Rachele Rastelli Signs First Professional Contract in Italy7/12/2023 11:00:00 AM  | Women's Volleyball
Four-time All-BIG EAST selection begins her professional career with Volley Melendugno
QUEENS, N.Y. – Following a standout five-season career with the Red Storm, <a href="/sports/womens-volleyball/roster/rachele-rastelli/4848" rel="smarttag" rev="4848">Rachele Rastelli</a> has signed her first professional contract with Italian volleyball club Volley Melendugno.
Rastelli left Queens as one of the most decorated student-athletes in program history. Over the course of her career, Rastelli picked up a 2021 BIG EAST Co-Player of the Year honor, four All-BIG EAST Team selections and four BIG EAST All-Academic Team nods. The Parma, Italy native is also a three-time AVCA East Coast All-Region Team recipient and a 2021 AVCA All-America Honorable Mention.
In her final season as a Johnnie, Rastelli helped lead St. John's to its 12th 20-win season in program history, making appearances in both the BIG EAST Tournament and the NIVC Tournament. The Red Storm took down Binghamton in straight sets behind a 10-kill performance to earn the program's first NIVC victory.
In 2022, she led the Red Storm with 525.5 points (39TH in NCAA), while amassing 459 total kills (43rd), which contributed to St. John's potent offense that recorded the fifth-most kills in the country.
Rastelli enjoyed an illustrious career at St. John's, ranking top five all-time in four statistical categories. finished second all-time in kills (1,874), second in total attacks (4,492), third in total blocks (403) and fifth in service aces (123).
One of various non-pharmacological treatments for people with dementia (PwD) is horticultural therapy. The aim of this double-blind, pre- and post-test, pilot study was to examine the effects of horticultural activities (HA) for PwD at a residential and daytime care facility. Whether combining HA with elements drawn from other psychosocial interventions (cognitive stimulation) would maximize any benefits was also newly examined.
Twenty-four PwD were involved either in HA, alone (TG1, N = 7) or combined with some cognitive stimulation (TG2, N = 8), or in indoor treatment-as-usual activities (CG, N = 9). Benefits were assessed in terms of general cognitive functioning (for participants with mild-to-moderate dementia), mood, behavioral and psychological symptoms, and quality of life.
Our results further confirm that engaging PwD in participatory HA in contact with natural elements can decrease their dementia symptoms and their caregivers’ distress, but also increase PwD’s quality of life. Our findings also suggest the need to consider dementia severity when assessing the benefits of horticultural therapy.
Volume 14 - 2023 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2023.1182136">https://doi.org/10.3389/fpsyg.2023.1182136</a>
Introduction: One of various non-pharmacological treatments for people with dementia (PwD) is horticultural therapy
pilot study was to examine the effects of horticultural activities (HA) for PwD at a residential and daytime care facility
Whether combining HA with elements drawn from other psychosocial interventions (cognitive stimulation) would maximize any benefits was also newly examined
Materials and methods: Twenty-four PwD were involved either in HA
N&#x2009;=&#x2009;7) or combined with some cognitive stimulation (TG2
or in indoor treatment-as-usual activities (CG
Benefits were assessed in terms of general cognitive functioning (for participants with mild-to-moderate dementia)
Results: No differences emerged between TG1 and TG2 in any outcome measure
so the two groups were combined (N&#x2009;=&#x2009;15)
the TG involved in HA exhibited less frequent and severe behavioral and psychological symptoms and an improved mood after the intervention
Caregivers also reported less distress in the TG after the intervention than in the CG
Considering only PwD with mild-to-moderate dementia
the TG also showed benefits in a measure of general cognitive functioning
Discussion: Our results further confirm that engaging PwD in participatory HA in contact with natural elements can decrease their dementia symptoms and their caregivers&#x2019; distress
but also increase PwD&#x2019;s quality of life
Our findings also suggest the need to consider dementia severity when assessing the benefits of horticultural therapy
The HA program was developed by various experts (psychologists specialized and dementia and cognitive stimulation therapies
drawing on the existing literature as regards the duration of the program
the selection of appropriate natural elements (plants
The HA were chosen for their multidimensional (sensory
