***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 
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    Input: 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 Intima-media thickness ( IMT ) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aim ed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases ( stroke , myocardial infa rct ion and peripheral artery diseases ) . The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to st and ardize IMT measurements is expressed through this up date d consensus . Plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50 % of the surrounding IMT value or demonstrates a thickness > 1.5 mm as measured from the media-adventitia interface to the intima-lumen interface . St and ard use of IMT measurements is based on physics , technical and disease-related principles as well as agreements on how to perform , interpret and document study results . Harmonization of carotid image acquisition and analysis is needed for the comparison of the IMT results obtained from epidemiological and interventional studies around the world . The consensus concludes that there is no need to ‘ treat IMT values ’ nor to monitor IMT values in individual patients apart from exceptions named , which emphasize that inside r and omized clinical trials should be performed . Although IMT has been suggested to represent an important risk marker , according to the current evidence it does not fulfill the characteristics of an accepted risk factor . St and ardized methods recommended in this consensus statement will foster homogenous data collection and analysis . This will help to improve the power of r and omized clinical trials incorporating IMT measurements and to facilitate the merging of large data bases for meta-analyses A , Delecluse C et al. Habitual level of physical activity and muscle fatigue of the elbow flexor muscles in older men . L et al. Lower extremity performance is associated with daily life physical activity  in individuals with and without peripheral arterial disease . Muscle strength in the triceps surae and objective ly measured customary walking activity in men and women over 65 years of age . A short physical performance battery assessing lower extremity function : association with self-reported disability and prediction of mortality and nursing home admission . The association between physical function and lifestyle activity and exercise in the health , aging and body composition study . Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77 : the Jerusalem longitudinal study . Rennie KL et al. Validity and repeatability of a simple index derived from the short physical activity question naire used in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study . SIR — The Folstein Mini-Mental State Examination ( MMSE ) , developed in 1975 as a bedside test of cognitive function , has been extensively used in clinical practice and research and is widely accepted as a clinical tool for diagnosing and monitoring dementia [ 1 ] . Despite its low sensitivity and specificity ( 0.56 and 0.73 , respectively , in one recent study ) [ 2 ] , comparable tools , including the Modified MMSE of Teng and Chui [ 3 ] have not received such widespread acceptance . It contains 11 questions that test orientation , registration , attention , calculation , recall , language and visuospatial functioning , with a maximum score of 30 . It takes minutes to administer and is practical for routine clinical use . Most questions are administered verbally . Hearing loss reduces performance on the verbal parts of the examination even in cognitively intact patients , with potential diagnostic error and alteration of management [ 4 ] . This is of concern , as hearing impairment affects over one-fourth of people over 65 years of age , and half of those over 75 years in most industrialised nations [ 5 ] . Uhlmann [ 6 ] tested 71 Alzheimer 's disease subjects with varying levels of hearing , using both written and st and ard versions of the MMSE .  Paradoxically , they found that hearing-impaired subjects scored higher in the st and ard than the written version , while subjects with normal hearing performed better using the written version , although these findings were not statistically significant . We ( M.M. ) developed a written version of the MMSE , found it clinical ly useful , and report here an evaluation of its performance in a hospital-based population Background : The cognitive continuum in the elderly population can be conceptually divided into those who are functioning normally ( control subjects ) , those with a mild cognitive impairment ( MCI ) , and those with probable AD . Objectives : To test the hypothesis that the annualized rates of hippocampal atrophy differ as a function of both baseline and change in clinical group membership ( control , MCI , or AD ) . Methods : The authors identified 129 subjects from the Mayo Clinic AD Research Center/AD Patient Registry who met established criteria for normal control subjects , MCI , or probable AD , both at entry and at the time of a subsequent clinical follow-up evaluation 3 ± 1 years later . Each subject underwent an MRI examination of the head at the time of the initial assessment and at follow-up clinical assessment ; the annualized percentage change in hippocampal volume was computed . Subjects who were classified as controls or patients with MCI at baseline could either remain cognitively stable or could decline to a lower functioning group over the period of observation . Results : The annualized rates of hippocampal volume loss for each of the three initial clinical groups decreased progressively in the following order : AD > MC > control . Within the control and MCI groups , those who declined had a significantly greater rate of volume loss than those who remained clinical ly stable . The mean annualized rates of hippocampal atrophy by follow-up clinical group were : control-stable 1.73 % , control-decliner 2.81 % , MCI-stable 2.55 % , MCI-decliner 3.69 % , AD 3.5 % . Conclusion : Rates of hippocampal atrophy match both baseline cognitive status and the change in cognitive status over time in elderly persons who lie along the cognitive continuum from normal to MCI to AD Cerebral white matter lesions ( WML ) seen on magnetic resonance imaging scans are associated with cardiovascular disease and vascular risk factors . To assess the association between WML and atherosclerosis , we studied 111 people , aged 65 to 85 years , r and omly sample d , and stratified by age and sex , from participants in the Rotterdam Study . Cerebral T2-weighted magnetic resonance images in the axial plane were obtained for all subjects . Carotid atherosclerosis was ultrasonographically assessed by the presence of stenosis , measurement of intima to media wall thickness ( IMT ) , and the presence of atherosclerotic plaques . A possible or definite myocardial infa rct ion on an electrocardiogram was used as an indicator of coronary atherosclerosis . The ankle to arm systolic blood pressure ratio ( ABI ) was determined , and peripheral arterial disease was defined as an ABI lower than 0.90 in at least one side . Carotid atherosclerosis was significantly more pronounced in people with WML . The difference in common carotid IMT was 0.13 mm ( 95 % confidence interval [ CI ] 0.04 - 0.21 ) , whereas the odds ratio of WML associated with plaques in the carotid bifurcation was 3.9 . The degree of internal carotid artery stenosis was not , however , associated with WML . The mean ABI was significantly lower in people with WML than in those without lesions with a difference of -0.11 ( 95 % CI -0.21 to -0.01 ) . The odds ratio of WML associated with peripheral arterial disease and a possible or definite myocardial infa rct ion was 2.4 and 3.1 , respectively . We conclude that atherosclerosis , indicated by increased common carotid IMT , carotid plaques , and a lower ABI , is related to WML To evaluate the association between common carotid intima-media thickness and noninvasively assessed atherosclerosis elsewhere in the carotid artery , we used data from the Rotterdam Study , a single-center population -based , prospect i ve follow-up study among 7983 subjects aged 55 years or older . Baseline measurements included  ultrasonographic evaluation  of the vessel wall characteristics of the carotid arteries , that is , assessment of the presence of atherosclerotic lesions , measurement of common carotid intima-media thickness , and determination of the presence of hemodynamically significant stenosis . The present analysis is based on data obtained from the first 1000 participants . The results were adjusted for age and gender . An increase of 1 st and ard deviation in common carotid intima-media thickness ( 0.19 mm ) doubled the risk of plaques in the carotid bifurcation : odds ratio 2.0 ( 95 % confidence interval ( CI ) : 1.6 , 2.4 ) . For hemodynamically significant stenosis of the right internal carotid artery ( > or = 50 % ) , a 1.4 ( 95 % CI : 1.0 , 2.0 ) increased risk was found . The risk of atherosclerotic plaques in the bifurcation in subjects with an intima-media thickness above 0.89 mm ( upper quintile ) relative to those with an intima-media thickness below 0.63 mm ( lowest quintile ) was 6.0 ( 95 % CI : 3.5 , 10.2 ) . For internal carotid artery stenosis , a relative risk of 2.8 ( 95 % CI 0.5 , 15.7 ) was found . The findings of the present study provide evidence that increased common carotid intima-media thickness indicates atherosclerosis at other sites of the carotid artery . This study lends support to the view that noninvasively assessed increased intima-media thickness of the distal common carotid artery is an indicator of generalized atherosclerosis Stroke is considered the second most common cause of dementia , but the magnitude of the risk posed by stroke has not been fully clarified . The aim of this study was to determine the long-term risk of developing dementia after stroke onset in a hospitalized cohort . We prospect ively examined 185 nondemented patients aged ≥60 years hospitalized with ischemic stroke and 241 age-matched nondemented controls without stroke from the same community using neurologic , neuropsychological , and functional assessment s given annually . Using criteria modified from the DSM-III-R , we diagnosed incident dementia based on the annual examination findings . We used life-table methods to estimate incidence in the two groups , Kaplan-Meier analysis to determine the proportion surviving without dementia , and Cox proportional-hazards analysis to compute the relative risk ( RR ) of dementia after 1 to 4 years of follow-up . The incidence of dementia was 8.4 per 100 person-years in the stroke group and 1.3 per 100 person-years in the control group . After 52 months of follow-up , the cumulative proportion ( ±SE ) surviving without dementia was 66.3 ± 5.5 % for stroke and 90.3 ± 4.3 % for control subjects . The RR of dementia associated with stroke compared with controls was 5.5 ( 95 % CI , 2.5 to 11.1 ) after adjusting for demographic factors . Older age at stroke onset and fewer years of education were significant covariates , but sex and race were not . A low score on the Mini-Mental State Examination at baseline was a significant predictor when added to this model . We conclude that ischemic stroke in elderly persons increases the long-term risk of developing dementia by approximately five-fold compared with those without stroke . Age , education , and baseline intellectual function contribute independently to that risk The agreement between  neuropsychologists  identifying  cognitive impairment ( CI ) in older adults was examined , as were factors influencing the classification process . Twenty four ne 
    Output:
    
However , currently no definitive evidence of an association between increased IMT and cognitive impairment can be established .