Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.

This paper is a systematic review of quantitative studies conducted on the benefits of visiting gardens and gardening therapy for people with dementia (PWD) in an effort to assess the effectiveness of such treatments and obtain information on the most appropriate garden design for this population. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. Four databases were searched (PubMed, Web of Science, PsycINFO, Scopus), with no time limits. Out of a total of 480 articles considered, 16 studies were selected for review. In all but two of the studies examined, gardening therapy and the use of therapeutic gardens induced psychophysiological improvements in PWD. The areas showing the greatest effects were Engagement, Agitation, Depression/Mood, Stress, and Medication. It also emerged that interest in this sphere has been growing in the last decade, but there is still a shortage of empirical evidence of the beneficial effects of therapeutic gardens in relation to the type and severity of dementia, and of garden design guidelines. Despite the limited number of studies investigated, the review confirmed the benefits of gardening and therapeutic gardens in PWD. There is nonetheless a need to conduct more quantitative research to support currently-available evidence and generate more information, focusing on garden design criteria, in-garden activities, the type and severity of dementia examined, and effects on caregivers as well as on PWD.

Mental imagery training in older adults: Which are benefits and individual predictors?

OBJECTIVES: Strategic memory training involves explicit instructions in mnemonic methods to improve recall. Mental imagery is considered among the most effective encoding strategies. The aim of the present study was to assess the benefits of a strategic memory training based on mental imagery (originally proposed by Carretti et al., 2007) and to further investigate its potentials. The study represents a replication in a new and independent cultural setting and features valuable methodological amendments, while it also examines individual predictors of training efficacy. DESIGN: A sample of 91 older volunteers (age 61-88), divided in training and control group, participated in the training. Specific training gain in the immediate word list recall (criterion task), as well as transfer effects on Letter-Number Sequencing (working memory [WM] task), long-term recall and recognition (LTM tasks) were tested at the pretest and at the posttest. RESULTS: Analysis of variance showed posttraining effects in immediate word recall and long-term verbal recall, but no effects in WM task and long-term recognition. Regression analysis showed age to be the only significant predictor in one task, the immediate word recall. CONCLUSIONS: Overall, proposed training can improve some aspects of memory performance by aiding in strategic use of mental imagery. Transfer to other tasks and contribution of individual predictors to training efficacy results limited, however. It seems that training benefits are evident when task similarity enables transfer-appropriate processing (as evidenced in gains of both recall tasks), while training efficacy relies on individual characteristics which contribute to the execution of some task components.

Supporting route learning in older adults: the role of imagery strategy.

OBJECTIVES: Route learning is an everyday spatial ability important to individuals' independent living, and is known to decline with age. This study aimed to investigate the benefit of using an imagery strategy to support route learning in young and older adults. METHODS: Forty young adults and 40 older adults learned a path from a video. Twenty of each age group were taught to use an imagery strategy (strategy groups [SGs]), while the others received no specific instructions (control groups [CGs]). Then participants were asked to recall the order and location of landmarks they had seen along the path (landmark ordering and locating tasks). RESULTS: Young adults recalled the order and location of landmarks better than older adults, and the SGs outperformed the CGs regardless of age. The Age group x Learning group interaction was only significant for the landmark locating task, with the young CG performing better than the older CG, while the older SG proved as good at recalling landmark locations as the young SG. Further, it was only among the older adults that the SG outperformed the CG. CONCLUSION: These findings newly suggest that using imagery helps to sustain older adults' route learning ability, especially in spatial recall tasks demanding the active manipulation of spatial information learnt, such as locating landmarks previously encountered while navigating a path. These results are discussed within the aging and spatial cognition frameworks.

Mental rotation training in older adults: The role of practice and strategy.

