***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: OBJECTIVES To provide evidence regarding the clinical efficacy of cognitive rehabilitation ( CR ) in early-stage Alzheimer disease ( AD ) . DESIGN Single-blind r and omized controlled trial comparing CR with relaxation therapy and no treatment . SETTING Outpatient , community-based setting . PARTICIPANTS Sixty-nine individuals ( 41 women , 28 men ; mean age 77.78 years , st and ard deviation 6.32 , range = 56 - 89 ) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above , and receiving a stable dose of acetylcholinesterase-inhibiting medication . Forty-four family carers also contributed . INTERVENTION Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies , techniques for learning new information , practice in maintaining attention and concentration , and techniques for stress management . MEASUREMENTS The primary outcomes were goal performance and satisfaction , assessed using the Canadian Occupational Performance Measure . Question naires assessing mood , quality of life and career strain , and a brief neuropsychological test battery were also administered . A subset of participants underwent functional magnetic resonance imaging ( fMRI ) . RESULTS CR produced significant improvement in ratings of goal performance and satisfaction , whereas scores in the other two groups did not change . Behavioral changes in the CR group were supported by fMRI data for a subset of participants . CONCLUSIONS The findings support the clinical efficacy of CR in early-stage AD . CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition The efficacy of a cognitive intervention consisting of training in face-name associations , spaced retrieval , and cognitive stimulation was tested in a sample of 37 patients ( 16 men , 21 women ) with probable Alzheimer disease ( AD ) . Patients with AD were r and omly assigned to receive either the cognitive intervention or a mock ( placebo ) intervention for 5 weeks . The placebo group then crossed over to receive the intervention . During the intervention , AD patients showed significant improvement in recall of personal information , face-name recall , and performance on the Verbal Series Attention Test . Improvement did not generalize to additional neuropsychologic measures of dementia severity , verbal memory , visual memory , word generation , or motor speed , or to caregiver-assessed patient quality of life . Results suggest that although face-name training , spaced retrieval , and cognitive stimulation may produce small gains in learning personal information and on a measure of attention , improvement does not generalize to overall neuropsychologic functioning or patient quality of life BACKGROUND Psychological therapy groups for people with dementia are widely used , but their cost-effectiveness has not been explored . AIMS To investigate the cost-effectiveness of an evidence -based cognitive stimulation therapy ( CST ) programme for people with dementia as part of a r and omised controlled trial . METHOD A total of 91 people with dementia , living in care homes or the community , received a  CST group intervention twice weekly for 8 weeks ; 70 participants with dementia received treatment as usual .  Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated . A cost-effectiveness analysis was conducted with cognition as the primary outcome , and quality of life as the secondary outcome . Cost-effectiveness acceptability curves were plotted . RESULTS Cognitive stimulation therapy has benefits for cognition and quality of life in dementia , and costs were not different between the groups . Under reasonable assumptions , there is a high probability that CST is more cost-effective than treatment as usual , with regard to both outcome measures . CONCLUSIONS Cognitive stimulation therapy for people with dementia has effectiveness advantages over , and may be more cost-effective than , treatment as usual OBJECTIVE The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease ( AD ) patients receiving a cholinesterase inhibitor . METHODS Twenty-five participants in the Cognitive Rehabilitation ( CR ) condition participated in two 45-minute sessions twice per week for 24 total sessions . CR training included face-name association tasks , object recall training , functional tasks ( e.g. , making change , paying bills ) , orientation to time and place , visuo-motor speed of processing , and the use of a memory notebook .  Nineteen participants in the Mental Stimulation ( MS ) condition had equivalent therapist contact and number of sessions , which consisted of interactive computer games involving memory , concentration , and problem-solving skills . RESULTS Compared with the MS condition , participants in CR demonstrated improved performance on tasks that were similar to those used in training . Gains in recall of face-name associations , orientation , cognitive processing speed , and specific functional tasks were present post-intervention and at a 3-month follow-up . CONCLUSION A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in mildly impaired AD patients The efficacy of a memory-training program to improve word-list recall and recognition was evaluated in 34 patients with probable Alzheimer 's disease ( AD ) . The patients , who were all taking donepezil throughout the 6-week intervention , were r and omly assigned to a cognitive intervention group or a control group . The Control group received didactic presentations but no formal memory training . Patients were assessed on neuropsychological tests before the 6-week training program , immediately after the training , and 8 weeks after completion of the training . Caregivers , who were blind to group assignment , completed activities of daily living ( ADLs ) and everyday memory question naires at all three timepoints . No significant main effects of group ( training vs. control ) or time were observed on any outcome measures , nor were any significant interactions found . In