and growth (to obtain an end product quickly and easily)
A further aim was to examine whether and to what extent including features and elements drawn from other effective psychosocial interventions for dementia&#x2014;especially evidence-based cognitive stimulation programs like Cognitive Stimulation Therapy (CST; <a href="#ref5">Carbone et al., 2021</a>; <a href="#ref33">Woods et al., 2023</a>)&#x2014;could promote the benefits afforded by HA
These features are indeed thought to make the stimulation activities more effective and facilitate the engagement of PwD in the proposed activities
Spatial&#x2013;temporal orientation activities for individuals and groups
and external cues or implicit learning modalities
were therefore newly incorporated in our structured HA program yielded to one group of participants
In line with previous evidence (<a href="#ref21">Lu et al., 2020</a>; <a href="#ref35">Zhao et al., 2022</a>), we expected the HA program to be more effective than TAU in decreasing behavioral and depressive symptoms, and agitation (<a href="#ref35">Zhao et al., 2022</a>)
As for the impact of HA on the other symptoms explored
we could also expect benefits in general cognitive functioning and QoL
We also investigated whether drawing on elements from other cognitive stimulation interventions could lead to greater benefits than the structured HA alone
The sample was recruited at a residential care home in Northern Italy
Eligibility was restricted to individuals with: (i) a diagnosis of major neurocognitive disorder (of any etiological subtype) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5); (ii) age over 65&#x2009;years; (iii) no learning disability
and no diagnosed comorbid psychiatric disorders or severe behavioral symptoms that might affect participation; and (iv) autonomous locomotion
<a href="#tab1">Table 1</a> shows the descriptive statistics of the sample&#x2019;s demographics by group
No significant differences emerged between the groups in terms of age [total sample: H(2) =&#x2009;1.71
p =&#x2009;0.45; mild-to-moderate dementia only: H(2) =&#x2009;3.13
p =&#x2009;0.19] or education [total sample: H(2) =&#x2009;3.36
p =&#x2009;0.18; mild-to-moderate dementia only: H(2) =&#x2009;4.73
The Montreal Cognitive Assessment (MoCA; <a href="#ref27">Nasreddine et al., 2005</a>) comprises items testing visuospatial abilities
The dependent variable was the sum of the scores (max
The Alzheimer&#x2019;s Disease Assessment Scale&#x2014;Cognitive subscale (ADAS-Cog; <a href="#ref30">Rosen et al., 1984</a>) consists of 11 tasks that assess orientation
with higher scores indicating a more impaired cognitive functioning
The Cornell Scale for Depression in Dementia (Cornell; <a href="#ref001">Alexopoulos et al., 1988</a>) consists of 19 items that assess signs and symptoms of major depression in individuals with dementia
Each item is rated for severity on a scale from 0 (absent) to 2 (severe)
The dependent variable was the sum of the scores for the 19 items
with higher scores indicating more severe depressive symptoms
The Neuropsychiatric Inventory (NPI; <a href="#ref7">Cummings et al., 1994</a>) assesses 12 behavioral and psychological disturbances in dementia patients (delirium
it is also possible to assess the emotional and psychological distress experienced by the caregiver
The dependent variables were: (i) the sum of the frequency&#x2009;&#x000D7;&#x2009;severity scores on each symptom; and (ii) the sum of the caregiver&#x2019;s distress scores on each symptom
Higher scores correspond to more frequent and more severe disturbances and more severe caregiver distress
The Quality of Life&#x2014;Alzheimer&#x2019;s Disease scale (QoL-AD; <a href="#ref20">Logsdon et al., 1999</a>) is a 13-item questionnaire assessing subjective components (e.g.
perceived QoL and psychological well-being)
behavioral competence and environment) of QoL
rated by caregivers and participants on a four-point scale from 1 (poor) to 4 (excellent)
The dependent variables were the sums of all the items separately rated by caregivers and participants
Pictures of the garden area with the raised garden beds (A) and materials (B) used for horticultural activities
and example of horticultural activities: planting and watering aromatic plants (C); transferring horticultural species (D); exploring colorful flowers (E); and shelling beans (F)
The HA were delivered to the two TGs by the same facilitator
a trained psychologist with experience of dementia care and group facilitation
and of the person-centered approach characteristic of psychosocial
The control group was involved in the care home&#x2019;s usual group-based indoor educational activities (e.g.
