — one of the 23 human chromosomes that carry a person’s entire genetic code.

This defect is "dominant," meaning that anyone who inherits it from a parent with huntington's will
eventually develop the disease. the disorder is named for george huntington, m.d., the physician who
first described it in the late 1800s.

The defective gene codes the blueprint for a protein called huntingtin. this protein's normal function
isn't yet known, but it's called "huntingtin" because scientists identified its defective form as the
cause of huntington's disease. defective huntingtin protein leads to brain changes that cause
abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability,
depression and other mood changes.

6. MIXED DEMENTIA :-

Mixed dementia is a condition in which brain changes of more than one cause of dementia occur
simultaneously.
In the most common form of mixed dementia, the abnormal protein deposits associated with
alzheimer's disease coexist with blood vessel problems linked to vascular dementia. alzheimer's
brain changes also often coexist with lewy bodies. in some cases, a person may have brain changes
linked to all three conditions — alzheimer's disease, vascular dementia and dementia with lewy
bodies.

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AIM :-

The aim of this project is to design a special care facility for people living with dementia and other
disorders under its umbrella. the facility will serve as an example for future designs elsewhere in
india. it will provide flexible, part-time care apart from residential care, creating a different kind of
marriage between the staff, patients and their family members. it will also have a facility that caters
to the training of the nurses and the caregivers. it will be a one of a kind facility which will help
spread awareness. in its execution, the facility will be breaking away from others in its typology and
will attempt to be true to its intent

Even though a building doesn't have the ability to cure dementia, it can improve the quality of life of
the users.

OBJECTIVES :-

● The thesis will look into how and why a special care facility for people suffering from
dementia is the need of the hour. it will thoroughly examine the existing facilities to see what
they lack. eventually, the main objective is

● To spread awareness about the disease and to provide a state of the art facility which

● Would serve as an example for future designs the aim is to make the life of the patient easier
and better using architectural design

● And its elements as catalysts. studying about various factors like colour schemes, materials,
etc. and then implementing the same in the design programme is also be a part of the
objective,

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METHODOLOGY OF STUDY :-

The research methodology will comprise of a profound study of the signs, causes and
characteristics of dementia. it will also help understanding of how dementia affects the person
and in turn the family members and the caregiver, by having a dialogue with dementia -afflicted
families. thereafter, it will include an intensive study of the existing indian scenario. the research
will also look into the workings of the existing facilities and study them on the basis of three major
criteria's -contextual analysis, programmatic analysis, and formal analysis. the contextual
analysis will be done on a macro scale which will include the urban study, for example the
connectivity to the main city and accessibility, the number of hospitals in the vicinity. the
programmatic analysis will be carried out on a micro scale which will include the programme of
the facilities and the zoning. the formal analysis will include the physical study which will look into
the spatial context and design philosophy as well as study of different materials

NEED FOR STUDY :-

● In india, there are more than 4 million people having some form of dementia today and
worldwide, at least 44 million people are living with dementia (alzheimer's association,
2016). despite the magnitude, there is gross ignorance, stigma and lack of awareness in
india which are the main reasons for a very low diagnosis.

● The increasing burden of care on family, direct or indirect, caring for a person with
alzheimer's or dementia can be a challenging task and the quality of life not only of the
person living with dementia but also of the caregiver is affected. people are following the
trend of nuclear families nowadays from the west. but nuclear family set ups with
diminishing family support affects care and caregiving also, most of the young adults in the
family migrate overseas for better job opportunities and other members of the family spend
more time at workplaces rather than homes which affect the care of elderly people.

● In india, the current capacity of care centres and support organisations fall pathetically short
when compared to the dire need. lack of such special care facilities forces people to enrol
patients with dementia in old age homes which are not specialised in the field of dementia
but also due to the negative image carried by the nursing homes, families are often hesitant
to put elderly family members in a home; however, they themselves are also ill-equipped to
provide for the necessary type of care.

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 ● Most care centres do not reflect on the fact that they are the final home of residents while still
providing the necessary medical requirements.

● Most of the existing facilities are merely rented bungalows or floors in a building that are run
by private ngo's. but in spite of the valiant efforts being made by these organisations they lack
architectural interventions that can benefit the health of the patients. the ageing population is
changing and it is time we think about the architecture for them.

● "Nowadays the old age homes do not admit patients with dementia and on the other hand
there are no special facilities that are up to the mark in our country", said mrs vidya shenoy,
secretary general of ardsi

SITE SELECTION :-

In-depth research about dementia and its repercussions lead to a conclusion that the ideal site for
the facility would be on the outskirts of the city for the day care centre to function well and also the
people with dementia are sensitive to their surroundings and need a quiet and a serene
environment.

The criteria for the site would depend on accessibility, public, transport facility, green cover, noise
buffer and existence of a hospital in the locality.

LIMITATIONS AND CONSTRAINTS :-

The existing facilities in india lack the necessary infrastructure and design ideologies hence, i will
have to rely on the secondary sources of data for the designing of the facility. due to the sensitive
nature of the topic, most of the facilities refuse to grant permission to conduct case studies and
click photographs which would have greatly added to my efforts.

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 WHAT IS ALZHEIMER’S DISEASE?

Alzheimer's is a type of dementia that affects memory, thinking and behavior. symptoms eventually
grow severe enough to interfere with daily tasks.

Alzheimer's is the most common cause of dementia, a general term for memory loss and other
cognitive abilities serious enough to interfere with daily life. alzheimer's disease accounts for 60-80%
of dementia cases.

Alzheimer's is not a normal part of aging. the greatest known risk factor is increasing age, and the
majority of people with alzheimer's are 65 and older. alzheimer’s disease is considered to be
younger-onset alzheimer’s if it affects a person under 65. younger-onset can also be referred to as
early-onset alzheimer’s. people with younger-onset alzheimer’s can be in the early, middle or late
stage of the disease.

Alzheimer's worsens over time. alzheimer's is a progressive disease, where dementia symptoms
gradually worsen over a number of years. in its early stages, memory loss is mild, but with late-stage
alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment.
on average, a person with alzheimer's lives 4 to 8 years after diagnosis but can live as long as 20
years, depending on other factors.

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Alzheimer's has no cure, but two treatments — aducanumab (aduhelm™) and lecanemab (leqembi™)
— demonstrate that removing beta-amyloid, one of the hallmarks of alzheimer’s disease, from the
brain reduces cognitive and functional decline in people living with early alzheimer’s. other treatments
can temporarily slow the worsening of dementia symptoms and improve quality of life for those with
alzheimer's and their caregivers. today, there is a worldwide effort underway to find better ways to treat
the disease, delay its onset and prevent it from developing.

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SYMPTOMS OF ALZHEIMER'S :-
The most common early symptom of alzheimer's is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age. most of us eventually notice some
slowed thinking and occasional problems with remembering certain things. however, serious memory
loss, confusion and other major changes in the way our minds work may be a sign that brain cells are
failing.

Alzheimer's changes typically begin in the part of the brain that affects learning. as alzheimer's
advances through the brain it leads to increasingly severe symptoms, including disorientation, mood
and behavior changes; deepening confusion about events, time and place; unfounded suspicions
about family, friends and professional caregivers; more serious memory loss and behavior changes;
and difficulty speaking, swallowing and walking.

DEMENTIA VS. ALZHEIMER’S DISEASE: WHAT IS

THE DIFFERENCE?

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life,
while alzheimer's is a specific disease. alzheimer’s is the most common cause of dementia.

Learning about the two terms and the difference between them is important and can empower
individuals living with alzheimer’s or another dementia, their families and their caregivers with
necessary knowledge.

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DEMENTIA OVERVIEW :-
Dementia describes a group of symptoms associated with a decline in memory, reasoning or other
thinking skills. many different types of dementia exist, and many conditions cause it. mixed dementia
is a condition in which brain changes of more than one type of dementia occur simultaneously.
alzheimer's disease is the most common cause of dementia, accounting for 60-80% of dementia
cases.

Dementia is not a normal part of aging. it is caused by damage to brain cells that affects their ability
to communicate, which can affect thinking, behavior and feelings.

ALZHEIMER’S OVERVIEW :-
Alzheimer’s is a degenerative brain disease that is caused by complex brain changes following cell
damage. it leads to dementia symptoms that gradually worsen over time. the most common early
symptom of alzheimer’s is trouble remembering new information because the disease typically
impacts the part of the brain associated with learning first.

