***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 develop a short cognitive test for screening mild cognitive impairment ( MCI ) in Hong Kong Chinese older adults . Methods : The Chinese Abbreviated MCI ( CAMCI ) test was developed with a multistage process . In phase 1 , a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers ( community-dwelling active elderly persons ) . In phase 2 , the CAMCI test was vali date d in an independent and r and omly recruited sample of 459 participants in a community survey . Additionally , the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months ’ follow-up . The discriminating power of the CAMCI test in differentiating MCI from normal control ( NC ) and mildly demented subjects was compared with Mini Mental State Examination ( MMSE ) and Alzheimer ’s Disease Assessment Scale-Cognitive ( ADAS-Cog ) subscales . Results : The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample . The receiver operating characteristics ( ROC ) revealed an area under the curve ( AUC ) of 0.91 . The ROC were further vali date d in the phase 2 sample . The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales . The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects ( χ2 test , p = n.s . ) . Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up . Both ADAS-Cog total [ Exp(B ) = 1.115 , p = 0.028 ] and CAMCI [ Exp(B ) = 0.88 , p = 0.045 ] scores were significant predictors for dementia status at follow-up . Conclusion : The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults . Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored Background We explored the efficacy and tolerability of rivastigmine among Chinese patients with subcortical vascular dementia . Methods Forty subjects were r and omized to either placebo ( n = 20 ) or rivastigmine ( n = 20 ) in a double-blind 26-week trial . Outcome measures were cognition ( mini-mental state examination , frontal assessment battery ) , neuropsychiatric inventory ( NPI ) , instrumental activities of daily living , clinical dementia rating scale , and adverse events . Results No statistical significant benefit could be observed in the active group in any of the efficacy measures . A trend favoring active group was observed only in the NPI subscore of irritability ( p = 0.066 ) and aberrant motor behavior ( p = 0.068 ) . Withdrawal rate was 30 % and 15 % in the active and placebo group , respectively . Conclusion Among Chinese subcortical vascular dementia patients , there was no apparent cognitive benefit associated with use of rivastigmine over the 6 months period . A trend favoring rivastigmine was observed in certain behavioral measures . Rivastigmine was associated with more withdrawals relative to placebo OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] BACKGROUND Vascular dementia is the second commonest form of dementia , and vascular factors contribute to the development of dementia in many patients with Alzheimer 's disease .  Galantamine amplifies the acetylcholine response by inhibiting acetylcholinesterase and modulating nicotinic receptors . It has shown broad , sustained benefits in patients with Alzheimer 's disease . We investigated the effects of galantamine in patients with a diagnosis of probable vascular dementia or Alzheimer 's disease combined with cerebrovascular disease . METHODS Eligible patients were r and omly assigned galantamine 24 mg/day ( n=396 ) or placebo ( n=196 ) in a multicentre , double-blind , 6-month trial . Primary endpoints were cognition ( Alzheimer 's disease assessment scale , cognitive subscale [ ADAS-cog ] ) and global functioning ( clinician 's interview-based impression of change plus caregiver input [ CIBIC-plus ] ) . Secondary endpoints included assessment s of activities of daily living and behavioural symptoms . Patients were monitored for adverse events . Analyses were on the basis of observed case or last observation carried forward . FINDINGS Galantamine showed greater efficacy than placebo on ADAS-cog ( galantamine change -1.7 [ SE 0.4 ] vs placebo 1.0 [ 0.5 ] ; treatment effect 2.7 points ; p<0.0001 ) and CIBIC-plus ( 213 [ 74 % ] vs 95 [ 59 % ] patients remained stable or improved , p=0.0001 ) . Activities of daily living and behavioural symptoms were also significantly improved compared with placebo ( p=0.002 and p=0.016 , respectively ) . Galantamine was well tolerated . INTERPRETATION Galantamine showed a therapeutic effect on all key areas of cognitive and non-cognitive abilities in this group of dementia patients Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems BACKGROUND The purpose of this study was to evaluate the utility ( i.e. , positive and negative predictive value ) of the 7 Minute Screen in identifying patients with probable Alzheimer 's disease ( AD ) in a primary care practice . A second objective was to estimate the number of undiagnosed AD patients in a typical primary care practice . METHODS One hundred thirty-seven successive admissions ( 96 % ) of patients over the age of 60 to a primary care practice over a 53-day period who completed informed consent documents were administered the 7 Minute Screen .  