This month, Connexion Healthcare wanted to highlight “A Walk to Remember,” a specially designed garden for patients with Alzheimer’s disease that was a hit at the 2015 Philadelphia Flower Show, the world’s oldest and largest indoor flower exhibition, which ran from February 28 through March 8. The garden was developed by students of the Horticulture Academy at Abraham Lincoln High School in Philadelphia, a major exhibitor at the Flower Show for the past 34 years.
Why Alzheimer’s disease is everyone’s concern
Alzheimer’s disease is a chronic neurodegenerative condition and the most common cause of dementia. No effective disease-modifying therapy is currently approved for it. In the United States, more than 5 million individuals have Alzheimer’s disease and it is the sixth leading cause of death, accounting for about 90,000 deaths each year. Almost two-thirds of Americans with Alzheimer’s are women. As the baby-boom generation ages, the number of people with dementia is expected to increase.
The concept of “therapeutic gardens”— gardens whose purpose is to promote health and well-being — was initially developed in 1993 by the American Horticultural Therapy Association (AHTA), which used evidence-based principles to help craft its landscape design elements. Most therapeutic gardens are tailored to the needs of specific patient groups. Alzheimer’s gardens are specifically designed to allow patients with dementia to enjoy nature in a safe environment, while the garden itself provides prompts that compensate for the diminished cognitive function that is characteristic of the disease. The regenerative powers of these gardens can also be enjoyed by caregivers and the general public. The orchestrated effects of the Alzheimer’s garden stem from its design, which is rooted in the science of the brain.
The hippocampus, a small, seahorse-shaped organ in the brain, distributes memories of experiences into the memory bank and retrieves them when needed. The hippocampus is damaged early in the course of Alzheimer’s disease. Memories of location and place, which include “cognitive mapping,” are therefore difficult for these patients to coordinate. Gardens designed to enable navigation without cognitive mapping may employ compensatory mechanisms, such as smell, light, or sound, as guides.
Located next to the hippocampus, the amygdala, which manages emotions, feelings, and mood, is not damaged until late in the disease process. For this reason, although other mental faculties diminish in patients with Alzheimer’s disease, these individuals remain exquisitely sensitive to emotional stimuli and experiences through much of the course of the disease. Gardens designed to strategically impart positivity, a sense of well-being, and calm can help patients orient themselves to an environment of health and contentment.
Cells in the brain called the chiasmatic nuclei help the body to maintain an “inner clock” that promotes sleep–wake cycles even when minimal contact with sunlight or other natural prompts is available. These cells are damaged in Alzheimer’s disease, causing patients who are confined to the indoors (eg, in a care facility) to develop disturbances in the sleep–wake cycle. For example, patients may awaken suddenly during the night and not understand that it is nighttime, or may experience “sundowning,” a form of confusion and agitation associated with the end of the day. Access to a healing garden can help diminish these symptoms.
Alzheimer’s disease garden design
As one might guess, the design of therapeutic gardens is more complicated than it appears. Successful Alzheimer’s gardens integrate 3 basic design principles: natural mapping, latent image elements, and zoning. Natural mapping environments require no book, map, or memory to navigate because they contain only a few straightforward paths, all of which are readily visible from everywhere in the garden. An entrance and exit to the garden also are clearly visible and marked in a way that is easy to understand. Gardens that do not require cognitive mapping skills to navigate reduce potential stress to those who would otherwise have difficulty finding their way.
Latent image elements facilitate an organizational perception of the garden by using pathways, edges, “districts,” landmarks, and specific focal points (eg, benches). For example, a landmark might be a palm tree in the middle of green ferns, or an Eiffel Tower model, the image of which becomes imprinted in the memory with repeated viewing and is easily singled out from other landmarks in the garden. “Districts” in a therapeutic garden may be flowerbeds of one variety or color, separated by green hedges or paths. These elements of local organization seem to be central to how the brain processes environmental place information.
Successful residential plans in most traditional societies incorporate the concept of zoning. An Alzheimer’s garden design should also consider techniques for creating spaces comparable to those around the home. A porch or front stoop, for example, marks the main entrance to the home, is accessible, and is intended for those whose entrance to the home is welcome, but not intended for those with no business there. A hall or foyer just past the front door is a formal welcoming area and typically stages entry to an area of the home with a more specified function (eg, entertainment).
Overlapping and merging into a unified plan, these 3 concepts comprise the major organizational design principles for successful Alzheimer’s therapeutic gardens.
For more information on the design of Alzheimer’s treatment gardens go to: http://www.healinglandscapes.org/
About the Connexion Healthcare Neuroscience Center of Excellence
Connexion Healthcare’s Neuroscience Center of Excellence offers executive talent with decades of experience in the pharmaceutical industry. Our team works with you to conceive a strategy and execute communications through the lifespan of your product—from drug discovery through market launch and beyond. With particular expertise in phase 2 through postlaunch, we will engage with you wherever you are in the development process and whenever you need us. Comprised of medical directors with scientific and clinical experience, account leads with project execution expertise, medical editors versed in neuroscience, and design leads at the top in their fields Connexion Healthcare ensures that your objectives are met effectively and even surpassed in an industry-eloquent and compliant manner.
For further information regarding the Neuroscience Center of Excellence at Connexion Healthcare and how we can develop neuroscience communications to differentiate therapies by their unique attributes, contact:
Nicholas C. Stilwell, PhD CMPP
Vice President, Scientific Services, Neuroscience Center of Excellence
Susan Stein, MPH