As alzheimer’s advances, symptoms get more severe and include disorientation, confusion and
behavior changes. eventually, speaking, swallowing and walking become difficult.

Though the greatest known risk factor for alzheimer’s is increasing age, the disease is not a normal
part of aging. and though most people with alzheimer’s are 65 and older, approximately 200,000
americans under 65 are living with younger-onset alzheimer’s disease.

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SYMPTOMS AND SIGNS OF DEMENTIA :-
Signs of dementia can vary greatly. examples include problems with:

● short-term memory.
● keeping track of a purse or wallet.
● paying bills.
● planning and preparing meals.
● remembering appointments.
● traveling out of the neighborhood.

Many conditions are progressive, which means that the signs of dementia start out slowly and
gradually get worse. if you or someone you know is experiencing memory difficulties or other
changes in thinking skills. and even if symptoms suggest dementia, early diagnosis allows a person
to get the maximum benefit from available treatments and provides an opportunity to volunteer for
clinical trials or studies. it also provides time to plan for the future.

CAUSES :-
Dementia is caused by damage to brain cells. this damage interferes with the ability of brain cells to
communicate with each other. when brain cells cannot communicate normally, thinking, behavior and
feelings can be affected.

The brain has many distinct regions, each of which is responsible for different functions (for example,
memory, judgment and movement). when cells in a particular region are damaged, that region cannot
carry out its functions normally.

Different types of dementia are associated with particular types of brain cell damage in particular
regions of the brain. for example, in alzheimer's disease, high levels of certain proteins inside and
outside brain cells make it hard for brain cells to stay healthy and to communicate with each other.
the brain region called the hippocampus is the center of learning and memory in the brain, and the
brain cells in this region are often the first to be damaged. that's why memory loss is often one of the
earliest symptoms of alzheimer's.
while most changes in the brain that cause dementia are permanent and worsen over time, thinking
and memory problems caused by the following conditions may improve when the condition is treated
or addressed:

● depression.
● medication side effects.
● excess use of alcohol.
● thyroid problems.
● vitamin deficiencies.

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DEMENTIA TREATMENT AND CARE :-
Treatment of dementia depends on its cause. in the case of most progressive dementias, including
alzheimer's disease, there is no cure, but two treatments — aducanumab (aduhelm™) and lecanemab
(leqembi™) — demonstrate that removing beta-amyloid, one of the hallmarks of alzheimer’s disease,
from the brain reduces cognitive and functional decline in people living with early alzheimer’s. others
can temporarily slow the worsening of dementia symptoms and improve quality of life for those living
with alzheimer's and their caregivers. the same medications used to treat alzheimer's are among the
drugs sometimes prescribed to help with symptoms of other types of dementias. non-drug therapies
can also alleviate some symptoms of dementia.

Ultimately, the path to effective new treatments for dementia is through increased research funding
and increased participation in clinical studies. right now, volunteers are urgently needed to participate
in clinical studies and trials about alzheimer's and other dementias.

DEMENTIA RISK AND PREVENTION :-

Some risk factors for dementia, such as age and genetics, cannot be changed. but researchers
continue to explore the impact of other risk factors on brain health and prevention of dementia.

Research reported at the 2019 alzheimer’s association international conference® suggests that
adopting multiple healthy lifestyle choices, including healthy diet, not smoking, regular exercise and
cognitive stimulation, may decrease the risk of cognitive decline and dementia.

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IS DEMENTIA A REPERCUSSION OF OLD AGE?

Mrs Vidya Shenoy the general secretary of alzheimer's and related disorders society of india (ardsi)
confirms that this is a question that is most commonly asked to doctors and ngo activists. though
this condition accounts for striking as early as thirty, only a small fraction of the population bends to
its will before the mid- sixties. thus, we observe that a major chunk of the population over sixty
years of age is diagnosed with dementia-related disorders. scientists and doctors have been able
to prove that dementia is not a normal part of ageing but is a severe condition of the brain. recent
studies show that increased prevalence of diabetes, hypertension and stroke due to change in
lifestyle has started affecting people younger than 65 years of age resulting in an early onset of
dementia.

"PEOPLE THINK IT'S AN OLD-AGE PERSON'S DISEASE. IT'S LIKE CANCER WAS 25 YEARS
AGO: YOU DIDN'T MENTION THE C WORD. CANCER ACTIVISTS HAVE DONE AN
EXCELLENT JOB OF DE-STIGMATIZING IT, PUTTING IT OUT THERE, AND MAKING A
DISORDER THAT NEEDS ATTENTION. ALZHEIMER'S IS STILL BEHIND THE EIGHT BALL
ON THAT SCORE"- DR RONALD PETERSON- DIRECTOR OF MAYO CLINIC ALZHEIMER'S
DISEASE RESEARCH CENTRE.

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OTHER CAUSES OF DEMENTIA :-

Even though the percentage of chances of getting dementia is less, there are other diseases,
disorders and habits that may result in dementia. such cases are specially observed amongst the
category of the people falling below the age group of 65. these causes include:

● If a person has been in a coma for more than 24 hours, he/she may develop a possibility to
get dementia.
● Alcohol-related brain damage can lead to dementia
● Smoking cigarettes and tobacco
● Corticobasal degeneration,
● Progressive supranuclear palsy.
● HIV infections pose the danger of getting dementia
● Nowadays a lot of people are being diagnosed with yod ( young onset dementia ) because
of stress, blood pressure and diabetes issues and also the changing lifestyle and the way of
living

MILD COGNITIVE IMPAIRMENT (MCI) :-

mild cognitive impairment (mci) is an early stage of memory loss or other cognitive ability loss
(such as language or visual/spatial perception) in individuals who maintain the ability to
independently perform most activities of daily living.

mild cognitive impairment causes cognitive changes that are serious enough to be noticed by
the person affected and by family members and friends but do not affect the individual’s ability
to carry out everyday activities.

mci can develop for multiple reasons, and individuals living with mci may go on to develop
dementia; others will not. for neurodegenerative diseases, mci can be an early stage of the
disease continuum including for alzheimer's if the hallmark changes in the brain are present.

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RISK FACTORS CAUSING DEMENTIA :-

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YOUNG - ONSET DEMENTIA :-

Dementia is described as ‘young onset’ when symptoms develop before the age of 65, usually
between 30 to 65 years of age. it is also referred to as ‘early onset’ or ‘working age’ dementia, but
these terms can cause confusion. ‘early onset’ can be interpreted as the early stages of dementia and
‘working age’ is now less defined as retirement age is more flexible.

As dementia is frequently, and wrongly, thought of as a condition that is just associated with old age,
the early symptoms of young onset dementia are not always recognised and may be attributed to
other causes including depression, stress, menopause, physical health problems and relationship
issues. this can lead to a significant delay (on average four years) in getting an accurate diagnosis
and access to appropriate support. this can have a negative impact on not just the person with
dementia’s life but also the whole family.

LATE-ONSET DEMENTIA :-

Dementia in almost all cases is diagnosed in elderly people ageing from 65 onwards. in 2005,
alzheimer's disease international (adi) commissioned a panel of experts to review all available
epidemiological data and reach a consensus estimate of prevalence in each of 14 world regions. the
panel estimated 24.3 million people aged 60 years and over with dementia in 2001, 60% living in
lmic. each year, 4.6 million new cases were predicted, with numbers affected nearly doubling every
20 years to reach 81.1 million.

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WHAT ARE THE DIFFERENT STAGES OF DEMENTIA :-

Dementia is a general term for a decline in cognitive function that affects memory, problem-solving
skills, language, and functions that affect daily living. specific types of dementias — including
alzheimer’s disease and vascular, lewy body, and frontotemporal dementia — advance at unique
rates and differ from person to person.

The seven stages are separated into three progressive phases of dementia:

● Pre-dementia or early-stage dementia. in this initial phase, a person can still live
independently and may not exhibit obvious memory loss or have any difficulty completing
regular tasks. mild dementia symptoms mimic episodes of age-related forgetfulness.
● Moderate or middle-stage dementia. moderate dementia symptoms significantly affect a
person’s personality and behavior. someone with middle-stage dementia will generally
need full- or part-time caregiver assistance with regular day-to-day activities. other
moderate-stage dementia symptoms include significant cognitive impairment and mood
swings.
● Severe or late-stage dementia. the final phase is associated with severe cognitive
impairment along with a loss of physical abilities. late-onset dementia symptoms are
pronounced memory loss, incontinence, and an inability to move without help.

