Impact of a Healing Garden on Self-Consciousness in Patients with Advanced Alzheimer’s Disease: An Exploratory Study¹

Article type: Research Article

Authors: Gueib, Claire^a | Pop, Alina^{a; b} | Bannay, Aurélie^d | Nassau, Emeline^a | Fescharek, Reinhard^f | Gil, Roger^g | Luc, Amandine^e | Rivasseau Jonveaux, Thérèse^{a; b; c; *}

Affiliations: [a] Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, Nancy, France | [b] Centre Mémoire Ressources Recherche de Lorraine, Hôpital de Brabois, Allée du Morvan, CHRU Nancy, Vandoeuvre les Nancy, France | [c] Laboratoire Lorrain de Psychologie et de Neurosciences de la Dynamique des Comportements 2LPN EA 7489, Nancy, France | [d] Service d’Evaluation et Information Médicales, CHRU Nancy, Nancy, France | [e] DRCI, Département MPI, unité de Méthodologie, Data management et Statistique, CHRU de Nancy Hôpital de Brabois, Allée du Morvan, Vandoeuvre les Nancy, France | [f] Fescharek Sculpture & Design, Marburg Lahn, Germany | [g] Espace Ethique Régional CHU Poitiers Université de Poitiers, Poitiers Cédex France

Correspondence: [*] Correspondence to: Dr. Thérèse Rivasseau Jonveaux, Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, 1 Rue Foller, 54 000 Nancy, France. E-mail: t.jonveaux@chru-nancy.fr.

Note: [1] “Self-awareness is a supreme gift, a treasure as precious as life. This is what makes us human”, Irvin D. Yalom (2010), Staring at the Sun: Overcoming the Terror of Death, John Wiley & Sons, p. 14.

Abstract: Background:The environment of patients with Alzheimer’s disease and related disorders (ADRD) intensifies the consequences of cognitive impairment and exacerbates behavioral problems if inappropriate or, conversely, mitigate these problems if its design is tailored to the needs of these persons. Objective:We evaluate the impacts of hospitalization and of a specific healing garden on self-consciousness which represent a central impairment in ADRD. The self-consciousness questionnaire (SCQ), validated for its assessment at mild to moderate phases of the disease, explores the dimensions of personal identity, awareness of cognitive deficiencies, self-assessment of affective state, awareness of body representation, prospective memory, capacity for introspection, and moral judgments. Methods:After having verified, by means of a preliminary study, its feasibility to the more advanced stages of the disease, this questionnaire allowed assessment of the impact of the environment by comparing, in routine care, patients hospitalized in a cognitive-behavioral unit who solely remain indoors with others who use the Art, Memory and Life healing garden. Results:A significant decrease in SCQ due to an increase in anosognosia during hospitalization was observed in the group that remained indoors. For the group using the garden, a positive effect on overall SCQ score was observed, as a result of a significant improvement in body representation as the driving parameter. Conclusion:Factors that are grounded in the hypotheses that spearheaded its conception, such as sensory enrichment, familiarity, contact with nature, scaffolding role for cognitive functions, supportive effect for social interactions, and the “Nancy hypotheses of beauty”, thus contribute to their validation.

Keywords: Alzheimer’s disease, anosognosia, body representation, healing gardens, self-consciousness

DOI: 10.3233/JAD-190748

Journal: Journal of Alzheimer's Disease, vol. 75, no. 4, pp. 1283-1300, 2020