***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: The call for formal capacity assessment s of potential research participants with impairments due to illnesses such as Alzheimer 's disease is increasing . Because such an evaluation of every potential subject requires significant re sources , clinicians and research ers may want to know the utility and the limits of a familiar cognitive screening test , the  Mini Mental State Examination ( MMSE ) , in capacity evaluations . In this study of 37 patients with mild to moderate Alzheimer 's disease , a fairly wide range of  MMSE scores ( 21 to 25 , which includes an often used cutoff for " normal " ) did not discriminate capacity status well . Nevertheless , there may still be approaches that enhance the practical utility of the  MMSE  in capacity assessment Though cognitive function is proven to be an independent predictor of survival in patients with intrinsic brain tumors , cognitive functions are still rarely considered . Aim of this study was to assess neurocognitive function and to identify risk factors for neurocognitive deficits . 103 patients with primary neuroepithelial tumors who received tumor resections or biopsies  were included in this prospect i ve study . The following data was acquired : mini-mental state examination , preoperative tumor volume , WHO grade , tumor entity and location , and the Karnofsky performance status scale . Furthermore , patients participated in extensive neuropsychological testing of attentional , memory and executive functions . General factors like age , clinical status , WHO grade , tumor volume and tumor location correlated with patients ’ neurocognitive functions . Affection of the parietal lobe result ed in significant impairment of attention and memory functions . Frontal lobe involvement significantly affected patients ’ abilities in planning complex actions and novel problem solving . Patients with temporal lesions were more likely to have impaired memory and executive functions . Comparing results among neuroepithelial tumor patients enables the identification of risk factors for cognitive impairment . General parameters such as age , KPS score , tumor size , and WHO grade are apart from the respective tumor location of high importance for neurocognitive function Objective : Patients with malignant glioma ( MG ) must make ongoing medical treatment decisions concerning a progressive disease that erodes cognition . We prospect ively assessed medical decision-making capacity ( MDC ) in patients with MG using a st and ardized psychometric instrument . Methods : Participants were 22 healthy controls and 26 patients with histologically verified MG . Group performance was compared on the  Capacity to Consent to Treatment Instrument ( CCTI ) , a psychometric measure of MDC incorporating 4 st and ards ( choice , underst and ing , reasoning , and appreciation ) , and on neuropsychological and demographic variables . Capacity outcomes ( capable , marginally capable , or incapable ) on the CCTI st and ards were identified for the MG group . Within the MG group , scores on demographic , clinical , and neuropsychological variables were correlated with scores on each CCTI st and ard , and significant bivariate correlates were subsequently entered into exploratory stepwise regression analyses to identify multivariate cognitive predictors of the CCTI st and ards . Results : Patients with MG performed significantly below controls on consent st and ards of underst and ing and reasoning , and showed a trend on appreciation . Relative to controls , more than 50 % of the patients with MG demonstrated capacity compromise ( marginally capable or incapable outcomes ) in MDC . In the MG group , cognitive measures of verbal acquisition/recall and , to a lesser extent , semantic fluency predicted performance on the appreciation , reasoning , and underst and ing st and ards . Karnofsky score was also associated with CCTI performance . Conclusions : Soon after diagnosis , patients with malignant glioma ( MG ) have impaired capacity to make treatment decisions relative to controls . Medical decision-making capacity ( MDC ) impairment in MG seems to be primarily related to the effects of short-term verbal memory deficits . Ongoing assessment of MDC in patients with MG is strongly recommended Background and Purpose — The Mini-Mental State Examination ( MMSE ) is insensitive to mild cognitive impairment and executive function . The more recently developed Montreal Cognitive Assessment ( MoCA ) , an alternative , brief 30-point global cognitive screen , might pick up more cognitive abnormalities in patients with cerebrovascular disease . Methods — In a population -based study ( Oxford Vascular Study ) of transient ischemic attack and stroke , the MMSE and MoCA were administered to consecutive patients at 6-month or 5-year follow-up . Accepted cutoffs of MMSE < 27 and MoCA < 26 were taken to indicate cognitive impairment . Results — Of 493 patients , 413 ( 84 % ) were testable . Untestable patients were older ( 75.5 versus 69.9 years , P<0.001 ) and often had dysphasia ( 24 % ) or dementia ( 15 % ) . Although MMSE and MoCA scores were highly correlated ( r2=0.80 , P<0.001 ) , MMSE scores were skewed toward higher values , whereas MoCA scores were normally distributed : median and interquartile range 28 ( 26 to 29 ) and 23 ( 20 to 26 ) , respectively . Two hundred ninety-one of 413 ( 70 % ) patients had MoCA < 26 of whom 162 had MMSE ≥27 , whereas only 5 patients had MoCA ≥26 and MMSE < 27 ( P<0.0001 ) . In patients with MMSE ≥27 , MoCA < 26 was associated with higher Rankin scores ( P=0.0003 ) and deficits in delayed recall , abstract ion , visuospatial/executive function , and sustained attention . Conclusion — The MoCA picked up substantially more cognitive abnormalities after transient ischemic attack and stroke than the MMSE , demonstrating deficits in executive function , attention , and delayed recall With more rapid advances in potential treatments for brain tumours , the number of clinical trials for brain tumour patients is rising . In the context of the challenges of recruitment and enrollment of patients with brain tumors , the dichotomy between the paucity of subjects and abundance of clinical trials creates a unique ethical dilemma , whereby a single patient may be eligible for several studies . Here , we identify and present three approaches for recruiting and enrolling patients who may be eligible for several trials . The ethical implication s of the full disclosure , paternalistic , and r and om approaches are discussed . The full disclosure approach presents information to patients regarding all ongoing concurrent trials , allowing them to make an informed decision , while the paternalistic approach allows the healthcare providers to select the trial for which they believe the patient is most suitable . These introduce the biases into circumstances where equipoise is necessary and risk selection bias in study design . The r and om approach r and omly allocates patients to each trial , which may erode patient autonomy and decrease trial enrollment .  Brain tumor patients comprise a vulnerable population and it remains incumbent on healthcare providers to maintain the highest ethical st and ards when approaching them for clinical research . Changes in clinical trial design are required to mitigate the conflicts created by competition for patients PURPOSE Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning . Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases . METHODS AND MATERIAL S Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were review ed . The hippocampus was contoured , and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus . Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy ( IMRT ) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions . RESULTS On average , the hippocampal avoidance volume was 3.3 cm(3 ) , occupying 2.1 % of the whole-brain planned target volume . Helical tomotherapy spared the hippocampus , with a median dose of 5.5 Gy and maximum dose of 12.8 Gy . LINAC-based IMRT spared the hippocampus , with a median dose of 7.8 Gy and maximum dose of 15.3 Gy . On a per-fraction basis , mean dose to the hippocampus ( normalized to 2-Gy fractions ) was reduced by 87 % to 0.49 Gy(2 ) using helical tomotherapy and by 81 % to 0.73 Gy(2 ) using LINAC-based IMRT .  Target coverage and homogeneity was acceptable with both IMRT modalities , with differences largely attributed to more rapid dose fall-off with helical tomotherapy . CONCLUSION Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity . Based on compelling pre clinical evidence , a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit 
    Output:
    
Summary Although there are obvious inherent limitations to solely assessing cognition , most research consistently demonstrated increased risk of incapacity in brain tumour patients with cognitive impairment .