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23
DEMENTIA STAGE :-

1: No cognitive impairment :- Though it may sound odd, stage 1 dementia often looks like normal
mental functioning without any cognitive decline. someone in the first three dementia stages doesn’t usually exhibit
enough symptoms to be diagnosed. however, it’s important to note that changes in the brain are still taking place.
while some cognitive impairment may be present, stages 1, 2, and 3 on the gds are recognized as pre-dementia
stages.

2: Very mild cognitive decline :- Stage 2 dementia includes simple memory mistakes like a loved one
wondering “where did i put my keys?” or, “what was that person’s name?” a significant amount of the senior population
experiences age-related forgetfulness, and caregivers or medical providers may not even notice such mild
impairment. this explains why stage 2 is also known as “age-associated memory impairment” on the gds.

Stage 2 dementia Symptoms: :--

● Losing track of familiar objects

● Inability to recall names of friends, family members, and former acquaintances

3: MILD COGNITIVE DECLINE (ALSO CALLED MILD COGNITIVE IMPAIRMENT) :-

When memory and cognitive problems become more regular, as well as noticeable to caregivers
and family members, a person is said to be suffering from mild cognitive decline, which is also
known as mild cognitive impairment (mci). stage 3 dementia doesn’t generally have a major
impact on day-to-day functioning.

How quickly does this dementia stage progress in the elderly? an estimated 10 to 20 percent of
people age 65 or older with mci will develop recognizable or diagnosable dementia within a year,
according to the national institute on aging.[03] since mci often precedes more severe dementia
stages, it’s important to recognize the signs of this stage and seek medical advice.

Stage 3 Dementia Symptoms: :-

● Forgetting to go to appointments or events

● Losing things and minor memory loss
● Getting lost while traveling
● Decreased work performance
● Difficulty finding the right words
● Verbal repetition
● Challenges with organization and concentration
● Trouble with complex tasks and problem-solving
● Problems with driving

24
4: Moderate cognitive decline :- stage 4 dementia is when a person has clear, visible signs of
cognitive impairment and exhibits personality changes — both of which are significant dementia
symptoms. a person is not typically diagnosed with dementia until they’re at stage 4 or beyond. while
the medical terminology for stage 4 dementia is moderate cognitive decline, this stage is officially
diagnosed by the gds as mild dementia.

At this stage, doctors and caregivers will likely observe hallmark signs that dementia is getting worse,
including difficulties with language and reduced problem-solving skills.

stage 4 dementia symptoms:

● social withdrawal
● emotional moodiness
● lack of responsiveness
● reduced intellectual sharpness
● trouble with routine tasks
● forgetting recent events
● denial of symptoms

5: Moderately severe cognitive decline :- This stage marks the onset of what many
professionals refer to as “mid-stage” in the seven stages of dementia. at this point, a person may
no longer be able to carry out normal activities of daily living (adls), such as dressing or bathing,
or instrumental activities of daily living (iadls) without some caregiver assistance. middle-stage
dementia often lasts between two and four years,[04] though every dementia patient will progress
at a unique rate.

In stage 5 dementia, your loved one will likely require more intense support and supervision.
they know major facts about themselves — such as their name and their children’s names — but
they may not remember grandchildren’s names, their longtime address, or where they went to
high school.

Stage 5 dementia symptoms:

● Pronounced memory loss, including personal details and current events

● Wandering
● Confusion and forgetfulness
● Disorientation and sundown syndrome
● Further reduced mental acuity and problem-solving ability

25
6: severe cognitive decline :- Stage 6 dementia marks a need for caregiver help to
perform basic daily activities, such as eating, using the toilet, and other self-care. seniors
experiencing this stage of moderately severe dementia may have difficulty regulating sleep,
interacting with others, or behaving appropriately in public settings.

At stage 6 of dementia, you may find yourself wondering if full-time care is necessary as
symptoms become more complex. you can stay prepared by tracking symptoms, monitoring
your loved one’s ability to perform adls and iadls, and exploring care options like memory care
or home care.

Stage 6 dementia symptoms:

● Sleep difficulties
● Urinary or fecal incontinence
● Aggression and anxiety
● Personality changes including paranoia or delusions
● Inability to perform adls
● Pronounced memory loss
● Inability to recognize loved ones and caregivers

7: Very severe cognitive decline :- Which is considered late-stage dementia, people can
no longer care for themselves. generally, for patients with severe dementia, all verbal ability is lost
and movement becomes severely impaired. symptoms of late-onset dementia disrupt bodily
functions like the ability to chew, swallow, and breathe.

stage 7 dementia symptoms:

● Inability to speak
● Lack of physical coordination and the inability to move without help
● Impaired bodily functions

26
CHARACTERISTICS OF DEMENTIA :-

Dementia symptoms vary depending on the cause, but common characteristics includes :-

● They have poor short term memory which makes it difficult for them to
remember familiar faces

● They have difficulty in remembering phone numbers and addresses

Cognitive Effects
● They easily get confused and overwhelmed

● It becomes difficult for them to register new information and even if

they do, they forget very quickly.

● They have difficulty in completing the everyday tasks like brushing

their teeth, combing their hair and may need assistance

Functional Effects ● Get confused in they skip a step in their daily routine and may get
irritated

● May have a problem to express their emotions, wants and needs

● Become sensitive to loud noises

Behavioural ● They may show repetitive behaviour

Effects
● They could become physically aggressive

● They may seem disinterested in activities and chores

● They may show signs of aggressiveness

Psychological ● They may get severe mood swings

Effects
● They might go into depression or anxiety if they are not taken care
of properly or if no one keeps a tab on their medicines.

● They may feel neglected if proper care is not taken as their

emotional levels are high.

27
GLOBAL SCENARIO :-

KEY FACTS

● Currently more than 55 million people have dementia worldwide, over 60% of who live in
low-and middle-income countries. every year, there are nearly 10 million new cases.
● Dementia results from a variety of diseases and injuries that affect the brain. alzheimer
disease is the most common form of dementia and may contribute to 60–70% of cases.
● Dementia is currently the seventh leading cause of death and one of the major causes of
disability and dependency among older people globally.
● In 2019, dementia cost economies globally 1.3 trillion us dollars, approximately 50% of
these costs are attributable to care provided by informal carers (e.g. family members and
close friends), who provide on average 5 hours of care and supervision per day.
● Women are disproportionately affected by dementia, both directly and indirectly. women
experience higher disability-adjusted life years and mortality due to dementia, but also
provide 70% of care hours for people living with dementia.

ESTIMATION OF NUMBERS OF PEOPLE WITH DEMENTIA AROUND THE WORLD :-

SUMMARY

There are over 50 million people worldwide living with dementia in 2020. this number will almost
double every 20 years, reaching 82 million in 2030 and 152 million in 2050. much of the increase
will be in developing countries. already 60% of people with dementia live in low and middle income
countries, but by 2050 this will rise to 71%. these figures are estimates based on the best currently
available evidence.

28
The 2015 Estimates

The world alzheimer report 2015, ‘the global impact of dementia: an analysis of prevalence,
incidence, cost and trends’, presented adi’s global dementia data. by carrying out a full update of
previous systematic reviews, the report made key recommendations to provide a global framework
for action on dementia.

The report also included a systematic review of the evidence for and against recent trends in the
prevalence and incidence of dementia over time, as well as an analysis of the broader societal
impact of dementia.

The noticeable increase in the projected numbers of people living with dementia worldwide
from the 2015 estimates to these 2017 estimates is mainly due to the revised un population
estimates (2015 un estimates instead of the 2013 un estimates used in the world alzheimer
report 2015) and new evidence which impacted on the strategies used to estimate numbers for
some of the global burden of disease (gbd) regions, rather than secular trends in the prevalence
of dementia.

29
ESTIMATION OF NUMBERS OF PEOPLE WITH DEMENTIA BY REGION :-

30
NUMBER OF INDIVIDUALS WITH DEMENTIA WORLDWIDE IN 2019 AND
FORECAST FOR 2030 AND 2050 :- (IN MILLIONS)

In 2019, there were around 55 million people who had dementia worldwide. by 2050, the number of
individuals with dementia is expected to increase to some 139 million people globally. this statistic
illustrates the number of individuals with dementia worldwide in 2019 and forecast for 2030 and
2050.

