Greenness and neuropsychiatric symptoms in dementia.

OBJECTIVES: It is acknowledged that living in a green environment may help mental well-being and this may be especially true for vulnerable people. However, the relationship between greenness and neuropsychiatric symptoms in dementia has not been explored yet. METHODS: We collected clinical, neuropsychiatric, and residential data from subjects with dementia living in the province of Modena, Northern Italy. Neuropsychiatric symptoms were measured with the Neuropsychiatry Inventory, a questionnaire administered to the caregiver who assesses the presence and severity of neuropsychiatric symptoms, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviors, sleep disturbances, and appetite/eating changes. Normalized Difference Vegetation Index (NDVI) was used as a proxy of greenness. Regression models were constructed to study the association between greenness and neuropsychiatric features. RESULTS: 155 patients with dementia were recruited. We found that greenness is variably associated with the risk of having neuropsychiatric symptoms. The risk of apathy was lower with lower levels of greenness (OR = 0.42, 95% CI 0.19-0.91 for NDVI below the median value). The risk of psychosis was higher with lower levels of greenness but with more imprecise values (OR = 1.77, 95% CI 0.84-3.73 for NDVI below the median value). CONCLUSION: Our results suggest a possible association between greenness and neuropsychiatric symptoms in people with dementia. If replicated in larger samples, these findings will pave the road for identifying innovative greening strategies and interventions that can improve mental health in dementia.

Multi-criteria analysis for improving strategic environmental assessment of water programmes. A case study in semi-arid region of Brazil.

Multi-criteria analysis (MCA) is a family of decision-making tools that can be used in strategic environmental assessment (SEA) procedures to ensure that environmental, social and economic aspects are integrated into the design of human development strategies and planning, in order to increase the contribution of the environment and natural resources to poverty reduction. The aim of this paper is to highlight the contribution of a particular multi-criteria technique, the analytic hierarchy process (AHP), in two stages of the SEA procedure applied to water programmes in developing countries: the comparison of alternatives and monitoring. This proposal was validated through its application to a case study in Brazilian semi-arid region. The objective was to select and subsequently monitor the most appropriate programme for safe water availability. On the basis of the SEA results, a project was identified and implemented with successful results. In terms of comparisons of alternatives, AHP meets the requirements of human development programme assessment, including the importance of simplicity, a multidisciplinary and flexible approach, and a focus on the beneficiaries' concerns. With respect to monitoring, the study shows that AHP contributes to SEA by identifying the most appropriate indicators, in order to control the impacts of a project.