Dementia, with Alzheimer as the most common form, is a cruel disease which robs a human being of their dignity, because it affects their most precious possession, their brain. Despite the endeavours of universities and industry, so far no cure is possible. Due to the ageing population and the generation of baby boomers who will be reaching retirement age within the next 10 years, the number of people diagnosed with dementia will also rise. And while awaiting a miracle drug, society can do nothing but look after people with dementia in the most ideal surroundings. The aim is to reduce the awful symptoms such as agitation, wandering off and aggression, which means that the patient's life and that of the carer or nursing staff can nevertheless be made bearable (1). The good news is that a lot of research has already been carried out in this field. In this blog, we look mainly at recommendations about use of colour.
Research has shown that short-term memory, which is the first to be impaired in Alzheimer's patients can still function due to specific use of a lively colour coding of their surroundings (2). This means that functional objects such as a door to the toilet can be remembered better in a specific colour, so that disorientation and 'wandering off' can be reduced or even prevented. A possible explanation for this could be that people can retain or remember events, functions and meaning better if they are linked to emotions (3). Colour is a strong emotional transferor, with the result that it makes more of an impression on the person with dementia. It seems likely that the colour code will work optimally if it supports the meaning or function.
There is growing evidence that perception itself is affected by dementia (4). This degeneration is connected with object recognition, spatial location and perspective. The impaired visual processing routes are connected with our ability to discern sensitivity to colour and contrast and with detection of movement. For the person with dementia, increasing the light intensity and improvement of visual stimulation while performing tasks such as a visit to the toilet, eating or engaging in a craft hobby have a positive effect (5). Use of tableware with high colour and brightness contrast will provide maximum visual contrast during meals. Painting skirting in a contrasting colour, or the use of light strips can help the person to distinguish where the walls end and the floor begins. Coloured strips for doors and steps will help to recognise stairs and entrances. Specially adapted spectacle lenses that increase contrast can also contribute to the patient's well-being (6).
The colour spectrum also shrinks for people with dementia. It has been established that differences in the blue-violet range can no longer be perceived (7). So a colour coding in which blue is put alongside purple cannot be used. If it is important for safety to make certain items stand out, then it is recommended to use the colour red. The retina has more receptors for capturing red, which makes the colour easier to see for most people. However, it is not advisable to paint all objects red. There must be clear semantic associations between the colour and the function. Furthermore, multiple meanings for a given colour code lead to confusion.
Furthermore, people with dementia are sensitive to stimuli (8). They have problems sleeping and soon become agitated. Some patients choose to close the curtains during the day, so that they are not irritated by bright light. The use of vivid colours and high contrasts therefore ought to be restricted to objects, furniture and rooms associated with actions or functions, because these characteristics have an activating effect. The use of psychologically 'calm' and light colours for the walls and ceiling of the bedroom or relaxation room is recommended, and increases the code effect of the colourful and contrasting elements by making them stand out more. Floors in dark colours provide more stability than those in light colours. A warm, homely colour range also contributes to reduced agitation (8).
Reflections from reflective materials lead to additional confusion in impaired perspective and orientation. Gloss paint or furniture with shiny surfaces are not advisable. Windows are best covered with a material that diffuses the light and eliminates the reflection of the glass, but which allows blue daylight to penetrate, which is necessary to improve the day/night rhythm and reduce restlessness (8).
In conclusion: the clearer and more consistently the visual codes are applied, the better it is for the patient. For the functional colour coding, this means clear distinctions in hue and brightness, conveying semantic meaning via colours and giving one function or meaning per colour.
- Fonteno, D. (2004) Effects of Alzheimer's Disease on Visual cognitive Abilities. Research paper for PSY 506 Fall 2004.
- Cernin, P. A., Keller, B. K., & Stoner, J. A. (2003). Color Vision in Alzheimer's Patients: Can We Improve Object Recognition with Color Cues? Aging, Neuropsychology, and Cognition, 10(4), 255-267. DOI: 10.1076/anec.10.4.255.28971
- Buijssen, H. (2007) De beleving van dementie. Utrecht, Het Spectrum.
- Fujimori,M., Imamura, T., Hirono, N., Ishii, K., Sasaki, M., & Mori, E. (2000). Disturbances of spatial vision and object correlate differently with regional cerebral glucose metabolism in Alzheimer's disease. Neuropsychogia, 38, 1356-1361.
- Cronin-Golomb, A., & Gilmore, G.C. (2003). Visual factors in cognitive dysfunction and enhancement in Alzheimer's disease. In S. Soraci, Jr.& K. Murata-Soraci (Eds.). Visual Information Processing (pp. 3-34). Westport: Praeger Publishers.
- Sakai, S., Hirayama, K., Lwasaki, S., Fujii, T., Hashimoto, R.,& Yamadori, A. (2002). Yellow glasses improve contrast sensitivity of a patient with a visual variant of Alzheimer's disease. European Neurology, 48, 224-225.
- Van Rhijin, S.J., Glosser, G., de Vries, J.J., Clark, C.M.,Newberg, A.B., & Alavi, A. (2004). Visual processing impairments and decrements in regional brain activity in Alzheimer's disease. Journal of Clinical and Experimental Neuropsychology, 26, 11-23.
- Van Audenhove, Prof. Dr. C. (2014). Nachtelijke onrust bij personen met dementie. Alzheimer Liga. LUCAS KULeuven.