watching historical documentaries and films
and Reality Orientation Therapy) for the same number of sessions
and with the same amount of time and interaction with a trained and expert facilitator
All analyses were run using non-parametric statistics and considering the sample as a whole
and then separately analyzing the individuals with mild-to-moderate dementia
First of all, at pre-test, we checked for any baseline differences between the three groups. The results of the Kruskal-Wallis test revealed no differences between them in any of the measures of interest, neither in the sample as a whole, nor for the individuals with mild-to-moderate dementia (see <a href="#SM1">Supplementary Tables S1</a>, <a href="#SM1">S2</a>)
who were also tested on measures of general cognitive functioning and perceived QoL
Based on these results, we merged the two TG groups together (to obtain a larger sample size in the subsequent analyses). <a href="#SM1">Supplementary Tables S4</a>, <a href="#SM1">S5</a> show descriptive statistics of the measures of interest by group
for the whole sample and for people with mild-to-moderate dementia
and the results show that there were no differences between the two TG groups
Differences between the TG and CG groups in terms of cognitive, behavioral and psychological symptoms, mood, and QoL were examined, computing the gain scores (post-test score&#x2014;pre-test score) for each measure of interest (see <a href="#tab3">Table 3</a>)
When participants with mild-to-moderate dementia were considered separately, our findings confirmed the TG&#x2019;s less frequent and severe behavioral and neuropsychiatric symptoms, compared with the CG. The results also showed that, by comparison with the CG, the TG gained significantly from pre-test to post-test in one of the general cognitive functioning measures (the MoCA) and in terms of self-reported QoL (QoL-AD scores; see <a href="#tab3">Table 3</a>)
To gain a better understanding of the dimensions of the benefits obtained with the HA, effect sizes (Cohen&#x2019;s d) were computed separately for the TG and CG (see <a href="#tab3">Table 3</a>)
Our findings did not reveal any clear differences between the groups of PwD who engaged in HA alone (TG1) or in HA combined with elements drawn from other cognitive stimulation programs (TG2)
Although in contrast with our expectations
this result may be because the characteristics of the two programs differed only slightly
Although participants in the TG2 were given additional cognitive stimulation (e.g.
personal/group and spatial&#x2013;temporal orientation activities
or implicit learning modalities) to promote their engagement in the proposed activities
these features were mainly used at the beginning and at the very end of the sessions
The structure of the sessions was broadly the same for the TG1 and TG2
and the HA forming the main part of each session overlapped
The same trained facilitator also managed the sessions for both groups
and this is another aspect that might have prevented us from capturing any differences between the two programs
thus further explore the potential additive effects of incorporating elements drawn from other cognitive stimulation interventions for dementia in participatory HA
when the PwD involved in HA were compared with the TAU controls
Participants in the TG exhibited a reduction in the frequency and severity of their behavioral
psychological and depressive symptoms from pre-test to post-test
Lower levels of distress were also reported by their caregivers
The same pattern of results emerged when only participants with mild-to-moderate dementia were considered (apart from caregivers&#x2019; distress ratings)
As expected, our PwD with mild-to-moderate dementia also gained from HA in terms of perceived QoL, confirming previous evidence (<a href="#ref21">Lu et al., 2020</a>; <a href="#ref35">Zhao et al., 2022</a>)
The effect sizes corroborated our findings
and&#x2014;although descriptively&#x2014;indicated more nuanced benefits for the TG
especially in terms of a decreased frequency and severity of behavioral and psychological symptoms as delirium
both for the whole sample and for participants with mild-to-moderate dementia
They revealed a worsening particularly in the frequency and severity of behavioral and psychological symptoms
and on their other behavioral/psychological symptoms
all these aspects of the proposed HA may have contributed to the behavioral and psychological improvements detected in our sample of PwD
future studies should further understand whether gender differences might influence the benefits of non-pharmacological interventions of PwD
Moreover, although there is evidence that participatory HA&#x2014;as the ones used here&#x2014;seems more effective in supporting PwD&#x2019;s cognitive and psychological functioning than those based on nature exposure (e.g., garden viewing, garden touring; <a href="#ref35">Zhao et al., 2022</a>)
it would be interesting to compare different programs based either on HA or on nature exposure to disentangle the potential additional benefits provided by a more active engagement with nature through HA for PwD
the results of this pilot study confirm the feasibility of our HA program
which proved easy to implement at a long-term care facility as well as appropriate for PwD at different dementia stages
The HA program showed to alleviate mood and behavioral and psychological symptoms -with beneficial effects also for carers
They thus suggest that HA can be also proposed to people with severe dementia
who seem to benefit from it as much as those in earlier stages of the disorder
Horticultural therapy can be considered as another promising
cost-effective psychosocial approach for supporting the cognitive
mood and behavioral functioning as well as QoL of PwD and their carers
The raw data supporting the conclusions of this article will be made available by the authors
The study was approved by the Ethical Committee of University of Padova (Univoc number: B0ED79C242237AB75E1452E090F3880A; number of protocol: 4275)
All participants were informed about the purposes of the study and gave their written informed consent in accordance with the Declaration of Helsinki (World Medical Association
The patients/participants provided their written informed consent to participate in this study
and FP contributed to the design and implementation of the research
and FP contributed to the analysis of the results and writing of the manuscript
All authors contributed to the article and approved the submitted version
This research received specific grants from University Padova Project
Uni-Impresa (2019): &#x201C;VERde e BENessere nell&#x2019;Alzheimer (VER.BEN.A)
Verso un modello di giardino terapeutico centrato sull&#x2019;interazione luogo-persona&#x201D; [Green and wellbeing in Alzheimer (Ver.Ben.a)
Toward a model of therapeutic garden centered on the place-person interaction]
All the people enabling the &#x201C;VERde e BENessere nell&#x2019;Alzheimer (VER.BEN.A) project
strengthening the collaboration between the University of Padova
the Casa Madre Teresa di Calcutta care dementia center
and the &#x201C;Giotto&#x201D; Social Cooperative
caregivers and all the staff at the Casa Madre Teresa di Calcutta dementia care center
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
The Supplementary material for this article can be found online at: <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1182136/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1182136/full#supplementary-material</a>
1. <a class="footnotetextanchor" href="#xfn0003" title="">^</a>Participants with severe dementia could no longer communicate or complete the general cognitive functioning measures and QoL questionnaire
so our results are reported for the whole sample
and separately for participants with mild-to-moderate dementia
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Received: 08 March 2023; Accepted: 12 May 2023; Published: 09 June 2023
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A security service member patrols the&nbsp;Trans-Adriatic Pipeline worksite in&nbsp;Melendugno in the province of Lecce
XLinkedInEmailLinkGiftFacebookXLinkedInEmailLinkGiftBy <a href="/authors/ASoVYbnHexc/chiara-albanese" rel="author" class="media-ui-Byline_author-YGQMoXqnRHQ- media-ui-Byline_hasProfile-IuU8MCrRlFs-">Chiara Albanese</a>July 5
2018 at 10:53 AM EDTBookmarkSaveOn a recent visit to a construction site near an olive grove along the coast of southern Italy
a reporter’s phone buzzed with an ominous text message: “We know you’re there.”
Italy (Reuters) - In the name of European energy security
a private guard wearing a navy blue uniform
aviator sunglasses and a baseball cap walks around a grove of olive trees in southern Italy.The 231 trees
surrounded by dry-stone walls on a dusty plain near the Adriatic coast
stand in the way of a $45 billion pipeline designed to bring gas from central Asia and help wean the European Union off its dependence on Russian energy.Local authorities want the pipeline re-routed away from the prized grove
which includes trees thought to be more than 400 years old
but developers have Rome&#x27;s approval to proceed
on condition they are transplanted while pipes are laid and buried.Wary of protests
Azeri state energy company SOCAR and Italian gas company Snam
work on the Italian side of the Trans Adriatic Pipeline (TAP) cannot proceed without local consent
threatening to delay a project that is meant within four years to carry the equivalent of 10 percent of Europe&#x27;s Russian energy imports.The olive grove
whose oldest trees are recognised as part of the world heritage by UNESCO
represents more than a weak link in European energy security.It also highlights an issue at the heart of Italy&#x27;s biggest constitutional reform debate in a decade: the power of local authorities to thwart Rome
Prime Minister Matteo Renzi proposes to dilute that power in a Dec
4 referendum.&quot;None of the regions are happy with this reform because they fear they will be weaker in the face of the central government and will have to suffer things they don&#x27;t understand
Italy&#x27;s biggest olive oil producer and a popular tourist spot.Italy&#x27;s economic development minister has previously accused Puglia&#x27;s government of using the grove near the town of Melendugno
and thousands of other trees further along the path of the pipeline
as an excuse to block the project.&quot;If it passes the referendum will ensure a more sensible division of powers
especially in the energy sector,&quot; the minister
told Reuters in an email.The TAP consortium
Spain&#x27;s Enagas and Switzerland’s Axpo
says it has asked Rome to work with Puglia to finalise tree removal and is confident the issue can be resolved soon.&quot;Even if the go-ahead is delayed it would only mean a narrowing of the time frame for moving the trees
not a stop to the project,&quot; said TAP&#x27;s country manager for Italy
Michele Mario Elia.FEW SIGNS OF LIFEThere were few signs of life when Reuters visited the olive grove outside Melendugno just over a week ago
there were some fenced-off areas where archaeologists are required to make preliminary excavations
to check for any buried antiquities before the pipeline work can begin.&quot;There is a risk that some olive trees won&#x27;t survive,&quot; said Melendugno mayor Marco Poti
explaining that transplanting them could expose them to xylella
a bacteria that has wiped out tens of thousands of trees in recent years.In approving the project last year
including one requiring a total of about 10,000 olive trees to be carefully removed to allow a trench to be dug for the pipeline
they are to be returned and replanted.Puglia is threatening to go to the constitutional court if the project goes ahead without its consent
arguing Rome never properly consulted the region
Puglia points to a recent court ruling stipulating that the central government should consult the regions before approving international pipeline projects.Rome says it fully consulted Puglia before giving TAP the go-ahead.Olive trees can stir deep passions in Puglia where they blanket the countryside and form part of the region&#x27;s identity
