***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate financial capacity in patients with Alzheimer disease ( AD ) using a new theoretical model and prototype psychometric instrument . DESIGN Cross-sectional comparisons of older control subjects ( n=23 ) and patients with mild ( n=30 ) and moderate AD ( n=20 ) . MAIN OUTCOME MEASURES Financial capacity was measured using the Financial Capacity Instrument , a prototype psychometric instrument that tests financial capacity using 14 tasks of financial ability comprising 6 clinical ly relevant domains of financial activity : basic monetary skills , financial conceptual knowledge , cash transactions , checkbook management , bank statement management , and financial judgment . RESULTS The Financial Capacity Instrument tasks and domains showed adequate to excellent internal , interrater , and test-retest reliabilities . At the task level , patients with mild AD performed equivalently with controls on simple tasks such as counting coins/currency and conducting a 1-item grocery purchase , but significantly below controls on more complex tasks such as using a checkbook/register and underst and ing and using a bank statement . At the domain level , patients with mild AD performed significantly below controls on all domains except basic monetary skills .  Patients with moderate AD performed significantly below controls and patients with mild AD on all tasks and domains . Regarding capacity status outcomes ( capable , marginally capable , incapable ) on domains , patients with mild AD had high proportions of marginally capable or incapable outcomes ( range , 47%-87 % ) , particularly on difficult domains like bank statement management ( domain 5 ) and financial judgment ( domain 6 ) , but variability in individual outcomes . Patients with moderate AD had almost exclusively incapable outcomes across the 6 domains ( range , 90%-100 % ) . CONCLUSIONS Financial capacity is already significantly impaired in mild AD . Patients with mild AD demonstrate deficits in more complex financial abilities and impairment in most financial activities .  Patients with moderate AD demonstrate severe impairment of all financial abilities and activities . The Financial Capacity Instrument has promise as an instrument for assessing domain-level financial activities and task-specific financial abilities in patients with dementia . Arch Neurol . 2000 OBJECTIVES We studied a representative cohort of community-dwelling elderly persons to ( i ) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses , ( ii ) compare the cognitive status of participants who have and have not lost independence in these functional activities , and ( iii ) determine whether a hierarchical scale of functional loss is associated with declining cognitive status . METHODS A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed . At baseline and 5 years later ,  cognitive status with the Modified Mini-Mental State Examination ( 3MS ) and functional status with 14 Older American Re sources and Services ( OARS ) items were measured . For each OARS functional item , the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared . RESULTS For each functional item , the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent ( e.g. , ability to do finances ) , with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence . A hierarchy of functional items existed , with instrumental activities of daily living ( ADLs ) ( e.g. , shopping , banking , and cooking ) being lost at higher cognitive scores than basic ADL items ( e.g. , eating , dressing , and walking ) , although there was some overlap . CONCLUSIONS This is the first prospect i ve study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks . Clear cognitive thresholds at which development of dependency in OARS functional items occurred . By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items , a natural hierarchy of functional loss associated with cognitive decline emerged . For caregivers , clinicians , and health policy makers , this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition , potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning Introduction Knowledge of longitudinal progression in mild Alzheimer ’s disease ( AD ) is required for the evaluation of disease-modifying therapies . Our aim was to observe the effects of long-term cholinesterase inhibitor ( ChEI ) therapy in mild AD patients in a routine clinical setting . Methods This was a prospect i ve , open-label , non-r and omized , multicenter study of ChEI treatment ( donepezil , rivastigmine or galantamine ) conducted during clinical practice . The 734 mild AD patients ( Mini-Mental State Examination ( MMSE ) score 20 to 26 ) were assessed at baseline and then semi-annually over three years . Outcome measures included the MMSE , Alzheimer ’s Disease Assessment Scale-cognitive subscale ( ADAS-cog ) , Clinician ’s Interview-Based Impression of Change ( CIBIC ) and Instrumental Activities of Daily Living ( IADL ) scale . Results After three years of ChEI therapy , 31 % ( MMSE ) and 33 % ( ADAS-cog ) of the patients showed improved/unchanged cognitive ability , 33 % showed improved/unchanged global performance and 14 % showed improved/unchanged IADL capacity . Higher mean dose of ChEI and lower educational level were both predictors of more positive longitudinal cognitive and functional outcomes . Older participants and those with a better IADL score at baseline exhibited a slower rate of cognitive decline , whereas younger participants and those with higher cognitive status showed more preserved IADL ability over time . Gender and apolipoprotein E ( APOE ) genotype showed inconsistent results . Prediction models using the abovementioned scales are presented . Conclusions In naturalistic mild AD patients , a marked deterioration in IADL compared with cognitive and global long-term outcomes was observed , indicating the importance of functional assessment s during the early stages of the disease . The participants ’ time on ChEI treatment before inclusion in studies of new therapies might affect their rate of decline and thus the comparisons of changes in scores between various studies . An increased underst and ing of expected disease progression in different domains and potential predictors of disease progression is essential for assessment of future therapies in AD BACKGROUND Subjects with a mild cognitive impairment ( MCI ) have a memory impairment beyond that expected for age and education yet are not demented . These subjects are becoming the focus of many prediction studies and early intervention trials . OBJECTIVE To characterize clinical ly subjects with MCI  cross-sectionally and longitudinally . DESIGN A prospect i ve , longitudinal inception cohort . SETTING General community clinic . PARTICIPANTS A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease ( AD ) , all from a community setting as part of the Mayo Clinic Alzheimer 's Disease Center/Alzheimer 's Disease Patient Registry , Rochester , Minn. MAIN OUTCOME MEASURES The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the  Mini-Mental State Examination , Wechsler Adult Intelligence Scale-Revised , Wechsler Memory Scale-Revised , Dementia Rating Scale , Free and Cued Selective Reminding Test , and Auditory Verbal Learning Test .  Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer 's Disease and Related Disorders Association criteria , respectively . RESULTS The primary distinction between control subjects and subjects with MCI was in the area of memory , while other cognitive functions were comparable . However , when the subjects with MCI were compared with the patients with very mild AD , memory performance was similar , but patients with AD were more impaired in other cognitive domains as well . Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD . CONCLUSIONS Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD . They appear to constitute a clinical entity that can be characterized for treatment interventions Background To investigate the long-term effects of cholinesterase inhibitor ( ChEI ) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services ( HHS ) by patients with Alzheimer ’s disease ( AD ) . Methods This 3-year , prospect i ve , multicenter study included 880 AD patients treated with donepezil , rivastigmine , or galantamine in a routine clinical setting . At baseline and every 6 months , the patients were assessed with several rating scales , including the Mini-Mental State Examination , Instrumental Activities of Daily Living ( IADL ) , and Physical Self-Maintenance Scale . Doses of ChEI and amounts of HHS per week were recorded . Cox regression models were used to predict the time to HHS , and multiple linear regression was used to predict the volume of HHS used . Results During the study , 332 patients ( 38 % ) used HHS . Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs , better IADL ability , and living with family . Men , younger individuals , and those with a slower IADL decline showed a longer time to HHS , whereas female sex , a lower cognitive status , or more medications at baseline predicted fewer hours of HHS . Conclusions Higher doses of ChEI might reduce the use of HHS , possibly reducing the costs of community-based care . Female spouses provide more informal care than do male spouses , so the likelihood of using HHS is greater among women with AD . The “ silent group ” of more cognitively impaired and frail elderly AD patients receives less HHS , which might precipitate institutionalization OBJECTIVES To study the subtle changes in instrumental activities of daily living ( IADLs ) over the 10 years preceding the clinical diagnosis of dementia . DESIGN Prospect i ve cohort design ed in 1988 to study cerebral and functional aging . SETTING Community-based study in southwestern France . PARTICIPANTS The sample included 104 incident cases of dementia at the 10-year follow-up ( T10 ) and 882 subjects free of dementia at the same visit , all forming part of the PAQUID Study . MEASUREMENTS Restriction in four IADLs  was studied  ( telephone , transportation , medication , and finances )  2 , 5 , 7 , and 10 years before the T10 visit . RESULTS The future dementia cases had greater IADL restrictions 10 years before the clinical diagnosis of dementia and more-rapid functional deterioration over time . Controlled for age , sex , and education , subjects restricted in at least two IADLs at baseline had a higher risk of dementia 10 years later ( odds ratio (OR)=2.59 , 95 % confidence interval (CI)=1.24 - 5.38 ) . In finances , difficulty at baseline was a predictor of dementia 10 years later ( OR=2.15 , 95 % CI=1.13 - 4.08 ) . CONCLUSION This study is the first to show that , 10 years before the clinical diagnosis of dementia , subjects who later developed dementia performed worse in complex activities of daily living , which may constitute an early marker of the disease . In practice , restriction in IADLs may be a simple and useful tool for screening subjects at risk of developing dementia in the long term OBJECTIVE The day-out task ( DOT ) , a naturalistic task that requires multitasking in a real-world setting , was used to examine everyday functioning in individuals with mild cognitive impairment ( MCI ) . METHOD Thirty-eight participants with MCI and 38 cognitively healthy older adult controls prioritized , organized , initiated , and completed a number of subtasks in a campus apartment to prepare for a day out ( e.g. , determine and gather change for bus , bring a magazine ) . Participants also completed tests assessing cognitive constructs important in multitasking ( i.e. , retrospective memory , prospect i ve memory , planning ) . RESULTS As compared with controls , the MCI group required more time to complete the DOT and demonstrated poorer task accuracy , performing more subtasks incompletely and inaccurately . Despite poorer DOT task accuracy , the MCI and control groups approached completion of the DOT in a similar manner . For the MCI group , retrospective memory was a unique predictor of the number of subtasks left incomplete and inaccurate , while prospect i ve memory was a unique predictor of DOT sequencing . The DOT measures , but not the cognitive tests , were predictive of knowledgeable informant report of everyday functioning . CONCLUSIONS THESE findings suggest that difficulty remembering and keeping track of multiple goals and sub goals may contribute to the poorer performance of individuals with MCI in complex everyday situations Current criteria for mild cognitive impairment ( MCI ) require “ essentially intact ” performance of activities of daily living ( ADLs ) , which has proven difficult to operationalize . We sought to determine how well the Functional Activities Question naire ( FAQ ) , a st and ardized assessment of instrumental ADLs , delineates the clinical distinction between MCI and very mild Alzheimer disease ( AD ) . We identified 1801 individuals in the National Alzheimer 's Coordinating Center Uniform Data Set with MCI ( n=1108 ) or very mild AD ( n=693 ) assessed with the FAQ and r and omized them to the development or test sets . Receiver-operator curve ( ROC ) analysis of the development set identified optimal cut-points that maximized the sensitivity and specificity of FAQ measures for differentiating AD from MCI and were vali date d with the test set . ROC analysis of total FAQ scores 
    Output:
    
Financial capacity in patients with MCI was affected in the majority of studies .
Performance-based instruments showed slight advantages ( in terms of effect sizes ) in detecting group differences in IADL functioning between patients with MCI , patients with Alzheimer ’s disease and healthy controls .
Conclusion IADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI .
A reliable identification of such deficits is necessary , as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits .