Horticultural Therapy in Patients With Dementia: A Systematic Review and Meta-Analysis

Abstract

Background: World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason results in hospitalization of dementia patients. Horticulture is one of the favorite activity for many peoples to relax their minds. Objectives: To investigate psychological health benefits of horticulture intervention in dementia patients. Methods: The databases including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, and Ovid Medline were searched up to August 2017. Results: Twenty-three articles for systematic review, whereas 8 articles were included in meta-analysis. Meta-analysis verified the beneficial effect of horticultural therapy (HT) on agitation level (standard mean difference: −0.59; P < .00001); increase time spent on activity engagement (mean differences [MD]: 45.10%, P < .00001); decrease time for doing nothing (MD: −29.36%, P = .02). Conclusions: Patients with dementia benefit from horticultural by alleviating their degrees of agitate behaviors, increasing time of engaging in activities and decrease time of doing nothing.

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer’s disease

“…Both interval and continued exercise decreased the levels of hippocampal Aβ40 and Aβ42 levels, reduced lipid peroxidation and enhanced antioxidant defenses [23]. However, free running did not alleviate microvascular dysfunction [31], while, in another study voluntary exercise increased tissue oxygenation, which supports the metabolic demand of neurons [30]. Moreover, voluntary physical exercise mitigated the neurodegenerative changes in the brain such as disintegration of the pyramidal layer structure, neuronal loss, severe pericellular edema, and accumulation of amyloid and cerebral amyloid angiopathy [21].…”

“…Physical activity also influenced the brain already affected by plaques and tangles. For example, treadmill exercise prevented inflammatory events triggered by Aβ in mice hippocampus [29] and was associated with fewer cortical Aβ deposits [30], increased number of proliferating neuronal stem cells in the dentate gyrus, reduced hippocampal volume occupied by amyloid plaques [31], reversed the lipid peroxidation increase and restored the reduction in AChE activity [26], compared to sedentary controls. Both interval and continued exercise decreased the levels of hippocampal Aβ40 and Aβ42 levels, reduced lipid peroxidation and enhanced antioxidant defenses [23].…”

“…The Aβ output from the brain into the circulation is regulated by the low-density lipoprotein receptor-related protein 1 (LRP1) and P-glycoprotein [32]. Exercise increased the level of LRP1 in the mice cortex [30], while aerobic training increased the mRNA expression of ATP-binding cassette transporter G-1 (ABCA1) in the rat hippocampus, even after the intra-hippocampal injection of Aβ1-42 [24]. However, it did not influence the level of Receptor for advanced glycation end products (RAGE) [30], which facilitates the influx of circulating Aβ into the brain [32].…”

“…In fact, a meta-analysis reported positive effects of participatory horticultural therapy on cognition, agitation, positive emotion, and engagement, while ornamental therapy did not affect agitation and positive emotion [78]. In another meta-analysis, horticultural therapy also decreased the time of "doing nothing" [30]. It was studied in patients with dementia, including AD, of all severities.…”

“…[65] Selection of music with slow-to-moderate tempos [91], individual selection of music related to happy memories [65] Visual art therapy (VAT) Beneficial effects on cognition in participants with cognitive decline, less clear in AD patients, alleviation of depression and anxiety [87] Patients without an art background must learn basic skills, some patients might have difficulties completing tasks, requiring sufficient hand function [82] Optimal choice of type, duration and intensity of the intervention, knowledge of the patient's previous abilities and skills Horticultural therapy (HT) Increase in engagement [30,78], decrease the time spent in inactivity [30], some effects on cognition [78], reduction of pain, improvement in attention, lessening of stress Ingestion of toxic plants by advanced dementia residents, getting wet or become stuck during inclement weather [101] Excluding toxic plants and pesticides from the therapeutic garden, close supervision of participants, use of gardens designed specifically for the safety and benefit of residents with dementia, such as wander gardens [101] Bright light therapy (BLT) No effects on behavioral AD symptoms [12], but beneficial effects on sleep, the only therapy to strengthen the circadian rhythm [51] Individuals in earlier AD stages may be more sensitive to light and become agitated with high amounts of short wavelengths [81] Scheduling administration time according to individual circadian rhythm; using more moderate light, levels, tailored on an individual basis, use with caution in agitated patients [80] Acupuncture therapy (AT) Potential to improve cognition and activities of daily living [69], might be even more effective on some cognitive outcomes than conventional medicines [92] Local skin irritation or injury was the most common, nausea, vomiting, dizziness, tiredness a [93], fainting [64] Proper training in acupuncture, recognizing conditions that increase the risk of complications (such as treatment with anticoagulants or immuno-suppressive agents) [93] AT = acupuncture therapy; AAT = animal-assisted therapy; BLT = bright light therapy; HT = horticultural therapy; MT = music therapy; VAT = visual art therapy; MT = manual massage therapy.…”