terms of " process " measures during the 6-week training program , the patients demonstrated modest improvement on recall and recognition of test material presented during the training sessions . These results suggest that although modest gains in learning and memory may be evident in AD patients who are taught specific strategies , the benefits do not generalize to other measures of neuropsychological functioning after a brief intervention 70 patients with probable Alzheimer 's disease were r and omly allocated to four groups : 17 patients received only social support , 18 cognitive training twice a week , in 17 cognitive training was combined with pyritinol 2 x 600 mg/day and in 18 cognitive training was combined with phosphatidylserine 2 x 200 mg/day . Treatment duration was 6 months . Before and after treatment , the patients underwent  neuropsychological testing as well as measurement of the regional cerebral metabolic rate for glucose using positron emission tomography and 18F-2-fluoro-2-deoxy-D-glucose .  Before treatment the groups were comparable in respect to resting and activated glucose pattern achieved by a visual recognition task . Electrophysiological changes were assessed as EEG power , globally and in 4 frequency b and s. This 6-month study in four groups of patients with Alzheimer 's disease indicated that phosphatidylserine treatment has an effect on different measures of brain function . Since neuropsychological improvements were best documented after 8 and 16 weeks and faded towards the end of the treatment period , it must be concluded that this symptomatic therapy is mainly of short-term benefit and was overcome by the progressive pathological changes at the end of the treatment period BACKGROUND Cholinesterase inhibitors produce small improvements in cognitive and global assessment s in Alzheimer 's disease . We aim ed to determine whether donepezil produces worthwhile improvements in disability , dependency , behavioural and psychological symptoms , carers ' psychological wellbeing , or delay in institutionalisation . If so , which patients benefit , from what dose , and for how long ? METHODS 565 community-resident patients with mild to moderate Alzheimer 's disease entered a 12-week run-in period in which they were r and omly allocated donepezil ( 5 mg/day ) or placebo .  486 who completed this period were rer and omised to either donepezil ( 5 or 10 mg/day ) or placebo , with double-blind treatment continuing as long as judged appropriate . Primary endpoints were entry to institutional care and progression of disability , defined by loss of either two of four basic , or six of 11 instrumental , activities on the Bristol activities of daily living scale ( BADLS ) . Outcome assessment s were sought for all patients and analysed by logrank and multilevel models . FINDINGS Cognition averaged 0.8 MMSE ( mini-mental state examination ) points better ( 95 % CI 0.5 - 1.2 ; p<0.0001 ) and functionality 1.0 BADLS points better ( 0.5 - 1.6 ; p<0.0001 ) with donepezil over the first 2 years . No significant benefits were seen with donepezil compared with placebo in institutionalisation ( 42 % vs 44 % at 3 years ; p=0.4 ) or progression of disability ( 58 % vs 59 % at 3 years ; p=0.4 ) . The relative risk of entering institutional care in the donepezil group compared with placebo was 0.97 ( 95 % CI 0.72 - 1.30 ; p=0.8 ) ; the relative risk of progression of disability or entering institutional care was 0.96 ( 95 % CI 0.74 - 1.24 ; p=0.7 ) . Similarly , no significant differences were seen between donepezil and placebo in behavioural and psychological symptoms , carer psychopathology , formal care costs , unpaid caregiver time , adverse events or deaths , or between 5 mg and 10 mg donepezil . INTERPRETATION Donepezil is not cost effective , with benefits below minimally relevant thresholds . More effective treatments than cholinesterase inhibitors are needed for Alzheimer 's disease Objective : To determine the efficacy of cognitive stimulation therapy ( CST ) in the treatment of neuropsychiatric symptoms in patients with Alzheimer ’s disease . Design : A r and omized , controlled , rater-blind clinical trial . Setting : The military sanatorium . Subjects : Thirty-two patients with mild to moderate Alzheimer ’s disease exhibiting marked neuropsychiatric symptoms were included in the study . Intervention : All 32 patients were r and omly assigned to a cognitive stimulation therapy group ( n = 16 ) or a control group ( n = 16 ) for 10 weeks . Main measure : The efficacy measures included the Mini Mental State Examination and the Neuropsychiatric Inventory . Results : Patients receiving cognitive stimulation therapy showed a greater improvement in the Neuropsychiatric Inventory total score ( mean change — 2.06 points versus 0.00 points , t = -4.766 , P<0.001 ) and in the Mini Mental State Examination total score ( mean change 0.81 points versus —0.19 points , t = 3.106 , P = 0.004 ) compared to control at week 10 . Analysis of the individual Neuropsychiatric Inventory domains revealed a statistically significant benefit for cognitive stimulation therapy-treated patients in the areas of apathy ( mean change —1.06 points versus —0.31 points , P = 0.017 ) and depression/dysphoria ( mean change —0.50 points versus 0.06 points , P = 0.047 ) . There were no statistically significant benefits for cognitive stimulation therapy-treated patients in the other individual Neuropsychiatric Inventory domains or in the caregiver distress score . Conclusions : Cognitive stimulation therapy has significant efficacy in lowering apathy and depression symptomatology and in the Mini Mental State Examination in patients with mild to moderate Alzheimer ’s disease R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community 
    Output:
    
Only the domain of global cognitive functioning , as measured by Mini-Mental State Examination , showed significant intervention effects .
No effects were observed in the remaining domains .