An Indoor Therapeutic Garden for Behavioral Symptoms in Alzheimer’s Disease: A Randomized Controlled Trial

Article type: Research Article

Authors: Pedrinolla, Anna^{a; 1} | Tamburin, Stefano^{a; 1; *} | Brasioli, Anna^b | Sollima, Alessio^c | Fonte, Cristina^a | Muti, Ettore^b | Smania, Nicola^a | Schena, Federico^a | Venturelli, Massimo^{a; d}

Affiliations: [a] Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy | [b] Monsignor Mazzali Foundation, Mantua, Italy | [c] Department of Clinical and Experimental Sciences, University Health and Wealth of Brescia, Brescia, Italy | [d] Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

Correspondence: [*] Correspondence to: Stefano Tamburin, MD, PhD, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134 Verona, Italy. Tel.: +39 045 812 4285; +39 347 523 5580; Fax: +39 045 802 7276; E-mail: stefano.tamburin@univr.it.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Behavioral and psychological symptoms of dementia (BPSD) affect 60–90% of patients with Alzheimer’s disease (AD). Objective:To determine if environmental therapy is an effective strategy to reduce BPSD, we tested 163 patients with AD with Neuropsychiatric Inventory (NPI) before and after 6 months of an indoor therapeutic garden (TG) or standard environment. Methods:A single-blind randomized controlled trial on AD patients with BPSD. Participants were randomized to an indoor TG (N = 82), or standard environment (control, N = 81) for 6 months. Primary outcome: change in the NPI score from baseline (T0) to end of treatment (T1). Secondary outcomes: change in use of quetiapine, cognition, activities of daily living, salivary cortisol, blood pressure from T0 to T1. Results:NPI score significantly ameliorated (TG versus control: –31.8 points), quetiapine dosage (–150 mg), blood pressure (–2.6 mm Hg), and salivary cortisol (–6.4 to –2.1 Nmol/l) were significantly reduced, the Mini-Mental State Examination significantly improved (1.8 points) in the TG versus control arm at T1 (p < 0.001). No adverse events were reported. Conclusion:The indoor TG seems safe and may reduce BPSD, medication intake, and cortisol levels in AD.

Keywords: Alzheimer’s disease, behavioral symptoms, cortisol, gardens, non-pharmacological treatment

Keywords: 0000-0002-1561-2187

DOI: 10.3233/JAD-190394

Journal: Journal of Alzheimer's Disease, vol. 71, no. 3, pp. 813-823, 2019