Orientation Impairment regarding Time and Place

Alzheimer patients who are experiencing reduced orientation with regard to time and place normally lack critical judgment (interpreting physical environments is an abstract function), possess varying degrees of storage dysfunction, are baffled, have personality changes, and have a loss of language skills. Caregivers and designers should consider several design elements when planning environments to help compensate for these deficits. The elements that need considering include illumination, colour, furnishings, and signage.

Illumination

Increase the concentration of lighting during hours of sunlight and decrease the strength during evening and night hours to reduce confusion relative to time.

Provide low light (e.g., a small night-light) in bedrooms, bathrooms, and hallways during night hours to provide information relative to place.

Colour

Color may be used to profit the individual in identifying important places within nursing homes where many passages look the same and the halls have similar doors, finding a restroom, or even a resident's own space, can be particularly challenging. Painting all bathroom doors a contrasting color to walls and bedroom doors, for example, may aid the person in being able to access the facility and therefore reduce the incidence associated with incontinence.

Furnishings

Decorating should clearly denote the nature of activities to reduce confusion as well as promote individual autonomy (e.g., dining rooms should not also be used for activity areas).

Make use of sound absorbent supplies in all areas; stress use of sound resistant materials in passages and dining areas to reduce audio misunderstandings.

Although clutter will be avoided, both at home and in nursing homes, familiar items (e.g., loved ones pictures, a favorite chair, a familiar mattress spread) should be used to assist with orientation.

Indicators

The use of appropriately placed and labeled signs can improve orientation. Signs should be ready with large letters and placed at eye level about the walls. When possible, graphic illustrations should be utilized (e.g., feminine figure or man figure on restroom door).

Large timepieces and calendars conspicuously displayed can facilitate time orientation.

Lecithin or even choline have been used in the attempt to increase the mind chemical acetylcholine, which is known to be reduced in Alzheimer's disease. Lecithin and choline are building blocks in the formation of acetylholine. Tacrine hydrochloride (Cognex) acts to lessen the breakdown associated with acetylcholine. Initial study reviews purported to show remarkable gains in intellectual performance and everyday activities of daily living with the use of tacrine (Cognex). Unfortunately, results from large-scale medical trials were not because impressive. Tacrine (Cognex) may be beneficial with a patients with mild to moderate illness; however, the drug does not stop be progression of the disease as well as any benefit produced can be expected to deteriorate with time. Realistically, probably the most that should be expected is a slowing in the progress of the disease by a number of months in some sufferers. Tacrine (Cognex) is approved by the U.S. Food and Drug Administration for that treatment of Alzheimer's disease.

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