31
According to the who report on dementia, 2012; america has the maximum number 4.4 million
people living with dementia. the nine countries with the largest number of people with dementia in
2010 (1 million or more) were china (5.4 million), usa (3.9 million), india (3.7 million), japan (2.5
million), germany (1.5million), russia (1.2 million), france (1.1 million) italy (1.1 million) and brazil
(1.0 million). (dementia: a public health priority)

The total number of people with dementia worldwide is projected to almost double every 20 years,
to 65.7 million in 2030 and 115.4 million in 2050. much of the increase is attributable to increases
in the numbers of people with dementia in lmic in 2010, 57.7% of all people with dementia lived in
lmic, and this proportion is expected to rise to 63.4% in 2030 and 70.5% in 2050. (dementia: a
public health priority)

These projections were taken into account by population growth and demographic ageing. world
regions fall into three broad groups. high-income countries start from a high base but will
experience only a moderate proportionate increase a 40% increase in europe, 63% in north
america, 77% in the southern latin american cone and 89% in the developed asia pacific
countries. other parts of latin america and north africa and the middle east start from a low base
but will experience a particularly rapid increase - 134-146% in the rest of latin america, and 125%
in north africa and the middle east. china, india and their neighbours in south asia and western
pacific start from a high base and will also experience rapid growth - 107% in south asia and 117%
in east asia. projected increases in sub-saharan africa (70-94%) are modest. (dementia: a public
health priority)

32
INDIAN SCENARIO :-

ACCORDING TO WORLD ALZHEIMERS REPORT RELEASED BY THE ALZHEIMERS DISEASE

INTERNATIONAL (ADI), TEN COUNTRIES WERE HOME TO OVER A MILLION PEOPLE WITH
DEMENTIA IN 2015 INCLUDING CHINA (9.5 MILLION), THE US (4.2 MILLION), INDIA (4.1
MILLION), JAPAN (3.1 MILLION), AMONG OTHER COUNTRIES.

"THE SCENARIO IN INDIA IS MORE OR LESS SIMILAR TO THE ONE IN THE WEST. WHILE
OLD PEOPLE ARE MORE VULNERABLE TO BE AFFECTED BY ALZHEIMERS, IN SOME
CASES GENETIC FACTOR ALSO PLAYS A ROLE," PRESIDENT OF INDIAN PSYCHIATRIC
SOCIETY DR G PRASAD RAO SAID.

New delhi, sep 21 (pti) elderly people, especially those aged above 70, are more at risk of being
affected by alzheimers disease, an irreversible brain disorder that slowly destroys memory and
eventually impairs the ability to carry out even the smallest tasks, say experts.

33
DELHI-BASED SENIOR CONSULTANT PSYCHIATRIST AT COSMOS INSTITUTE OF MENTAL
HEALTH AND BEHAVIOURAL SCIENCES, DR SUNIL MITTAL, SAYS "WORLD OVER, 44
MILLION PEOPLE ARE LIVING WITH DEMENTIA OF SOME FORM, WITH OVER 4 MILLION
INDIANS CONTRIBUTING TO THIS FIGURE, MAKING DEMENTIA A GLOBAL HEALTH CRISIS."

PTI / SEP 21, 2016 07:05 PM IST

NUMBER OF PERSONS WITH DEMENTIA IN INDIA :-

In the last 10 years, the evidence on dementia prevalence in india has increased considerably. more
than 42,000 older people have been studied by eight centres in 5 urban and 4 rural sites across the
country, and there are wide variations in estimates. prevalence of dementia using survey diagnosis
or clinical diagnosis of dsm iv or icd 10 reported from indian studies amongst the elderly range from
0.6% to 10.6% in rural areas and 0.9% to 7.5% in urban areas

The number of people living with dementia in the year 2010 was 3.7 million as stated in the india
report on dementia by ardsi. this number has shot to 4.1 million people living with dementia in india
in the year 2016 as confirmed by mrs vidya shenoy, secretary general of ardsi. in just a mere time
span of six years, there has been an increment of 0.4 million people. it is, therefore, time to take
dementia seriously and the government ought to declare it as a national priority.

PREVALENCE OF DEMENTIA IN INDIA 2010

ACCORDING TO AGE AND GENDER

34
The survey in the year 2010 showed that out of 3.7 million people affected by dementia, 2.1 million
were women and about 1.5 million were male.
This led to a conclusion that, since the prevalence of dementia seem to be more among women,
dementia could be gender related.
The fact that women in india, live longer than the men due to scientific reasons was taken into
consideration. however studies of the age - specific incidence of dementia among older people
show no significant difference for men and women.

PREVALENCE OF DEMENTIA BY AGE OVER TIME :-

Mostly, the people who develop dementia at the age of 60 years to 75 years show a steady decline
in their state of mind. the people suffering from dementia in the age group of 75 and up, show a
rapid decline in their health as they have already accelerated to the 2nd or the 3rd stage of the
disorder.

35
FUTURE PROJECTIONS OF DEMENTIA :-

In the ardsi dementia report 2010, the future projections were estimated on the assumption that
prevalence of dementia would be stable over time, which may not be true. it had been kept in
mind that.
For example, in india the number of people with ad and other dementias is increasing every year
because of the steady growth in the older population and stable increment in life expectancy.

Mumbai, maharashtra, india: alkem foundation and the mumbai chapter of alzheimer's &
related disorders society of india (ardsi) organized an alzheimer’s awareness campaign on 25th
september, 2022 at the mumbai university campus, kalina. the event saw more than 500 people
participate, including citizens from all strata of society, medical practitioners, caregivers,
corporate people, and non-governmental organizations.

According to the global burden of disease study (lancet public health), 3.84 million individuals
suffered from dementia in 2019, a figure expected to reach 11.44 million by 2050. this disease,
alzheimer’s, gradually decreases the ability to remember and think clearly, escalating to a point
where it affects an individual’s daily lifestyle and well-being.

36
 STATE - WISE ESTIMATES OF NUMBER OF PWD IN INDIA :-

In the ardsi dementia report for 2010, state-wise estimates were made using meta- analyzed
prevalence estimation for india the projected number of people aged 65 and older with dementia
for years 2011, 2016 and 2026 varied by state and region in india and corresponding variability in a
number of people with dementia was also observed. the percentage change in dementia between
the base year 2006 and each of the subsequent time periods was then calculated.

Projected changes between 2006 and 2026 in number of people living with dementia by state

37
By 2026, more than 500,000 older pwd are expected to be living in uttar pradesh end maharashtra.
in other states, rajasthan, gujarat, bihar, west bengal, madhya pradesh, orissa, andhra pradesh,
karnataka, kerala and tamil nadu around 20,000 to 40,000 pwd are expected within the next 26
years compared to 2006, delhi, bihar and jharkhand are expected to experience 200% (or greater)
increment in a total number of dementia cases over the 26 year period. other states (jammu and
kashmir, uttar pradesh, rajasthan, madhya pradesh, west bengal, assam, chhattisgarh, gujarat,
andhra pradesh, haryana, uttaranchal maharashtra, karnataka and tamil nadu) are estimated to
experience 100% (or more) change in a number of people older pwd

PROJECTED NUMBER OF PEOPLE WITH DEMENTIA IN EACH STATE OF INDIA

IN COMPARISON TO THE YEAR OF 2006.

38
PROJECTED NUMBER OF PEOPLE WITH DEMENTIA IN EACH STATE OF
INDIA IN COMPARISON TO THE YEAR OF 2006.

39
The above studies clearly show that there is a severe need for infrastructure in the coming period as
the number of persons living with dementia is going to keep on increasing as the time goes by.

DEMENTIA CARE CENTERS OR FACILITIES ARE NEEDED IN INDIA FOR SEVERAL

REASONS:-
1. Increasing prevalence: the prevalence of dementia in india is increasing due to factors such
as an aging population and changes in lifestyle. as more people are diagnosed with dementia,
there is a growing need for specialized care facilities that can provide appropriate support and
services.

2. Specialized care: dementia care centers are equipped with trained staff who have expertise
in managing the unique needs and challenges of individuals with dementia. these centers can
provide a safe and supportive environment where individuals with dementia can receive
specialized care, including assistance with daily activities, memory support, and behavioral
management.

3. Caregiver support: dementia places a significant burden on family caregivers who often
struggle to provide round-the-clock care and support at home. dementia care centers can
provide respite for caregivers, giving them the opportunity to take a break, attend to their own
needs, or seek additional support services while ensuring their loved one receives
professional care.

40
4. Safety and security: individuals with dementia may experience memory loss, confusion, and
wandering tendencies, which can put their safety at risk. dementia care centers have secure
environments with measures in place to prevent wandering, ensure safety, and reduce the risk of
accidents or injuries.

5. Social engagement and stimulation: dementia care centers offer opportunities for socialization,
cognitive stimulation, and engagement in meaningful activities. these activities can help slow down
cognitive decline, improve quality of life, and promote overall well-being for individuals with
dementia.

6. Access to healthcare professionals: dementia care centers often have access to healthcare
professionals, including nurses, doctors, and therapists who specialize in dementia care. this
ensures that residents receive appropriate medical care, medication management, and regular
health check-ups.

7. Emotional support: living with dementia can be emotionally challenging for both the individuals
affected and their families. dementia care centers provide emotional support and counseling
services to residents and their families, helping them navigate the emotional aspects of the disease
and cope with the changes it brings.

8. Education and awareness: dementia care centers play a crucial role in raising awareness about
dementia and educating the public about the condition. they can conduct training programs,
workshops, and awareness campaigns to promote understanding, reduce stigma, and improve
overall dementia care in the community.

overall, dementia care centers provide a dedicated and specialized approach to the care of
individuals with dementia, addressing their unique needs and ensuring a supportive and safe
environment. these centers contribute to improving the quality of life for individuals with dementia
and supporting their families in india.

41
RESOURCES NECESSARY FOR DEMENTIA CARE :-

Dementia care requires a comprehensive approach that addresses the physical, emotional, and
social needs of individuals living with dementia. Here are some essential resources necessary for
dementia care:

Full-time residential care services are facilities where people living with dementia are cared for a
long period of time. Such facilities are different from old age homes as people living with dementia
may need round the clock medical assistance. Thus, it is very important for all the staff members to
have special training to care for PwD. These full-time care services are as good as final homes for
people living there. Most of the full-time care centres

in India are rented thus they lack the infrastructure and the personal touch the place needs to make
the people living there feel at home India developing at an alarming rate almost erasing the line
between work hours at office and leisure time to spend with family at home. Time schedules are as
chocker blocked as the roads of the country. Thus, given such a situation it becomes difficult to care
for a person living with dementia at home and that is why people opt for long-term residential care
where their loved one is not lonely and gets medical help round the clock.

42
DAY CARE SERVICES :-

The day-care centres for people suffering from dementia are similar to day-care centres for children.
Such kind of a facility is not only beneficial to the person living with dementia but also to the career.
Some families are not comfortable with keeping their loved one far away from home so, for such
families the day-care centre gives them the much needed free time to take care of personal chores,
go to work and revive and rejuvenate themselves.

As for the people suffering from dementia, this becomes a place to socialise with new faces every
day, take part in various activities arranged by the day-care centre. The various services that most of
the daycare centre's offer are

● Transport facilities such as a pick-up and drop-ups

● Exercises and games
● Various activities
● Anger management classes
● Music therapies, speech therapies

RESOURCE CENTRES OR DOMICILIARY HELP :-

Resource centres are basically centres which provide necessary help to the families of people
living with dementia. These centres ideally should be set up in all the cities as most of the times,
the families go to such centres to gather information on dementia and to ask queries about the
disorder. These centres also provide domiciliary help to families by arranging awareness talks and
programmes in certain parts of the city. The centres also provide training sessions for a month long
to train the nurses and the families.

These resource centres organise memory screening camps in villages to spread awareness
Domiciliary services as sending professionals home to take care of the person living with dementia
can be arranged. ARDSI in India has taken the necessary step to have at least one resource centre
by starting ARDSI Chapters all over India

43
MEMORY CLINIC :-

Memory clinics are set up in each and every super specialised hospital. One is asked to visit a
memory clinic when the General physician suspects dementia.
The idea behind memory clinic is that the doctors at the memory clinic specialise in dementia and
would do a thorough check up along with some tests and help figure out more about the condition.

HELPLINE :-

Helplines help solve and gather information about dementia over the phone Most of the resource
centres look after this. The main reason for help lines is that: people living with dementia have a
tendency to wander which can lead to the person getting lost. There are special helplines for such
cases that may help find the lost person.

Estimated number of people with dementia among elderly persons (aged

60+) in states *of India during 2020-2021

44
THE IMPORTANCE OF SPECIAL CARE FACILITIES IN DEMENTIA :-

Need for infrastructure in special care facilities

There is a dire need of special care infrastructure in the course of the fight against dementia in
today's time. While the existing facilities for dementia are doing the best they can, the concept of
spaces still remains unexplored and restricted

The number of facilities down in the south of India is more than compared to the number of
facilities otherwise around India This proves that there is a lot more awareness about dementia in
the southern region and people are trying to understand and contain it by taking necessary actions.
All these facilities are located in an environment which is best suitable for people living with
dementia. These places have a certain kind of aura that can bring a person back into existence

Being surrounded by nature makes one get connected to it in a way that is not possible in the
metropolitan cities like Mumbai Nature has the ability to calm the mind and takes the person) with
dementia back to a time when there used to be less of a concrete jungle and more of open spaces,
which they tend to like.

45
 TYPES OF DEMENTIA, DIAGNOSIS AND TREATMENT :-

1. CREUTZFELDT-JAKOB DISEASE :- Prion diseases, such as Creutzfeldt-Jakob

disease, occur when prion protein, which is found throughout the body but whose normal
function isn't yet known, begins folding into an abnormal three-dimensional shape. This
shape change gradually triggers prion protein in the brain to fold into the same abnormal
shape.

DIAGNOSIS :-

Rapid symptom progression is one of the most important clues that a person may have
Creutzfeldt-Jakob disease.

There is no single test — or any combination of tests — that can conclusively diagnose sporadic
Creutzfeldt-Jakob disease in a living person, but the following tests may help determine whether
an individual has Creutzfeldt-Jakob disease:

● Electroencephalogram (EEG) measures the brain's patterns of electrical activity similar to

the way an electrocardiogram (ECG) measures the heart's electrical activity.
● Brain magnetic resonance imaging (MRI) can detect certain brain changes consistent with
Creutzfeldt-Jakob disease.
● Lumbar puncture (spinal tap) tests spinal fluid for the presence of certain proteins.
● Protein misfolding cyclic amplification (PMCA): PMCA is an amplification
technique for the detection of misfolded protein aggregates.

TREATMENT AND OUTCOMES :-

There is no treatment that can slow or stop the underlying brain cell destruction caused by
Creutzfeldt-Jakob disease and other prion diseases. Various drugs have been tested but have not
shown any benefit. Clinical studies of potential Creutzfeldt-Jakob disease treatments are
complicated by the rarity of the disease and its rapid progression.

Current therapies focus on treating symptoms and on supporting individuals and families coping
with Creutzfeldt-Jakob disease. Doctors may prescribe painkillers such as opiates to treat pain if it
occurs. Muscle stiffness and twitching may be treated with muscle-relaxing medications or
antiseizure drugs. In the later stages of the disease, individuals with Creutzfeldt-Jakob disease
become completely dependent on others for their daily needs and comfort.

Creutzfeldt-Jakob disease progresses rapidly. Those affected lose their ability to move or speak
and require full-time care to meet their daily needs. An estimated 90 percent of those diagnosed
with sporadic Creutzfeldt-Jakob disease die within one year. Those affected by familial
Creutzfeldt-Jakob disease tend to develop the disorder at an earlier age and survive somewhat
longer than those with the sporadic form, as do those diagnosed with variant Creutzfeldt-Jakob
disease. Scientists have not yet learned the reason for these differences in survival.

46
2. DEMENTIA WITH LEWY BODIES :-

DIAGNOSIS :-

As with other types of dementia, there is no single test that can conclusively diagnose dementia
with Lewy bodies. Today, DLB is a "clinical" diagnosis, which means it represents a doctor's best
professional judgment about the reason for a person's symptoms. The only way to conclusively
diagnose DLB is through a postmortem autopsy.

Most experts believe that dementia with Lewy bodies and Parkinson's disease dementia are two
different expressions of the same underlying problems with brain processing of the protein
alpha-synuclein. They recommend continuing to diagnose DLB and Parkinson's disease
dementia as separate disorders.

TREATMENT AND OUTCOMES :-

There are no treatments that can slow or stop the brain cell damage caused by dementia with
Lewy bodies. Current strategies focus on helping symptoms.