All patients who screened positive ( n = 13 ) and a r and om sample of those who screened negative ( n = 26 ) returned for full diagnostic evaluation . Positive predictive value ( PPV ) and negative predictive value ( NPV ) of the 7 Minute Screen were determined using the criterion st and ard of clinical diagnosis established by examination , history , and laboratory studies . Test-retest reliability and time for administration were also determined . RESULTS Of the 137 patients evaluated , 13 screened positive and 124 screened negative . Eleven of the 13 patients who screened positive were willing to return to the primary care practice for follow-up evaluation . A r and om sample of 26 patients who screened negative all agreed to return for follow-up evaluation . Of the 11 patients who screened positive and who returned for evaluation , 10 were subsequently diagnosed with probable AD . The remaining patient was diagnosed with mixed dementia . The caregivers of the two patients who refused to return were contacted and both indicated that the patients were having significant cognitive problems as verified by an activities of daily living scale . Of the 26 patients who screened negative , 25 were judged to be cognitively normal and the 26th was judged to have mild cognitive impairment . DISCUSSION In successive admissions of patients over the age of 60 in a primary care practice , the 7 Minute Screen showed a PPV of 91 % and an NPV of 96 % in identifying patients who were subsequently identified with AD or other dementing disorder . These data suggest that this may be a useful instrument in identifying patients who should undergo diagnostic evaluation for AD and other dementing disorders . Additionally , extrapolation from the data in this practice suggests that there may be between 75 and 100 AD patients in the typical primary care practice , many of whom may not be diagnosed CONTEXT Many observational studies have shown that physical activity reduces the risk of cognitive decline ; however , evidence from r and omized trials is lacking . OBJECTIVE To determine whether physical activity reduces the rate of cognitive decline among older adults at risk . DESIGN AND SETTING R and omized controlled trial of a 24-week physical activity intervention conducted between 2004 and 2007 in metropolitan Perth , Western Australia . Assessors of cognitive function were blinded to group membership . PARTICIPANTS We recruited volunteers who reported memory problems but did not meet criteria for dementia . Three hundred eleven individuals aged 50 years or older were screened for eligibility , 89 were not eligible , and 52 refused to participate . A total of 170 participants were r and omized and 138 participants completed the 18-month assessment . INTERVENTION Participants were r and omly allocated to an education and usual care group or to a 24-week home-based program of physical activity . MAIN OUTCOME MEASURE Change in Alzheimer Disease Assessment Scale-Cognitive Subscale ( ADAS-Cog ) scores ( possible range , 0 - 70 ) over 18 months . RESULTS In an intent-to-treat analysis , participants in the intervention group improved 0.26 points ( 95 % confidence interval , -0.89 to 0.54 ) and those in the usual care group deteriorated 1.04 points ( 95 % confidence interval , 0.32 to 1.82 ) on the ADAS-Cog at the end of the intervention . The absolute difference of the outcome measure between the intervention and control groups was -1.3 points ( 95 % confidence interval,-2.38 to -0.22 ) at the end of the intervention . At 18 months , participants in the intervention group improved 0.73 points ( 95 % confidence interval , -1.27 to 0.03 ) on the ADAS-Cog , and those in the usual care group improved 0.04 points ( 95 % confidence interval , -0.46 to 0.88 ) . Word list delayed recall and Clinical Dementia Rating sum of boxes improved modestly as well , whereas word list total immediate recall , digit symbol coding , verbal fluency , Beck depression score , and Medical Outcomes 36-Item Short-Form physical and mental component summaries did not change significantly . CONCLUSIONS In this study of adults with subjective memory impairment , a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12605000136606 BACKGROUND An integrated multidisciplinary approach to dementia is often recommended but has rarely been evaluated . AIMS To evaluate the clinical effects of an integrated multidisciplinary diagnostic facility for psychogeriatric patients . METHOD Patients suspected of having complex psych 
    Output:
    
Medications approved by the U.S. Food and Drug Administration for Alzheimer disease ( k = 58 ) and caregiver interventions ( k = 59 ) show a small benefit of uncertain clinical importance for patients and their caregivers .
Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions .
Although promising , cognitive stimulation ( k = 6 ) and exercise ( k = 10 ) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment .
Brief instruments to screen for cognitive impairment can adequately detect dementia , but there is no empirical evidence that screening improves decision making .
Whether interventions for patients or their caregivers have a clinical ly significant effect in persons with earlier detected cognitive impairment is still unclear .