***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: 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 OBJECTIVE To determine the long-term effectiveness of comprehensive support and counseling for spouse-caregivers and families  in postponing or preventing nursing home placement of patients with Alzheimer disease ( AD ) . DESIGN R and omized controlled intervention study . SETTING Outpatient research clinic in the New York City metropolitan area . PARTICIPANTS Referred , volunteer sample of 206 spouse-caregivers of AD patients who enrolled in the study during a 3 1/2-year period . All patients were living at home at baseline and had at least 1 relative living in the area . INTERVENTION Caregivers in the treatment group were provided with 6 sessions of individual and family counseling within 4 months of enrollment in the study and were required to join support groups . In addition , counselors were available for further counseling at any time . MAIN OUTCOME MEASURE Time from enrollment of caregivers in the study to placement of the AD patients in a nursing home . RESULTS Using Kaplan-Meier survival analysis , we estimated that the median time ( weighted average of estimates for male and female caregivers ) from baseline to nursing home placement of AD patients was 329 days longer in the treatment group than in the control group ( z=2.29 ; P=.02 ) . The relative risk ( RR ) from a Cox proportional hazard model of nursing home placement ( intent-to-treat estimate ) after adjusting for caregiver sex , patient age , and patient income was 0.65 ( 95 % confidence interval [ CI ] , 0.45 to 0.94 ; P=.02 ) , indicating that caregivers were approximately two thirds as likely to place their spouses in nursing homes at any point in time if they were in the treatment group than if they were in the control group . Treatment had the greatest effect on risk of placement for patients who were mildly demented ( RR , 0.18 ; 95 % CI , 0.04 to 0.77 ) or moderately demented ( RR , 0.38 ; 95 % CI , 0.17 to 0.82 ) . CONCLUSIONS A program of counseling and support can substantially increase the time  spouse-caregivers are able to care for AD patients at home , particularly during the early to middle stages of dementia when nursing home placement is generally least appropriate Spouse-caregivers of Alzheimer 's disease patients were r and omly assigned to either a treatment group ( individual and family counseling , support group participation , and ad hoc consultation ) or a control group ( only routine support ) . In the first year after intake , the treatment group had less than half as many nursing home placements as the control group . This suggests that a comprehensive counseling program can reduce the socioeconomic impact of Alzheimer 's disease . Nursing home placement also was affected by the patient 's need for assistance with activities of daily living , patient income , and the age of the patients and caregivers 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 We studied 56 subjects , 30 patients with a clinical diagnosis of Alzheimer ’s disease ( AD ) and 26 healthy controls , using two telephone screens for cognitive impairment , a self-report interview referred to as the TELE and the Telephone Interview for Cognitive Status ( TICS ) . The sensitivity and specificity of the TELE to differentiate AD patients from healthy controls was 90.0 and 88.5 % and those of the TICS were 86.7 and 88.5 % , respectively . When receiver operator characteristic curves were constructed , the area under the curve for the TELE was 96.0 % ( SE 2.4 % ) and for the TICS 90.3 % ( SE 4.2 % ) . Pearson ’s correlation between the TELE and the Mini-Mental State Examination ( MMSE ) was 0.87 ( p < 0.0001 ) and between the TICS and the MMSE 0.86 ( p < 0.0001 ) . The correlation between the TELE and the sum of the boxes of the Clinical Dementia Rating scale ( CDR-SB ) was –0.71 ( p < 0.0001 ) and –0.75 between the TICS and the CDR-SB ( p < 0.0001 ) . These results indicate that both screens are sensitive and specific instruments for differentiating AD patients from healthy controls and have a strong correlation with face-to-face measures of cognitive function Among the psychiatric illnesses associated with old age primary degenerative dementia of the Alzheimer type ( DAT ) has gained increasing importance in recent years . Even though a curative treatment of the disease is currently impossible , various drugs can be used to slow down its progression . In the present study the influence of oral treatment with 240 mg/day of Ginkgo biloba special extract EGb 761 ( Tebonin ® forte , manufactured by Dr. Willmar Schwabe , Karlsruhe ) on the clinical course of DAT was investigated in a double-blind , r and omized , placebo-controlled parallel-group design in 20 out