***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 objective of this paper is to summarize current knowledge on the possible advantages of lifestyle interventions , with particular attention to physical fitness , cognitive activity , leisure and social activity as well as nutrition . There is a large amount of published papers providing partial evidence and asserting the need for immediate , appropriate preventive lifestyle measures against dementia and AD development . Nevertheless , there are currently great difficulties in drafting effective guidelines in this field . This depends mainly upon lack of r and omized controlled trials assessing benefits versus risks of particular lifestyle interventions strategies . However , due to the rapid increase of dementia burden , lifestyle factors and their amelioration should be already made part of decision making in light of their health-maintaining effects while awaiting for results of well- design ed large prospect i ve cohort studies in dementia OBJECTIVES To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes . DESIGN Multisite r and omized controlled double-blind trial with two treatment groups . SETTING Communities in northern and southern California and Minnesota . PARTICIPANTS Community-dwelling adults aged 65 and older ( N=487 ) without a diagnosis of clinical ly significant cognitive impairment . INTERVENTION Participants were r and omized to receive a broadly-available brain plasticity-based computerized cognitive training program ( intervention ) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual ( active control ) . Duration of training was 1 hour per day , 5 days per week , for 8 weeks , for a total of 40 hours . MEASUREMENTS The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality ( RBANS Auditory Memory/Attention ) . Secondary measures were derived from performance on the experimental program , st and ardized neuropsychological assessment s of memory and attention , and participant-reported outcomes . RESULTS RBANS Auditory Memory/Attention improvement was significantly greater ( P=.02 ) in the experimental group ( 3.9 points , 95 % confidence interval (CI)=2.7 - 5.1 ) than in the control group ( 1.8 points , 95 % CI=0.6 - 3.0 ) . Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group ( word list total score , word list delayed recall , digits backwards , letter-number sequencing ; P<.05 ) , as did the participant-reported outcome measure ( P=.001 ) . No advantage for the experimental group was seen in narrative memory . CONCLUSION The experimental program improved generalized measures of memory and attention more than an active control program BACKGROUND Home-based computerised cognitive training ( CCT ) is ineffective at enhancing global cognition , a key marker of cognitive ageing . OBJECTIVES To test the effectiveness of supervised , group-based , multidomain CCT on global cognition in older adults and to characterise the dose-response relationship during and after training . DESIGN A r and omised , double-blind , longitudinal , active-controlled trial . SETTING Community-based training centre in Sydney , Australia Participants : Eighty nondemented community-dwelling older adults ( mean age = 72.1 , 68.8 % females ) with multiple dementia risk factors but no major neuropsychiatric or sensory disorder . Of the 80 participants admitted to the study , 65 completed post-training assessment and 55 were followed up one year after training cessation . INTERVENTIONS Thirty-six group-based sessions over three months of either CCT targeting memory , speed , attention , language and reasoning tasks , or active control training comprising audiovisual educational exercises . MEASUREMENTS Primary outcome was change from baseline in global cognition as defined by a composite score of memory , speed and executive function . Secondary outcome was 15-month change in Bayer Activities of Daily Living from baseline to one year post-training . RESULTS Intention-to-treat analyses revealed significant effects on global cognition in the cognitive training group compared to active control after three weeks of training ( ES = 0.33 , P=.039 ) that increased after 3 months of training ( ES = 0.49 , P=.003 ) and persisted three months after training cessation ( ES = 0.30 , P=0.023 ) . Significant and durable improvements were also noted in memory and processing speed . Dose-response characteristics differed among cognitive domains . Training effects waned gradually but residual gains were noted twelve months post-training . No significant effects on activities of daily living were noted and there were no adverse effects . CONCLUSIONS In older adults with multiple dementia risk factors , group-based CCT is a safe and effective intervention for enhancing overall cognition , memory and processing speed . Dose-response relationships vary for each cognitive domain , vital information for clinical and community implementation and further trial design The concepts of brain and cognitive reserve capture several elements of common wisdom – that we all differ in the neural re sources we are endowed at birth , that experience and especially complex mental activities then modify how these neural re sources are organized and cultivated , and that after any form of brain injury there is significant individual variation in the degree to which clinical deficits may manifest . Transforming these insights into a formal and refutable working definition , however , has been more challenging . Depending on the scale of analysis , brain and cognitive reserve have been defined from neurocentric , neuropsychological , computational , and behavioral perspectives . In our research , we have focused on the behavioral definition , whereby an individual ’s lifetime exposure to complex mental activities is used for prediction of longitudinal cognitive and neurological change . This approach also benefits from a wealth of epidemiological studies linking heightened complex mental activity with reduced dementia risk . Research in the field of cognitive training is also beginning to indicate that incident cognitive decline can be attenuated , with recent clinical trials addressing the major challenges of transfer of gain and durability of effect . High quality r and omized clinical trials are therefore the most urgent priority in this area so that the promise of brain and cognitive reserve can be harnessed for the purpose of the primary prevention of dementia The ultimate goal of cognitive enhancement as an intervention for age-related cognitive decline is transfer to everyday cognitive functioning . Development of training methods that transfer broadly to untrained cognitive tasks ( far transfer ) requires underst and ing of the neural bases of training and far transfer effects . We used cognitive training to test the hypothesis that far transfer is associated with altered attentional control dem and s mediated by the dorsal attention network and trained sensory cortex . In an exploratory study , we r and omly assigned 42 healthy older adults to six weeks of training on Brain Fitness ( BF-auditory perception ) , Space Fortress ( SF-visuomotor/working memory ) , or Rise of Nations ( RON-strategic reasoning ) . Before and after training , cognitive performance , diffusion-derived white matter integrity , and