Benefit of a healing garden on sleep in neurocognitive diseases / Bénéfice d'un jardin thérapeutique sur le sommeil dans les maladies neurocognitives

Progressive neurocognitive pathologies frequently alter the architecture of sleep with: advanced sleep phase or phase delay, sleep fragmentation, decrease of slow-wave sleep, REM sleep, nocturnal agitation and wandering or even complete reversal of the nycthemeral rhythm. This has a clear impact on the health and quality of life of the patient. Hospitalization increases the risk of sleep disturbances due to inactivity, some sensory deprivation and daytime hypovigilance. The therapeutic gardens offer in an attractive, sensorially stimulating setting and exposed to natural light, the possibility of an adapted physical exercise. Their impact on the quality and quantity of sleep in cognitive-behavioral units has been evaluated in an exploratory manner. The hypnogram of two groups of 30 patients was compared depending on whether they used the garden (weather permitting, in summer) or not (in winter). The results show that the patients who use the garden are significantly more active during the day, have a longer nighttime sleep duration and are less restless at night. In addition, patients who use and walk longer in the garden benefit from an increase in their sleep time. In view of their multiple interests, therapeutic gardens, if they meet validated design criteria, should be integrated more widely into establishments welcoming people with neurocognitive diseases.

Les pathologies neurocognitives évolutives altèrent fréquemment l'architecture du sommeil avec : avance ou retard de phase, fragmentation du sommeil, diminution du sommeil lent profond et du sommeil paradoxal, agitation et déambulation nocturnes voire inversion complète du rythme nycthéméral. Cela retentit nettement sur la santé et la qualité de vie du patient. L'hospitalisation accroît le risque de perturbations du sommeil du fait de l'inactivité, d'une certaine privation sensorielle et de l'hypovigilance diurne. Les jardins thérapeutiques offrent, dans un cadre attractif, stimulant sensoriellement et exposé à la lumière naturelle, la possibilité d'un exercice physique adapté. Leur impact sur la qualité et la quantité de sommeil en Unité cognitivo-comportementale a été évalué de manière exploratoire. L'hypnogramme de deux groupes de 30 patients a été comparé selon qu'ils utilisaient le jardin (lorsque la météo le permettait, en été) ou non (en hiver). Les résultats montrent que les patients qui utilisent le jardin sont significativement plus actifs la journée, ont une durée supérieure de sommeil nocturne et sont moins agités la nuit. De plus, les patients utilisant et marchant plus longtemps dans le jardin bénéficient d'une augmentation de leur durée de sommeil. Au vu de leurs intérêts multiples, les jardins thérapeutiques, pour peu qu'ils répondent à des critères de conception validés, devraient être intégrés plus largement dans les établissements accueillants des personnes atteintes de maladies neurocognitives.

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

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.

How to facilitate the orientation of elderly subjects with psychical disabilities to a health alternative to hospitalization?

This paper is aimed to improve the socio-psycho-therapeutic support for older patients with heavy psychiatric disability. First, we review the literature to question the specific grounds reported by professionals regarding the orientation of these vulnerable subjects. Secondly, we emphasize that integration of these subjects within alternatives to hospitalization requires a type of support similar to that usually proposed, an accompaniment of psychosocial rehabilitation. Then, we propose to build an indicator called the psychosocial age, which reduces the weight of the chronological age for the orientation of these subjects. Ultimately, we question the health policies in psychiatry.