If your treatment plan includes medications, it's important to work closely with your physician to
identify the drugs that work best for you and the most effective doses. Treatment considerations
involving medications include the following issues:

● Cholinesterase inhibitor drugs are a common approach for addressing thinking changes in
Alzheimer's. They also may help certain DLB symptoms.
● Antipsychotic drugs should be used with extreme caution in Lewy body dementia, including
both dementia with Lewy bodies and Parkinson's disease dementia. Although physicians
sometimes prescribe these drugs for behavioral symptoms that can occur in Alzheimer's,
they may cause serious side effects in as many as 50% of those with Lewy body dementia.
Side effects may include sudden changes in consciousness, impaired swallowing, acute
confusion, episodes of delusions or hallucinations, or appearance or worsening of
Parkinson's symptoms.
● Antidepressants may be used to treat depression, which is common with DLB, Parkinson's
disease dementia and Alzheimer's. The most commonly used antidepressants are
selective serotonin reuptake inhibitors (SSRIs).

Like other types of dementia that destroy brain cells, dementia with Lewy bodies gets worse over
time and shortens lifespan.

47
3. ALZHEIMER’S DISEASE :-

DIAGNOSIS :-

An important part of diagnosing Alzheimer's disease includes being able to explain your
symptoms. Input from a close family member or friend about your symptoms and their impact on
your daily life helps. Tests of memory and thinking skills also help diagnose Alzheimer's disease.

In the past, Alzheimer's disease was diagnosed for certain only after death when looking at the
brain with a microscope revealed plaques and tangles. Health care providers and researchers are
now able to diagnose Alzheimer's disease during life with more certainty. Biomarkers can detect
the presence of plaques and tangles. Biomarker tests include specific types of PET scans and
tests that measure amyloid and tau proteins in the fluid part of blood and cerebral spinal fluid.

PHYSICAL AND NEUROLOGICAL EXAM :-

A health care provider will perform a physical exam. A neurological exam may include testing:

● Reflexes.
● Muscle tone and strength.
● Ability to get up from a chair and walk across the room.
● Sense of sight and hearing.
● Coordination.
● Balance.

Lab tests

Blood tests may help rule out other potential causes of memory loss and confusion, such as a
thyroid disorder or vitamin levels that are too low. Blood tests also can measure levels of
beta-amyloid protein and tau protein, but these tests aren't widely available and coverage may be
limited.

Mental status and neuropsychological testing

Your provider may give you a brief mental status test to assess memory and other thinking skills.
Longer forms of this type of test may provide more details about mental function that can be
compared with people of a similar age and education level. These tests can help establish a
diagnosis and serve as a starting point to track symptoms in the future

Brain Imaging :-

mages of the brain are typically used to pinpoint visible changes related to conditions other than
Alzheimer's disease that may cause similar symptoms, such as strokes, trauma or tumors. New
imaging techniques may help detect specific brain changes caused by Alzheimer's, but they're used
mainly in major medical centers or in clinical trials.

48
 ● Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic
field to produce detailed images of the brain. While they may show shrinkage of
some brain regions associated with Alzheimer's disease, MRI scans also rule out
other conditions. An MRI is generally preferred to a CT scan to evaluate dementia.

● Computerized tomography (CT). A CT scan, a specialized X-ray technology,

produces cross-sectional images of your brain. It's usually used to rule out tumors,
strokes and head injuries.

Positron emission tomography (PET) can capture images of the disease process. During a PET
scan, a low-level radioactive tracer is injected into the blood to reveal a particular feature in the
brain. PET imaging may include:

● Fluorodeoxyglucose (FDG) PET imaging scans show areas of the brain in which
nutrients are poorly metabolized. Finding patterns in the areas of low metabolism
can help distinguish between Alzheimer's disease and other types of dementia.
● Amyloid PET imaging can measure the burden of amyloid deposits in the brain.
This test is mainly used in research but may be used if a person has unusual or very
early onset of dementia symptoms.
● Tau PET imaging, which measures the tangles in the brain, is generally used in the
research setting.

49
4. FRONTOTEMPORAL DEMENTIA :-

DIAGNOSIS :-
The diagnosis of behavioral variant frontotemporal dementia and PPA are based on expert
evaluation by a doctor who is familiar with these disorders. The type of problems experienced by the
patient and the results of neurological exams are the core of the diagnosis. Brain scans such as
magnetic resonance imaging (MRI) and glucose positron emission scans are very helpful additional
tests, but they must be interpreted in the context of the patient’s history and neurological exam.

TREATMENT AND OUTCOMES :-

There are no specific treatments for any of the frontotemporal subtypes. There are medications that
can reduce agitation, irritability and/or depression. These treatments should be used to help
improve quality of life.

Frontotemporal dementia inevitably gets worse over time and the speed of decline differs from
person to person. For many years, individuals with frontotemporal dementia show muscle weakness
and coordination problems, leaving them needing a wheelchair — or unable to leave the bed.

These muscle issues can cause problems swallowing, chewing, moving and controlling bladder
and/or bowels. Eventually, people with frontotemporal degeneration die because of the physical
changes that can cause skin, urinary tract and/or lung infections.

5. MIXED DEMENTIA :-

DIAGNOSIS :-
Most individuals whose autopsies show they had mixed dementia were diagnosed with one specific
type of dementia during life, most commonly Alzheimer’s disease. For example, in the NIA study
involving long-term cognitive assessments followed by brain autopsy, 94% of participants who were
diagnosed with dementia were diagnosed with Alzheimer’s. Yet, the autopsies of those diagnosed
with Alzheimer’s showed that 54% had coexisting pathology in addition to hallmark Alzheimer’s
brain changes. The most common coexisting abnormality was previously undetected blood clots or
other evidence of vascular disease. Lewy bodies were the second most common coexisting brain
change.

50
TREATMENT AND OUTCOMES :-
Because most people with mixed dementia are diagnosed with a single type of dementia,
physicians often base their prescribing decisions on the type of dementia that's been diagnosed.
No drugs are specifically approved by the U.S. Food and Drug Administration (FDA) to treat
mixed dementia. Physicians who think that Alzheimer's disease is among the conditions
contributing to a person's dementia may consider prescribing the drugs that are FDA-approved
for Alzheimer's.

Many researchers are convinced that a more in-depth understanding of mixed dementia, coupled
with recognition that vascular changes are the most common coexisting brain change, may
create an opportunity to reduce the number of people who develop dementia. Controlling overall
risk factors for diseases of the heart and blood vessels may also protect the brain from vascular
changes.

6. VASCULAR DEMENTIA

DIAGNOSIS :-

Under the diagnostic approach recommended in the 2011 statement, the following criteria
suggest the greatest likelihood of mild cognitive impairment (MCI) or dementia is caused by
vascular changes:

1. The diagnosis of dementia or mild cognitive impairment is confirmed by neurocognitive

testing, which involves several hours of written or computerized tests that provide detailed
evaluation of specific thinking skills such as judgment, planning, problem-solving,
reasoning and memory.
2. There is brain imaging evidence, usually with magnetic resonance imaging (MRI),
confirming:
○ A recent stroke, or
○ Other vascular brain changes whose severity and pattern of affected tissue are
consistent with the types of impairment documented in cognitive testing.
3. There is no evidence that nonvascular factors may be contributing to cognitive decline.

The statement also details variations in these criteria that may suggest a possibility rather than a
strong likelihood that cognitive change is due to vascular factors

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TREATMENT AND OUTCOMES :-
The U.S. Food and Drug Administration (FDA) has not approved any drugs specifically to treat
symptoms of vascular dementia, but there is evidence from clinical trials that drugs approved to
treat Alzheimer’s symptoms may also offer a modest benefit in people with vascular dementia.
Treatment primarily works to prevent the worsening of vascular dementia by treating the
underlying disease, such as hypertension, hyperlipidemia or diabetes mellitus.

Controlling risk factors that may increase the likelihood of further damage to the brain’s blood
vessels is an important treatment strategy. There’s substantial evidence that treatment of risk
factors may improve outcomes and help postpone or prevent further decline.

Individuals should work with their physicians to develop the best treatment plan for their
symptoms and circumstances.

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 CASE STUDIES :-
01
INTERNATIONAL CASE STUDY

1. ALZHEIMER’S RESPITE CENTRE, DUBLIN ( DESIGN CASE STUDY)

what is it: alzheimer's respite centre is a care facility in dublin, ireland designed by a famous
architect- niall mclaughlin in 2009. it is a facility that has respite care along with residential care. it is
one of a kind as the facility has been designed keeping in mind the varied groups of users from an
architectural point of view. unlike many other elderly care facilities, the respite centre is a building
dedicated only to the care of dementia patients

PURPOSE: to understand the design interventions and ideologies used by the architect and the
programme and the working of the facility.