Plans to destroy some infected trees last year had to be scrapped when protesters climbed them and took to the streets.&quot;I presume the same thing will happen this time round,&quot; mayor Poti said.Local regulations say the developers have from Nov
1 to April 30 to move the trees in their slow-growth period but full clearance to do so has still not been granted.If that window shuts
they cannot begin until November 2017.The 878-km (546 miles) TAP project will run from the Turkish-Greek border and carry gas across Greece
Albania and the Adriatic Sea to the small Italian beach of San Foca
It is the last stage of the so-called Southern Gas Corridor that is meant to pump 10 billion cubic metres (bcm) of gas each year
from Azerbaijan’s giant Shah Deniz II field into European markets.For Brussels
it is a way of diversifying away from Russia
Italy imports about 90 percent of its energy and hopes the TAP pipeline will enable it to become a gas hub for southern Europe
declined comment on the dispute.BUILDING SANDCASTLESIn Melendugno&#x27;s sleepy town square
Some believe the investment will breathe new life into the area and others fear it will threaten the region&#x27;s tourism.&quot;The town is divided but the majority doesn&#x27;t want the pipeline,&quot; said 72-year-old pensioner Pantaleo
chatting to friends.Another local concern is that the pipeline will make landfall at the popular Puglia beach of San Foca
an underground concrete tunnel will extend 700 metres inland and 800 metres out to sea where general contractor Saipem will join it to the undersea pipeline laid out under the Adriatic
Saipem has agreed to pull the pipe through the tunnel in winter when few tourists are around.On the other side
gas grid company Snam will build a 55 km pipeline to link TAP to the national grid.Puglia&#x27;s governor
wants the pipeline to land further north at the city of Brindisi where he says it could connect directly to Snam&#x27;s existing gas network.&quot;Neither the government nor TAP has explained to us why it has to arrive so far south,&quot; he says.But TAP executive Elia says studies showed the Brindisi option to be unfeasible
The central government insists local authorities were involved throughout the permit process.TAP developers secured government clearance for the pipeline on May 20 last year
But Renzi&#x27;s government attached 66 demands - some of which can only be fulfilled with the cooperation of local authorities.The clock is ticking.As an incentive to speed up work
Brussels offered to exempt the TAP developers from an anti-trust rule if they started work by May 16 this year at the latest and finish within four years
The rule would require TAP to allow rivals to use the pipeline.TAP - which has cordoned off the Melendugno site
swept for unexploded war bombs and checked for archaeological relics - says it officially started work on May 16.Rome had also set May 16 as a deadline for the start of project work
But regional governor Emiliano says construction work has not begun and has asked the central government to restart the approvals process from the beginning.&quot;We believe they have to start everything all over again,&quot; he said.Editing by Mark Bendeich and Janet McBride
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‘Red Zone’ established around Trans Adriatic Pipeline leaves residents stunned
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Italian authorities are using a Mussolini-era law to put an entire town under lockdown while they force through a gas pipeline against the wishes of the local community, activists have said.
A so-called “red zone” was declared around Melendugno by the central government’s military police force this month, after months of protests against the effect of the Trans Adriatic Pipeline (TAP) on the local area.
Activists on the ground who contacted The Independent say the police swooped in the middle of the night and barred people from leaving their homes, blockaded streets, and fenced off olive farms. 
“Some locals have been expelled and cannot access Melendugno... for the next three years”, Sabina Giese, one resident of the town said.
“We need a pass to use the roads and go home, in the evening there is only police in the roads and everything else is closed and abandoned. People are scared to come to the sea and go in the restaurant. Economy and tourism are affected.”
The town, situated in the region of Puglia, in the heel of Italy’s boot, has been a centre of protests against the uprooting of thousands of centuries-old olive trees to make way for the pipeline.
The project is opposed by local residents and officials, who have been in a tense stand-off with the central government in Rome over the plans. 
On the night of 12 November, a local official in Lecce enacted ordinance Decreto Regio (Royal Decree) No 773, which dates back to 1931, to put the territory surrounding TAP construction site “at the availability of the police”. 
Now a new barbed-wire fence and concrete barriers, as well as security patrols, are making it harder for local residents to move around the area. People who own land inside the so-called “red zone” need special permits to enter, but everyone else is barred – making it difficult to bring labour in to harvest olives inside the zone.
Locals have also complained of alleged property damage from the movement of vehicles. Local police could be reached for comment.
After progress was slowed by protesters in the spring, the consortium behind the pipeline was forced to wait until the start of November to again begin uprooting the trees – prompting the action of the police a week ago. The pipeline’s proponents say the trees can be re-planted after construction work on the project is finished.
TAP is being built to transport natural gas from Greece via Albania to Italy and onto the rest of western Europe. It would connect to another pipeline bringing gas from Azerbaijan.