functional connectivity of the superior parietal cortex ( SPC ) were assessed . We found the strongest effects from BF training , which transferred to everyday problem solving and reasoning and selectively changed integrity of occipito-temporal white matter associated with improvement on untrained everyday problem solving . These results show that cognitive gain from auditory perception training depends on heightened white matter integrity in the ventral attention network . In BF and SF ( which also transferred positively ) , a decrease in functional connectivity between SPC and inferior temporal lobe ( ITL ) was observed compared to RON-which did not transfer to untrained cognitive function . These findings highlight the importance for cognitive training of top-down control of sensory processing by the dorsal attention network . Altered brain connectivity - observed in the two training tasks that showed far transfer effects - may be a marker for training success A r and omized pilot experiment examined the neural substrates of response to cognitive training in participants with mild cognitive impairment ( MCI ) . Participants performed exercises previously demonstrated to improve verbal memory and an active control group performed other computer activities . An auditory-verbal fMRI task was conducted before and after the two-month training program .  Verbal memory scores improved significantly and left hippocampal activation increased significantly in the experimental group ( gains in 5 of 6 participants ) relative to the control group ( reductions in all 6 participants ) . Results suggest that the hippocampus in MCI may retain sufficient neuroplasticity to benefit from cognitive training BACKGROUND Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies . In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability ( FINGER ) , a proof-of-concept r and omised controlled trial , we aim ed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population . METHODS In a double-blind r and omised controlled trial we enrolled individuals aged 60 - 77 years recruited from previous national surveys . Inclusion criteria were CAIDE ( Cardiovascular Risk Factors , Aging and Dementia ) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age . We r and omly assigned participants in a 1:1 ratio to a 2 year multidomain intervention ( diet , exercise , cognitive training , vascular risk monitoring ) , or a control group ( general health advice ) . Computer-generated allocation was done in blocks of four ( two individuals r and omly allocated to each group ) at each site . Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation . The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery ( NTB ) Z score . Analysis was by modified intention to treat ( all participants with at least one post-baseline observation ) . This trial is registered at Clinical Trials.gov , number NCT01041989 . FINDINGS Between Sept 7 , 2009 , and Nov 24 , 2011 , we screened 2654 individuals and r and omly assigned 1260 to the intervention group ( n=631 ) or control group ( n=629 ) . 591 ( 94 % ) participants in the intervention group and 599 ( 95 % ) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis . Estimated mean change in NTB total Z score at 2 years was 0·20 ( SE 0·02 , SD 0·51 ) in the intervention group and 0·16 ( 0·01 , 0·51 ) in the control group . Between-group difference in the change of NTB total score per year was 0·022 ( 95 % CI 0·002 - 0·042 , p=0·030 ) . 153 ( 12 % ) individuals dropped out overall . Adverse events occurred in 46 ( 7 % ) participants in the intervention group compared with six ( 1 % ) participants in the control group ; the most common adverse event was musculoskeletal pain ( 32 [ 5 % ] individuals for intervention vs no individuals for control ) . INTERPRETATION Findings from this large , long-term , r and omised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population . FUNDING Academy of Finl and , La Carita Foundation , Alzheimer Association , Alzheimer 's Research and Prevention Foundation , Juho Vainio Foundation , Novo Nordisk Foundation , Finnish Social Insurance Institution , Ministry of Education and Culture , Salama bint Hamdan Al Nahyan Foundation , Axa Research Fund , EVO funding for University Hospitals of Kuopio , Oulu , and Turku and for Seinäjoki Central Hospital and Oulu City Hospital , Swedish Research Council , Swedish Research Council for Health , Working Life and Welfare , and af Jochnick Foundation Remembering the location of objects , an integral part of everyday life , is known to decline with advancing age and early in the course of neurodegenerative dementia . Here , we aim ed to test if object-location learning and its retention could be modified by noninvasive brain stimulation . In a group of 20 elderly ( mean age 62.1 years ) right-h and ed individuals , we applied transcranial direct current stimulation ( tDCS ; 20 minutes , 1 mA ) over the right temporoparietal cortex , while subjects acquired the correct position of buildings on a street map using an associative learning paradigm . Each subject participated in a r and omized and balanced order in 1 session of anodal tDCS and 1 session of sham stimulation , in a double-blind design with 2 parallel versions of the task . Outcome measures were learning success at the end of each session , and immediate as well as delayed ( 1 week ) free recall . We found that subjects performed comparably in the learning task in the 2 conditions , but showed improved recall 1 week after learning with anodal tDCS compared with learning with sham stimulation . In conclusion , retention of object-location learning in the elderly may be modulated by noninvasive brain stimulation , a finding of potential relevance not only for normal aging but also for memory deficits in pathological aging Background Whether healthy older people can benefit from cognitive training ( CogTr ) remains controversial . This study explored the benefits of CogTr in community dwelling , healthy , older adults and compared the effects of single-domain with multi-domain CogTr interventions . Methods A r and omized , controlled , 3-month trial of CogTr with double-blind assessment s at baseline and immediate , 6-month and 12-month follow-up after training completion was conducted . A total of 270 healthy Chinese older people , 65 to 75 years old , were recruited from the Ganquan-area community in Shanghai . Participants were r and omly assigned to three groups : multi-domain CogTr , single-domain CogTr , and a wait-list control group . Twenty-four sessions of CogTr were administrated to the intervention groups over a three-month period . Six months later , three booster training sessions were offered to 60 % of the initial training participants . The Re 
    Output:
    
Results of this systematic review are mixed : CCT was found to increase and decrease both brain structure and function in older adults .
In addition , depending on region of interest , both increases and decreases in structure and function were associated with behavioural performance .
Conclusions Of all studies included in this systematic review , results from the highest quality studies , which were two r and omized controlled trials , demonstrated that multi-domain CCT could lead to increases in hippocampal functional connectivity .