● ARCHITECT :- NIALL MCLAUGHLIN

● YEAR :- 2009
● TYPOLOGY :- RESPITE AND A DAY CARE CENTRE
● STRENGTH :- 11 BEDS AND UPTO 25 PATIENTS FOR DAY CARE

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OVERVIEW :-
The alzheimer's respite centre in dublin by Niall Mclaughlin is a project by the alzheimer's society
of ireland. the society preferred an outsider to design a structure for patient's sufferings from
alzheimer's thus, they divided the project into 2 phases: phase 1 that included an in-depth
research about alzheimer's and phase 2 included a design proposal for the same.

After the in-depth research the architect came to a conclusion that the building would have 2 major
purposes:

● Promote community solidarity and

● Strengthen a person's sense of orientation

Unlike many other facilities, respite centre is one of a kind as it only caters to people suffering from
alzheimer's.

CONCEPT :-

The architect thought of designing a facility which would be flexible in its use and provide a sense
of solidarity among the elders. The architect wanted the place to promote a good balance between
the staff, the elderly user and the family

The facility is designed keeping in mind the traits of people affected by Alzheimer's Some of them
are :-
● The cognitive ability of the mind is compromised and their memory is affected thus they
have trouble remembering certain things
● They also can become simply disoriented and are liable to wandering.
● On prime of this they're old and sometimes have a problem with walking.

DESIGN PARAMETERS :-
The main aim of the design is framing a community and aiding orientation.

Planning

Planning is crucial as the people need to be reminded where they are at all times as they
are prone to wandering and might get lost.

• The facility is planned in such a way that the interconnected routes that flow through the
courtyards, gardens, rooms are all linked to each other bringing the person who takes any
possible route back to the social core of the facility. This helps the people wander or roam
within the facility without feeling lost

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● Due to this there is a continuous movement or flow from the
inner spaces to the outer spaces without feeling lost or
overwhelmed.

● A unique feature in the design is the series of brick walls

that create a labyrinth-like space which enclosed the
gardens that follow the person who walks through.

● The labyrinth-like walls give a sense of protection to the

people within.

● The facility is designed inside the 18th Century walls, the

building is surrounded by a series of gardens, each oriented
in a different direction (north, south, east, west) and each
planted appropriately to its orientation (courtyard, orchard,
allotment, lawn).

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 ● There are windows throughout the facility. They allow a clear view of the gardens and thus if
one moves through the interior of the facility, one could follow the sun like a clock
experiencing different lighting and shadows throughout the day.

● For people with Alzheimer's this type of connection with the building is important as they are
very sensitive to their surroundings.

OTHER ELEMENTS THAT SHOULD BE CONSIDERED WHILE PLANNING :-

Another most important element of designings is the material and colours used

Interior view of the facility showing colour codings for walls considering
the patients can recognise easily
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People suffering from Alzheimer's may have problems related to their vision as most of them are
already above the age of 65, thus colour coordination is a must. It is important that the colour of
the toilet doors and other appliances need to be of different colours. If the toilet seat is also the
same colour as the toilet then the patients can easily get confused and scared which might lead
them to aim badly or, worse still, miss the seat completely and fall which can cause serious
injury.

Similarly, shiny floors can appear to look like water and they will not feel safe walking on them
and may get disoriented and fall.

● The architect has made sure the distances between seating areas are short and the
passages are wide enough to fit wheelchairs.

● windows and lighting have been designed to minimise glare and shadow

● The floor, skirting and walls, doors are clearly differentiated by use of colour and tone

● It is made sure that the flooring doesn't have any patterns as that might irritate the user.

● To distinguish between toilets, rooms and non-access, coloured walls are in key positions
to aid orientation

● There are no dark corridors or dead there are continuous handrails throughout the facility

● Staff rooms have been situated to allow for constant passive contact with residents and all
rooms are connected but can be isolated if necessary.

● The architect has tried to make the corridors less boring by adding seating's that could be
used by the residents if they feel tired while walking the corridors also use of colours help
make it lively.

View of the garden and abundance of light from the windows proves to
be beneficial for the health of the patients
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INTERFERENCE :-

The case study on Alzheimer's Respite Centre in Dublin threw light mainly on the architectural
aspect. It helped understand the importance of small details that can help make the design stand
out and dementia-friendly. It stressed the importance of colour schemes while designing a
dementia care facility, helped understand the kind of planning the design needs.

The centre also helped understand the importance of green spaces and how important it is to
have a connection between nature and the architecture. It helped get a basic a gist of all the
spaces that need to be designed for a dementia care facility.

The Respite centre is a working example which proves that the right architecture and
infrastructure is the need for the hour to help the people with dementia live a better life.

58
CASE STUDIES :-
02
INTERNATIONAL CASE STUDY

2. THE HOGEWEYK - DEMENTIA VILLAGE, NETHERLANDS

This case study will look at two contrasting examples of accommodation for older people in the
Netherlands, comparing the successful care of dementia, as exemplified by De Hogeweyk , a
‘Dementia Village’, with accommodation for independent living with integrated care as
exemplified by the award winning Pelgromhof project.

The Hogeweyk is the outcome of an innovative and disruptive vision on living, care and wellbeing
for people living with severe dementia. It means a paradigm shift in nursing home care. The
traditional nursing home has been deinstitutionalized, transformed and normalized. The
Hogeweyk is just like any other neighborhood. A neighborhood that is part of the broader society
in the town of Weesp. In The Hogeweyk you will find houses where people live together based on
similar lifestyles. They can visit the pub, restaurant, theater, the supermarket or one of the many
offered clubs. The concept supports unique needs, lifestyles and personal preferences. Living in
The Hogeweyk puts boredom, loneliness and hopelessness in another perspective. It focusses
on possibilities, not on disabilities. And it goes without say that this is all supported by trained
professionals.

● ARCHITECT :- MOLENAAR & BOL & VANDILLEN ARCHITEKTEN, VUGHT

● LOCATION :- HEEMRAADWEG 1, 1382 GV WEESP, NETERLANDS
● YEAR :- 2009
● TYPOLOGY :- DEMENTIA VILLAGE
● STRENGTH :- 23 HOUSES FOR 152 DEMENTIA SUFFERING SENIORS
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OVERVIEW :-
The Hogeweyk is a village for people suffering from dementia which was completed in 2009 It is
situated in an industrialised suburb of Amsterdam. The architect has tried to design Hogeweyk as a
village from 1950's.

In 1992, Hogeweyk was just another ordinary nursing home in Weesp, a suburb 20-minute drive
from Amsterdam, Netherlands. It was run just like any other care facility for people with dementia but
it was run in all the wrong ways with locked doors, crowded dayrooms, non- stop TV, nurses in white
coats and, of course, heavy medication. However, when Yvonne van Amerongen, who worked there,
suddenly lost her father she other co-workers started to think about the type of facility they hoped
their relatives would live in, for the final stage of their lives

Hogeweyk is designed right in the residential area and people living around it can catch a glimpse of
the elderly living at Hogeweyk

The dementia village was designed keeping in mind 2 main objectives, They are :-

● To provide a safe and a familiar environment for people suffering from dementia Hogeweyk
aims to counter the negative feelings like confusion, anxiety, etc. that is most commonly seen
in people living with dementia.

● To keep the residents active and happy by engaging them in various programmes.

CONCEPT :-
Hogeweyk is a unique and one of a kind facility in the world. The main concept behind designing
Hogeweyk was to give the people suffering from dementia the second chance at life. The dementia
village is a facility that is designed as per the parameters of a city in which all the residents are
people diagnosed with dementia. Other people living there are round the clock doctor and nurses
and caregivers. The most striking feature is that the aim of this project is to give the people suffering
from dementia a normal life thus, all the staff that is, the nurses, caretakers are in clothes other than
their uniforms. This helps create a hyper-reality in which the residents feel safe and free to do as
they wish without feeling like being watched all the time.

DESIGN PARAMETERS :-

● Occupying 15,310 square meters, of which 7,702 is not built on, Hogeweyk, is designed as a
full-fledged village or a township with streets, alleys, large squares, fountains and a park so
that residents can enjoy the life they would otherwise not be able to outside the closed
gates.

● The facility is designed to have all the amenities like a theatre, a restaurant, a café, a
supermarket, a barber/ beauty salon, a post office that are required in the day-to-day life.

60
● The panning is done in such a way that all the spaces flow into each other and are well
connected with no dead ends as this would upset the patients.