The project’s proponents say it would increase Europe’s energy security and reduce reliance on coal; it is on course to receive funding from the European Investment Bank.
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Exposure to nature is known to support psychological wellbeing, and can support People with Dementia (PwD). Here we describe a case study conducted at a care facility for PwD to examine the effect of their exposure to nature after intervention to renovate an existing Therapeutic Garden (TG). Changes in frequency of attendance and behavior in the TG were examined. A single case was also considered to assess individual benefits.
Twenty-one PwD participated in the study. Their behavior in the TG was observed for 4 weeks before and after the intervention (using behavioral mapping), and measures of individual characteristics (general cognitive functioning, behavioral/neuropsychiatric symptoms, depression, and quality of life) were administered.
These results support the benefits of exposure to nature for PwD, and underscore the importance of considering users’ profiles to optimize their use of a TG.
Volume 14 - 2023 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyt.2023.1183934">https://doi.org/10.3389/fpsyt.2023.1183934</a>
Introduction: Exposure to nature is known to support psychological wellbeing
and can support People with Dementia (PwD)
Here we describe a case study conducted at a care facility for PwD to examine the effect of their exposure to nature after intervention to renovate an existing Therapeutic Garden (TG)
Changes in frequency of attendance and behavior in the TG were examined
A single case was also considered to assess individual benefits
Materials and methods: Twenty-one PwD participated in the study
Their behavior in the TG was observed for 4&#x2009;weeks before and after the intervention (using behavioral mapping)
and measures of individual characteristics (general cognitive functioning
Results: Ten of the 21 PwD visited the TG more often after the intervention
and their active isolated behavior in the garden (e.g.
The increase in social behavior related to less severe baseline depressive symptoms
Passive isolated behaviors related to more impaired baseline cognitive functioning
A extended the findings for the whole sample: although her dementia symptoms (apathy
she visited the TG more often after the intervention
her social exchanges and active isolated actions increased
Discussion: These results support the benefits of exposure to nature for PwD
and underscore the importance of considering users&#x2019; profiles to optimize their use of a TG
there are four key components that characterize a restorative environment: fascination (the property of the environment to hold our attention with no voluntary effort on our part); extent (the opportunity to feel immersed in the environment); being away (establishing a distance between us and our everyday routine); and compatibility (with our own inclinations)
It is hard to say which key environmental features are most relevant for humans interacting with nature
The complexity increases when individuals&#x2019; personal characteristics are considered
especially for those with behavioral and cognitive disorders like people with dementia (PwD)
Dementia is a neurocognitive disorder characterized by a gradual decline in cognitive functions (e.g., memory, orientation) and deterioration in emotional, social, and behavioral control that affect individuals&#x2019; day-to-day autonomy (DSM-V). With a greater life expectancy comes an increase in the incidence of dementia&#x2014;and its related sub-types [(<a href="#ref9">9</a>); (e.g., <a href="#ref10">10</a>)]&#x2014;among older adults
to consider the potential benefits of the interaction with nature is a resource for PwD
Lactuca sativa &#x201C;Simpson Elite&#x201D;) in an indoor and an outdoor garden
The results showed an overall reduction in agitation and improvement in quality of life in both gardens
These two studies show that TGs promote interaction with nature in PwD
thereby reducing their behavioral symptoms
They also suggest that attention should be paid to the choice of vegetation and type of garden
Most studies on the topic have focused on the effects of exposing PwD to TGs in terms of their dementia symptoms and psychological aspects (mood, wellbeing) (<a href="#ref16">16</a>), but there is a paucity of evidence regarding specific interventions in gardens (<a href="#ref26">26</a>) and in relation to their individual dementia profiles
It would be interesting to see whether ameliorating a TG
by adding various plant species (flowers and shrubs) that could maximize its therapeutic and stimulating potential
could add to its beneficial effects on PwD
The main aim of the present paper is to examine whether and to what extent intervention to improve the greenery maximizes the beneficial and stimulating effects of a TG for PwD
influencing the frequency of their visits and their behavior in the garden
This was examined considering a sample of PwD at the care facility where the TG intervention was completed
mapping their behavior before and after the intervention
The relationship between their garden visiting and behavior patterns with their individual characteristics (cognitive functioning
behavioral disturbances and quality of life) was also assessed
To qualitatively corroborate the beneficial effects of the modified TG
