Challenging behavior (CB) is a group of behaviors, reactions and symptoms due to dementia, which can be challenging for the caregivers. The study aims to research the influence of acoustics on CB in people with dementia (PwD). An ethnographic method was used to study the daily life of PwD in their nursing homes with a specific focus on how people react to everyday environmental sounds. Thirty-five residents were included in the sample based on purposeful, homogeneous group characteristics and sampling. Empirical data were collected using 24/7 participatory observations. The collected data were analyzed using a phenomenological–hermeneutical method: a naïve understanding, a structural analysis and a comprehensive understanding. The result shows that the onset of CB depends on whether the resident feels safe and is triggered by an excess or lack of stimuli. The excess or shortage of stimuli and whether and when it affects a person is personal. It depends on various factors, the person’s state and the time of day, the nature of the stimuli, familiarity, or strangeness is also a determining factor for the onset and progression of CB. The results can form an essential basis for developing soundscapes to make the PwD feel safe and reduce CB.

Soundscape refers to the perception of the sonic environment; the recent pandemic has changed our perception of our living environment and reminded us of the need to study unpredicted and unpleasant soundscapes. For many, the pandemic brought quietness and a lack of stimuli; however, the soundscape was chaotic and fearful for healthcare workers and frontline workers. The experience also reminded us that there are neglected soundscapes to evaluate. One acoustic environment rarely studied or evaluated is the soundscape of war. There is insufficient attention to the auditory sensation of horror and terror caused by conflicts. When talking about the soundscape of war not referring to sonophobia, as one may not fear loud noises, yet being in the conflict has its specific auditory effect. How to use soundscape methods to evaluate the war soundscape? When soundwalk and interview are not practical, what will be the best way to evaluate the soundscape? Where are terror and horror in eight scale evaluation of pleasant, chaotic, vibrant, uneventful, calm, annoying, eventful and monotonous? There are studies on the effect of sound on veterans with PTSD, but not on people living in war zones. Should research use Virtual Reality to evaluate the soundscape of war? The goal is to find ways to assess the short-term and long-term effects of war soundscape on people and to find ways to improve their well-being.

Recently, there has been an increased interest in adapting the sonic environment to support people with cognitive difficulties, such as dementia. Research shows that incorporating “pleasant” sounds into the environment positively impacts behaviour and reduces psychological symptoms of dementia. Introducing sound into the acoustic environment creates an enhanced auditory experience, an augmented soundscape, resulting in an improved interpretation of the environment. People with dementia experience changes in their perception, which includes misperceptions, misidentifications, hallucinations, delusions, and time-shifting. Sound augmentation can support a better understanding of the environment and help in navigation time during the day. Dementia is a broad name for a degenerative disease; different types of dementia result in different syndromes and diverse auditory scene analyses. Some key auditory symptoms of different variants of the disease are auditory hallucinations, auditory disorientation, increased sound sensitivity, auditory agnosia (difficulty processing auditory input), agnosia for environmental sounds, amusia (tonal deafness) and Musicophilia. These different syndromes of auditory perception need more understanding when designing a soundscape augmentation for people with dementia. This talk aims to discuss different auditory symptoms of dementia based on a literature review and introduce ways to design an augmented soundscape to foster individual auditory needs.

We navigate through the environment using our sensory stimuli. Sound is significant in guiding us through space and making us aware of time. Soundscape is an acoustic environment as perceived and experienced by a person. While an unfamiliar and chaotic soundscape can increase anxiety and stress, a well-designed soundscape can make the experience pleasant and improve moods. People with dementia suffer from a neurodegenerative disorder, leading to a progressive decline in cognitive health. Behavioural and psychological symptoms of dementia (BPSD) refer to a group of noncognitive behaviours that affect the prediction and control of dementia. Reducing the occurrence of BPSD is one of the main goals of dementia care. People with severe dementia usually live in nursing homes, long-term care facilities or memory care units where sensory perception is unfamiliar. The strange sensory stimuli add to the anxiety and distress of residents as care facilities are often not customized based on individual needs. Research shows that incorporating pleasant sounds into the environment, known as an ‘augmented soundscape,’ positively impacts behaviour and reduces BPSD. Most design tools and guidelines include eliminating unwanted noise. To date, there are no guidelines for sound augmentation in dementia care design. The previous study of sound selection showed promising results in sound augmentation and identifying sounds that a person with dementia may prefer during a specific time of the day. The sharpness and high-pitch sounds, such as animal localization, had positive results. Cricket sounds showed positive feedback during nighttime and evening; either its tranquillity made it favourable, or the continuous sound masked other noises during the night (like white noise). These results can be used to introduce sound augmentation guidelines. The goal is to introduce sound as a positive design implementation to enhance mood, reduce apathy and depression, lower anxiety and stress, and promote health.

Background: Auditory Scene Analysis (ASA), the brain's ability to organize and interpret complex acoustic environments (Bragman, 1993), is differentially impaired across dementia subtypes. While research has established the impact of soundscape on behavioural and psychological symptoms of dementia (BPSD) (Janus et al., 2021; De Pessemier et al., 2022; Talebzadeh, Decoutere et al., 2023; Talebzadeh et al., 2024) limited work has examined how distinct ASA deficits in different forms of dementia should inform environmental design. This study synthesizes clinical trials and observational studies findings to develop a theoretical framework linking dementia‐specific ASA impairments to targeted soundscape interventions. Methods: We conducted a systematic analysis of ASA deficits across dementia subtypes through multiple complementary approaches. First, we performed ethnographic observations in dementia care settings to understand the relationship between acoustic environments and behavioural responses. These observations informed the development of a randomized controlled trial ( n = 28) examining soundscape augmentation effects on BPSD. Finally, we synthesized these findings through functional block diagrams mapping the relationship between auditory deficits and dementia variants, integrating both the theoretical ASA framework and empirical intervention outcomes. Results: Analysis revealed distinct patterns of ASA impairment across dementia subtypes: Alzheimer's disease showed primary deficits in sound source segregation and spatial processing; posterior cortical atrophy demonstrated severe ASA segregation/grouping impairments exceeding typical Alzheimer's; frontotemporal dementia exhibited specific deficits in rhythm, pitch, and emotional processing; while Lewy body dementia showed disrupted reality monitoring and auditory hallucinations. The RCT demonstrated that soundscape augmentation could improve behavioural symptoms, with significant reductions in resistance to care scores (‐0.81, 95% CI ‐1.59 to ‐0.03, p = 0.042), though these improvements were not specifically linked to dementia subtypes. These findings, combined with the identified ASA deficit patterns, suggest the potential for more targeted interventions. Conclusions: This work establishes a novel framework linking dementia‐specific ASA deficits to environmental design principles. Results indicate that soundscape interventions must be tailored to the particular pattern of auditory processing impairment in different dementia subtypes. These findings have significant implications for designing acoustic environments in dementia care settings and suggest that environmental modifications should consider both bottom‐up (primitive) and top‐down (schema‐based) auditory processing deficits specific to each form of dementia.