There is evidence of mental rotation (MR) abilities responding to training even in older adults, but it is still not clear whether such training would have generalized and maintained effects. The aim of the present study was to examine the specific short- and long-term gains, and any transfer effects, induced by rotation training in healthy older adults. The study involved 43 healthy older adults: 14 practiced with 2 MR tasks, that is, a 3D same/different comparisons task and a Tetris game (the Mental Rotation [MR] group); 15 were trained to use a strategy based on concrete object manipulation and imagery, then practiced with the 2 rotation tasks (Strategy [S] + MR group); and 14 were involved in alternative nonspatial activities (active control group). Transfer and maintenance effects were assessed (after 1 month) using tasks similar to those used in the training (criterion tasks), different spatial tasks (mental rotation and perspective taking tasks) and a fluid intelligence task. The results showed a trend toward an improvement in successive training sessions. The S + MR and MR groups both gained substantially more than the active control group in the short- and long-term, in the criterion tasks and most of the tasks testing transfer effects. The S + MR group showed greater long-term gains than the MR group in most tasks. These findings support a positive effect of rotation training in older adults, particularly when associated with strategy use. (PsycINFO Database Record

Training working memory in older adults: Is there an advantage of using strategies?

The purpose of the present study was to test the efficacy of a working memory (WM) training in elderly people, and to compare the effects of a WM training based on an adaptive procedure with one combining the same procedure with the use of a strategy, based on the construction of visual mental images. Eighteen older adults received training with a WM task (the WM group), another 18 received the same WM training and were also taught to use a visual imagery strategy (the WM + Strategy group), and another 18 served as active controls. Training-related gains in the WM (criterion) task and transfer effects on measures of verbal and visuospatial WM, short-term memory (STM), processing speed, and reasoning were considered. Training gains and transfer effects were also assessed after 6 months. After the training, both the trained groups performed better than the control group in the WM criterion task, and maintained these gains 6 months later; they also showed immediate transfer effects on processing speed. The two trained groups also outperformed the control group in the long term in the WM tasks, in one of the STM tasks (backward span task), and in the processing speed measure. Long-term large effect sizes were found for all the tasks involving memory processes in the WM + Strategy group, but only for the processing speed task in the WM group. Findings are discussed in terms of the benefits and limits of teaching older people a strategy in combination with an adaptive WM training. (PsycINFO Database Record

Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia.

OBJECTIVE: Cognitive stimulation therapy (CST) has been shown to have significant benefits in enhancing cognitive functioning and improving the quality of life of people with mild to moderate dementia. The present study examines the efficacy of the Italian version of the therapy (CST-IT). METHODS: Older adults with mild to moderate dementia (n = 39) were randomly assigned to two programs: one group participated in the CST-IT, consisting of 14 sessions (twice a week for 7 weeks) and the active control group took part in alternative general activities. The outcome measures were cognitive functioning (measured by the Mini-Mental State Examination-MMSE-, the Alzheimer's Disease Assessment scale-cognitive subscale, the backward digit span test, and a narrative language test); quality of life (Quality of life--Alzheimer's Disease scale); mood (Cornell scale for depression in dementia and the social and emotional loneliness scale); functional activities in daily living (Disability Assessment for Dementia); and behavior (neuropsychiatric inventory). RESULTS: After the intervention, only the CST-IT group maintained its MMSE score, while the control group displayed deterioration. The CST-IT group also performed better in some of the cognitive measures (Alzheimer's Disease Assessment Scale-Cognitive subscale and narrative language), mood measures (Cornell scale, social and emotional loneliness scale with a decrease in reported loneliness), and the Quality of life--Alzheimer's Disease scale. No other treatment effect was observed. CONCLUSIONS: The findings confirm the efficacy, at least in the short term, of the CST in sustaining cognitive functions and perceived quality of life in older adults with dementia in the Italian care setting as well.

Impact of metacognition and motivation on the efficacy of strategic memory training in older adults: analysis of specific, transfer and maintenance effects.

The current study examines the contribution of a number of metacognitive and motivational variables in explaining specific, transfer and maintenance effects of a strategic memory training program, based on the use of mental imagery, in older adults. Participants were assessed before and after the training (immediately post-test, and at 3- and 6-month follow-up) on list recall (criterion) and working memory (transfer) tasks. At the pre-test, metacognition (use of strategies, belief about memory, control on memory) and motivational measures (cognitive engagement, self-efficacy) were also collected. The training produced a benefit in both the criterion and transfer tasks, which was maintained at follow-up. Some of the metacognitive and motivational measures, over and above the level of performance obtained at pre-test, predicted the gains in the objective memory measures. The findings confirmed the importance of considering the role of metacognitive attitudes of older adults in memory training activities.