The case was selected to analyze the positive changes in her behavior after the intervention
The sample was recruited from a care facility in Northeast Italy. Eligibility was restricted to individuals with: (i) a diagnosis of major neurocognitive disorder [of any etiological subtype) made by the patients&#x2019; reference clinical center for cognitive decay (DSM-5; (<a href="#ref30">30</a>)]; (ii) global functioning score (using the Montreal Cognitive Assessment) compatible with mild-to-moderate cognitive impairment
Behavioral mapping [inspired by (<a href="#ref33">33</a>)]. This assesses: (i) the frequency of visits to the garden and locations where PwD stopped and (ii) their behaviors, classified as passive isolated, active isolated, social, aggressive, agitated, conscious movement, and disoriented movement (wandering). <a href="#SM1">Supplementary Table S1</a> shows the list of specific behaviors for each category
Montreal Cognitive Assessment [MoCA; (<a href="#ref34">34</a>)]. This consists of 30 items that test visuospatial abilities, executive functions, language, delayed recall, attention, and temporal and spatial orientation. The dependent variable was the sum of the scores (max 30), corrected for age and education. A score below the cut-off of 17 indicates cognitive impairment (<a href="#ref35">35</a>)
Alzheimer&#x2019;s Disease Assessment Scale-Cognitive subscale [ADAS-Cog; (<a href="#ref36">36</a>)]
This consists of 11 tasks assessing orientation
The variable was the sum of the scores (max&#x2009;=&#x2009;70)
Cornell for Depression in Dementia scale [CDDS; (<a href="#ref37">37</a>)]
This consists of 19 items assessing signs and symptoms of major depression in individuals with dementia
The variable was the sum of the scores (max&#x2009;=&#x2009;38)
with higher scores indicating more severe depressive symptoms (scores between 1 and 10 indicate probable major depression
Neuropsychiatric Inventory [NPI; (<a href="#ref38">38</a>)]
This assesses 12 behavioral disturbances in dementia patients (delirium
the caregiver&#x2019;s emotional and psychological distress can also be measured
The variables were: (i) the sum of the frequency &#x000D7; severity scores on each symptom and (ii) the sum of the caregiver&#x2019;s distress scores on each symptom
Higher scores (max&#x2009;=&#x2009;144) indicate more frequent and more severe disturbances
Quality of Life-Alzheimer&#x2019;s Disease scale [QoL-AD; (<a href="#ref39">39</a>)]
This consists of 13 items assessing subjective components of quality of life (e.g.
perceived quality of life and psychological wellbeing)
rated by caregivers on a 4-point scale from 1 (poor) to 4 (excellent)
The variable was the sum of all the items (max&#x2009;=&#x2009;52)
where higher scores indicate a better quality of life
There are about 450 late winter and spring flowering bulbs with a variety of colors and smells (e.g.
There are about 200 shrubs that flower at different times of year (e.g.
and about 20 aromatic herbs (Rosmarinus officinalis and Salvia officinalis)
The therapeutic garden: aerial view (Panel a) and observer&#x2019;s view (Panel b) before the intervention
TG layout showing the plants before the intervention in gray
It is also reported the behavioral mapping of Mrs A: the numbers indicate the observation times (blue circles for times 1&#x2013;48 pre-intervention; pink circles for times 1&#x2013;48 post-intervention)
she engaged in both active isolated and social behaviors
The study began in September 2021 and ended in July 2022 (see <a href="#fig3">Figure 3</a> for the timeline) in compliance with COVID-19 measures during both periods with temperatures suitable for staying outside
In September tests and questionnaires were administered to PwD (MoCA
From September to October 2021 (14&#x2013;19\u00B0C&#x000B0;)
the pre-intervention behavioral mapping of participants was performed for 4&#x2009;weeks
The TG intervention was completed in October (2021; taking 2&#x2009;weeks)
From June to July 2022 (19&#x2013;14\u00B0C&#x000B0;)
post-intervention behavioral mapping was performed for 4&#x2009;weeks for the maximum seasonal flowering
The behavioral mapping involved recording behaviors twice a day (once in the morning 10&#x2013;12&#x2009;h.
once in the afternoon 13&#x2013;15&#x2009;h.) at times when PwD were not engaged in other activities and were free to access the garden if they wished
with 6 behavior recording times in each session (at the start
then every 10&#x2009;min for 50&#x2009;min in all) for a total of (2x4x6=) 48 behavior recordings before and 48 after the intervention
The data were collected by two psychologists at a time (one was the first observer) and for the analyses we considered the first observer&#x2019;s data (as they correlated closely with the other psychologist&#x2019;s both pre-and post-intervention
Rhos =&#x2009;0.99 ps &#x02264;&#x2009;0.001)
The rectangle with the dotted lines only concerns Mrs
Associations between baseline measures and changes in the frequency of visits and behaviors exhibited by PwD in the garden
We expected a less impaired neuropsychological profile to be associated with a greater benefit of the intervention
One-tailed Spearman correlations between the gains in the number of visits to the garden and the frequency of certain actions (numbers post-intervention minus numbers pre-intervention) and the baseline scores for cognitive functioning
behavioral disturbances and quality of life (i.e.