patients . The duration of treatment was 3 months . The primary outcome variable was the sum score in the SKT-test for the determination of attention and memory . Other psychometric tests ( trailmaking test , ADAS , CGI ) and electrophysiological investigations ( EEG topography ) were evaluated descriptively . Although the active-treatment group , with a mean sum score of 19.67 points in the S.K.T. , had a poorer baseline level than the placebo group ( 18.11 points ) , it experienced an improvement to 16.78 points under treatment with EGb 761 whereas the placebo group deteriorated to 18.89 points . The differences between the baseline and final values formed the basis for a statistical group comparison , which gave a result favourable to EGb 761 , at a significance level of p < .013 . In addition to this psychometric confirmation of efficacy , certain descriptive trends were found at the psychopathological ( Clinical Global Impression ) and dynamic functional ( EEG findings ) levels , which can be interpreted as evidence of effectiveness of Ginkgo biloba special extract EGb 761 in mild to moderate dementia and of local effects in the central nervous system . Inter-group differences in the ADAS cognitive and non-cognitive subscales did not reach statistical significance , probably because of the small sample size OBJECTIVE To determine the efficacy of donepezil hydrochloride for the treatment of Alzheimer disease in patients drawn from clinical practice . DESIGN Two-center , r and omized , placebo-controlled , double-masked crossover study . SETTING Memory disorders units at Massachusetts General and Brigham and Women 's hospitals , Boston . PATIENTS Sixty individuals ( 30 men and 30 women ; mean + /- SD age , 75.0+/-9.5 years ) with probable Alzheimer disease and scores of 20 or less on the information-memory-concentration subscale of the Blessed Dementia Scale . INTERVENTIONS Placebo wash-in , followed in r and omized sequence by ( 1 ) donepezil hydrochloride therapy , 5 mg/d , for 6 weeks , followed by placebo washout for 6 weeks and ( 2 ) placebo treatment for 6 weeks . PRIMARY OUTCOME MEASURE Change in Alzheimer 's Disease Assessment Scale cognitive subscale scores from the beginning to the end of the two 6-week treatment periods . RESULTS Among patients completing treatment and testing for both periods ( n = 48 ) , subscale scores improved ( mean + /- SEM ) 2.17+/-0.98 points ( 95 % confidence interval , 0.20 - 4.10 points ) during donepezil therapy relative to placebo therapy ( P = .04 ) . Scores returned toward baseline within 3 weeks of drug washout . There was no associated change in caregiver-rated global impression  ( donepezil vs placebo : proportion improved , 0.24 vs 0.22 ; proportion worsened , 0.27 vs 0.35 ; P = .34 ) or on specific tests of explicit memory or verbal fluency . Contrary to studies with tacrine , the presence of the apolipoprotein E epsilon4 allele did not predict donepezil treatment failure . Most common adverse events related to donepezil therapy were nausea ( 5 patients ) , diarrhea ( 3 patients ) , and agitation ( 3 patients ) . Serious events possibly related to drug use were seizure , pancreatitis , and syncope ( 1 patient each ) . CONCLUSION This independent confirmation of data from phase 3 trials suggests that donepezil therapy modestly improves cognition in patients with Alzheimer disease who are encountered in clinical practice Dementia induces morbidity not only in the patients but also in the families taking care of them . Many studies described the impact of care-giving on physical and psychological health . Support groups were design ed to alleviate the burden of care-givers . The objective of this study was to measure the efficacy of a support group programme for care-givers of demented patients in the community . Forty-one primary care-givers were r and omly assigned to a study ( n=23 ) or a control group ( n=18 ) . Subjects of the study group attended a structured programme of eight 2-h sessions . These weekly sessions consisted of information on the disease , role-playing on management of behavior problems , discussion on emotional impact of care-giving , and learning of stress management techniques . Subjects of the control group were referred to informal monthly meetings of the Alzheimer  's Society  .  Subjects of both groups were evaluated at the entry ( T1 ) , after 8 weeks ( T2 ) and after 8 months ( T 
    Output:
    
For patients , it leads to increased dependency and complicates other comorbid conditions .
Results The best evidence for or against screening for dementia would be derived from a well- design ed RCT of screening with health outcomes .
New screening in primary care practice could therefore potentially double the number of patients who receive a diagnosis of dementia .