● The solid to void ratio is well thought of while designing as each complex has been designed
in a way that it opens up in a courtyard or a green recreational space.

● All the roads and streets are interconnected along with green recreational spaces which are
also interlinked to make it safe for the residents to walk freely without feeling overwhelmed

Ground floor plans

● Each green space that is designed in Hogeweyk has a different purpose. For example, the
theatre square can be used for street theatre; the boulevard has stores along it, the green
space outside the nursing home can be used for physical therapy.

● Green spaces help stimulate the mind and promote the well-being of the residents.

● The architects have not forgotten that since this is a village for people affected by dementia,
there needs to be a nursing home for sensorimotor stimulation and a physiotherapist.

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● The homes called as building blocks in general design are the main feature of the facility.
These blocks define the character of the spaces. The building block is chosen according to the
lifestyle preferred by the resident.

● Hogeweyk was projected in a way so that the block of apartments forms a boundary from the
outside world and there is no need for fences and walls to keep residents inside

● .Each apartment has around 220 square metres and is home for 6 up to 7 people. It is better
for people to live in small groups in one house at it makes them feel at home and have a family
of their own once again

● Every house has three common areas, a kitchen, a lounge, and a dining room

● Each house is allocated a team of caregivers to help the residents in their day to day chores
like washing, cleaning and also keep a check on each individual living in the house.

● Every apartments has a wide glass window that leads to the street or to some garden.

● For example, the residents in artisan lifestyle are all proud of their trade. They are plumbers,
carpenters, etc. The interiors of these houses are done to suit the preferences of the people
living in it. The layout of the house is solid and traditional.

Plan showing flow of green spaces

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 Various interiors of the houses

INFERENCE :-

● Both the international case studies are very different from each other in the sense of the
concept, typology and design. The Alzheimer's Respite centre in Dublin is a small facility for
about 10-20 people whereas the De Hogeweyk is a much larger facility - more like a
township as compared to the Respite centre

● De Hogeweyk is the very first township or village in the world and is one of a kind. The
concept of this facility is to give people with dementia a second chance at life after getting.
diagnosed with Alzheimer's or dementia. This case study helps gain a different perspective
on designing a facility for dementia care.

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● This case study helps to understand the project on a larger urban level scale. Various planning
factors such as the importance of solid-voids, green spaces and the concept of not having
gates but forming a boundary with the help of houses that creates a boundary has proven to
be very helpful.

● The concept of providing different architectural styles for people with different preferences,
helps people feel comfortable and at home.

● Therefore, both the case studies have helped understand the power of design and architecture
in the course of dementia.

Image showing the central courtyard

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CASE STUDIES :-
02
3. JAGRUTI REHABILITATION CENTRE, PUNE

FOUNDER :- Dr.
Amar Shinde
LOCATION :-
Hadapsar. Pune
YEAR :- 2015
TYPOLOGY :-
Residential building
STRENGTH :- 200
beds, approx 90
dementia patients
STAFF :- 10

SOLAPUR - PUNE HIGHWAY RESIDENTIAL

JAGRUTI REHABILITATION CENTRE SECONDARY

ROAD 64
OVERVIEW

● This cases study aims at understanding the workings of the existing facilities in
the field of dementia.
● The Jagruti Rehabilitation centre is a new venture started by Dr Shinde in the
year 2015 after the successful workings of the facility he had started in the year
2008 for people suffering from mental disorders.
● The facility is located 10 km further from Pune on the Pune-Solapur road and a
few km away from Hadapsar.
● The facility is located in a fairly residential area but still away from the city of
Pune. It is housed in a residential building of stilt + 4 floors and a total of 16 flats
and 51 persons living with dementia.
● The facility consists of 2 buildings- a psychiatric centre with patients with mental
disorders like Schizophrenia, manic depression, etc. and the other one that was
recently started exclusively for people suffering from dementia
● The institute is divided into two buildings ; one for the psychiatric patients
suffering from mental diseases such as schizophrernia and manic depression,
and the other, which was recently opened, is specially for people suffering from
dementia.

CONCEPT
The dementia care facility along with the psychiatric care is not a government aided
facility and is managed solely by Dr Shinde who is also the founder of the facility. The
main aim of the centre was to take an initiative in setting up a special care facility for
people with dementia and setting an example. The reason behind setting up the facility
in a residential building. according to Dr Shinde was to give the people living in it a
homely feeling, a feeling of togetherness and family, where they would live together in a
single unit just like they had before at the dementia facility. The centre also acts as a
respite centre where the person can be enrolled for a short period of time.
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 CASE STUDIES :-
03
INTERNATIONAL CASE STUDY

4. CARPE DIEM DEMENTIA VILLAGE

A new treatment- and housing centre for people suffering from dementia opened autumn 2020 in
Bærum, Norway. The complex consists of 136 communal housing units and 22 high care dementia
units.

● ARCHITECT :-ROBERT RITZMANN, INGRID LAVIK ( NORDIC OFFICE OF ARCHITECTURE )

● LOCATION :- DØNSKIVEIEN 45, 1346 GJETTUM, NORWAY
● YEAR :- 20017 - 2020
● TYPOLOGY :- DEMENTIA VILLAGE ( Hospital and health care planning and design,
Residential design)
● AREA :- 18000 sqm

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 Village feel :- Designed to cultivate the familiar domestic atmosphere of a small village, the
residences, housing- and treatment centre, and community centre are broken up into smaller units,
separated by gardens and squares. Varied building heights and roof typologies adds to the friendly
neighbourhood feeling.

OVERVIEW :-

A treatment and housing center for people suffering from dementia has opened in Bærum, Norway.
An increasingly important issue with the predicted ageing population is to achieve a better and more
efficient care system for elderly people with dementia. Inspired by the De Hogeweyk dementia village
in the Netherlands, the 18.000 m2 pilot project addresses these issues and provides a foundation for
future dementia care in Norway.

Recognisable surroundings :- People suffering from dementia often have trouble recognising their
surroundings and finding their way. It is therefore crucial that all areas are perceived as clearly
identifiable spaces. They have added various markers and easily recognisable elements
throughout the village to ease wayfinding and help make the residents feel at home.

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CONCEPT :-

Nordic – Office of Architecture created a comprehensive architectural and aesthetic concept that
provides the best possible quality of life for dementia residents. The buildings and outdoor spaces
were designed to help residents increase their activity and master everyday life. Residents can walk
freely throughout the facility without closed doors. The complex consists of two levels of care: 136
communal housing units and 22 high-care dementia units. Residents in the communal living areas
enjoy their familiar domestic comforts and welcoming common areas such as cafes, community
center, fitness facilities and other amenities.

The 22 high-care dementia units are provided for residents who are not capable of using the
communal functions.

Carpe Diem Dementia Village was designed to feel like a recognizable home rather than an
institution. Designed as a unified village, the residences, treatment center, and community center,
have a natural border and an open dialogue with the surrounding area. The common house and
administration area, together with the main entrance, form a square with an urban expression. The
residences were designed to create a homely atmosphere in a typical small house environment,
enhanced with gardens and squares. The two-to-three story buildings are broken up into smaller
units for a pleasant village feel. Varied building heights and roof typologies adds to the friendly
neighborhood feeling.

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FLOOR PLANS :- ROOF PLAN BASEMENT PLAN

GROUND FLOOR PLAN 1ST FLOOR PLAN

69
 2ND FLOOR PLAN 3RD FLOOR PLAN

INCLUSIVE DESIGN :-

People with dementia often have trouble recognizing their surroundings and orienting themselves. It
is therefore crucial that outdoor areas are perceived as clearly identifiable spaces. We have added
various markers and easily recognizable elements throughout these spaces to ease wayfinding for
the residents. Moving away from the use of artificial guidelines, we prioritized natural guidelines in the
form of edges, facades, material separators, etc. Outdoor and indoor spaces, as well as all pathways
and entrances, have also been developed according to inclusive design principles.

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MATERIAL USE :-

The overall design concept distinguishes between city and country. The square is surrounded by
buildings of urban character and homes in green surroundings. This is emphasized externally in the
choice of materials. The main material in all the facades is brick, which varies with two color shades
that give a bright and consistent impression. As a secondary material, untreated wood cladding and
wooden arrows of ore pine are used to create variety and give a homely character. Throughout the
facility, there is extensive use of long-lasting, maintenance-free and robust materials in the facade
and permanent fixtures, meeting the environmental requirements for the Nordic Ecolabel.

71