pre-intervention scores in the respective measures for the 10 PwD who visited the TG) showed that: the gain in social interactions was inversely related to the baseline CDDS score (Rho&#x2009;=&#x2009;&#x02212;0.61 p&#x2009;=&#x2009;0.031)
PwD with less severe depressive symptoms at the baseline engaged in more social interactions after the intervention on the TG; and the gain in passive isolated behaviors (that increased slightly post-intervention) was directly associated with baseline ADAS-Cog (Rho&#x2009;=&#x2009;0.62 p&#x2009;=&#x2009;0.027)
it was the PwD with a worse cognitive functioning (higher scores) at the baseline whose passive isolated behaviors increased
Mrs. A was one of the PwD whose visits to the TG increased from pre-to post-intervention (September 2021 to July 2022) despite a worsening of her behavioral symptoms. The changes qualitatively perceived by the staff prompted a new assessment of her general cognitive functioning, mood, behavior and quality of life (in August 2022; See <a href="#fig3">Figure 3</a>)
Mrs. A is a 70-year-old with a diagnosis of Alzheimer&#x2019;s disease. She once worked as a nurse. She is widowed, and has three children. She loved cooking and gardening. Before entering the center, she often tended to wander, and would get lost. On arrival in 2019 (3&#x2009;years before our study) her cognitive impairment was moderate&#x2013;severe [Mini-Mental State Exam&#x2013;MMSE: 11.90/30; (<a href="#ref31">31</a>)]
By 2021 she had stopped speaking and seeking contact and interaction with others
She moves autonomously indoors and was able to go out into the garden unassisted
Same as in the case study, but the measures administered at pre-intervention (MoCA, ADAS-Cog, CDDS, NPI, QoL-AD; see <a href="#fig3">Figure 3</a>) were administered again at post-intervention
In the 12&#x2009;months (September 2021 to August 2022)
A&#x2019;s cognitive functioning level worsened
making it impossible to administer the MoCA or ADAS-Cog at post-test (MoCA pre&#x2009;=&#x2009;10.4
post&#x2009;=&#x2009;NA; ADAS-Cog pre&#x2009;=&#x2009;53.3
The frequency and severity of her behavioral symptoms worsened (NPI pre-&#x2009;=&#x2009;12
her depression became more severe (CDDS pre&#x2009;=&#x2009;0
and her quality of life deteriorated (QoL-AD pre&#x2009;=&#x2009;30
A&#x2013;specific active isolated and social behaviors after the intervention
The results of the study on the whole sample and a single case show the benefits of intervention to improve an existing TG at a dementia care center
The intervention involved adding various types of medium-sized plants (flowers and shrubs) to provide more color (with branches and flowers) and smells in all seasons
and our results indicate that less severe depressive symptoms in PwD favored the expression of positive (social) behaviors after the greenery in a TG was improved
A had a passion for gardening before she developed dementia
and this may be part of the reason why she spends time in the garden nowadays and interacts with its elements
increasing her functional behaviors despite her worsening clinical profile
This underscores the importance of the person-centered approach to quality-improving interventions
which in the present case involved making changes to the greenery in a TG
and whether interventions can counteract dementia symptoms at this level too
This study offers a contribution on the positive effect of improvement interventions based on adding plant species in existing TGs for PwD
Such interventions seem to be beneficial in increasing the frequency of their visits and their functional behaviors
This seems particularly evident in PwD with less severe depressive symptoms
This line of research deserves to be furthered to identify customized TG design criteria
and upgrading of TGs for people with dementia considering individual profiles to sustain their psychological wellbeing
For garden design consulting: Rossella Sibella
The Supplementary material for this article can be found online at: <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1183934/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1183934/full#supplementary-material</a>
1. <a class="footnotetextanchor" href="#xfn0003" title="">^</a>The etiology for the 21 PwD was: 4 with Alzheimer&#x2019;s disease; 4 with vascular dementia; 5 with mixed dementia; and 8 with other types of dementia
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Basso A and Pazzaglia F (2023) Psychological impacts of intervention to improve a therapeutic garden for older adults with dementia: a case study conducted at a care facility
Received: 13 March 2023; Accepted: 17 April 2023; Published: 10 May 2023
Copyright &#x000A9; 2023 Meneghetti, Murroni, Borella, Melendugno, Carbone, Goldin, Cavalli, Basso and Pazzaglia. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
&#x0002A;Correspondence: Chiara Meneghetti, <a id="encmail">Y2hpYXJhLm1lbmVnaGV0dGlAdW5pcGQuaXQ=</a>; Francesca Pazzaglia, <a id="encmail">ZnJhbmNlc2NhLnBhenphZ2xpYUB1bmlwZC5pdA==</a>
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