***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 treatments of choice in Alzheimer 's disease ( AD ) are cholinesterase inhibitors and NMDA-receptor antagonists , although doubts remain about the therapeutic effectiveness of these drugs . Herbal medicine products have been used in the treatment of Behavioral and Psychological Symptoms of Dementia ( BPSD ) but with various responses . The objective of this article was to review evidence s from controlled studies in order to determine whether herbs can be useful in the treatment of cognitive disorders in the elderly . R and omized controlled studies assessing AD in individuals older than 65 years were identified through search es of MEDLINE , LILACS , Cochrane Library , dissertation Abstract ( USA ) , ADEAR ( Alzheimer 's Disease Clinical Trials Data base ) , National Research Register , Current Controlled trials , Centerwatch Trials Data base and PsychINFO Journal Articles . The search combined the terms Alzheimer disease , dementia , cognition disorders , Herbal , Phytotherapy . The crossover results were evaluated by the Jadad 's measurement scale . The systematic review identified two herbs and herbal formulations with therapeutic effects for the treatment of AD : Melissa officinalis , Salvia officinalis and Yi-Gan San and BDW ( Ba Wei Di Huang Wan ) . Ginkgo biloba was identified in a meta- analysis study . All five herbs are useful for cognitive impairment of AD .  M. officinalis and Yi-Gan San are also useful in agitation , for they have sedative effects . These herbs and formulations have demonstrated good therapeutic effectiveness but these results need to be compared with those of traditional drugs . Further large multicenter studies should be conducted in order to test the cost-effectiveness of these herbs for AD and the impact in the control of cognitive deterioration Background : MLC601 is a possible modulator of amyloid precursor protein processing , and in a clinical trial study MLC601 showed some effectiveness in cognitive function in Alzheimer 's disease ( AD ) patients . We aim ed to evaluate the effectiveness and safety of MLC601 in the treatment of mild to moderate AD as compared to 3 approved cholinesterase inhibitors ( ChEIs ) including donepezil , rivastigmine and galantamine . Methods : In a multicenter , nonblinded , r and omized controlled trial , 264 volunteers with AD were r and omly divided into 4 groups of 66 ; groups 1 , 2 , 3 and 4 received donepezil , rivastigmine , MLC601 and galantamine , respectively . Subjects underwent a clinical diagnostic interview and a cognitive/functional battery including the Mini-Mental State Examination ( MMSE ) and Alzheimer 's Disease Assessment Scale - Cognitive subscale ( ADAS-Cog ) . Patients were visited every 4 months , and the score of cognition was recorded by the neurologists . Results : There were no significant differences in age , sex , marital status and baseline score of cognition among the 4 groups . In total , 39 patients ( 14.7 % ) left the study .  Trend of cognition changes based on the modifications over the time for MMSE and ADAS-cog scores did not differ significantly among groups ( p = 0.92 for MMSE and p = 0.87 for ADAS-Cog ) . Conclusion : MLC601 showed a promising safety profile and also efficacy compared to 3 FDA -approved ChEIs There was no long-term clinical study on galantamine in Alzheimer 's disease ( AD ) in the Asian population . The objectives of this study were to evaluate the efficacy of galantamine on cognitive function , daily functioning , behavioural symptoms and its safety in Chinese AD patients . This was a 2-year open-label clinical trial . The inclusion criteria were patients with probable AD by the NINCDS-ADRDA criteria . A historical control group ( n = 19 ) of AD patients with no galantamine or other cholinesterase inhibitor therapy was employed . In the galantamine group , 33 and 32 subjects had completed a 1-year and 2-year follow up , respectively . Within the galantamine group and at a 6-month follow up , the Alzheimer 's Disease Assessment Scale Cognitive Subscale ( ADAS-cog score ) showed an improvement of 2.9 + /- 1.18 ( p = 0.019 , paired t-test ) but remained the same at 1 and 2 years . The Alzheimer 's Disease Cooperative Study -Activities of Daily Living Inventory ( ADCS-ADL ) deteriorated by 4.31 + /- 2.06 ( p = 0.044 , paired t-test ) at 6 months but showed no significant decline at 1 and 2 years vs. baseline . The Neuropsychiatric Inventory ( NPI ) score also showed a significant deterioration of 5 + /- 1.99 ( p = 0.017 , paired t-test ) at 6 months , 8.06 + /- 1.97 ( p < 0.001 , paired t-test ) at 1 year and 7.31 + /- 1.76 at 2 years . Comparison between the two groups showed a statistically significant improvement in the 1-year ADAS-cog score but decline in the NPI score in the galantamine vs. control groups . Adverse effects were commonly mild . In Chinese mild-moderate AD patients , galantamine showed beneficial effects mainly on the cognitive function The British Association for Psychopharmacology ( BAP ) coordinated a meeting of experts to review and revise its first ( 2006 ) Guidelines for clinical practice with  anti-dementia drugs .  As before , levels of evidence were rated using accepted st and ards which were then translated into grade s of recommendation A to D , with A having the strongest evidence base ( from r and omized controlled trials ) and D the weakest ( case studies or expert opinion ) . Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice ( B ) and brain imaging can improve diagnostic accuracy ( B ) . Cholinesterase inhibitors ( donepezil , rivastigmine , and galantamine ) are effective for mild to moderate Alzheimer ’s disease ( A ) and memantine for moderate to severe Alzheimer ’s disease ( A ) . Until further evidence is available other drugs , including statins , anti-inflammatory drugs , vitamin E and Ginkgo biloba , can not be recommended either for the treatment or prevention of Alzheimer ’s disease ( A ) . Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment ( A ) . Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation ( A ) , though selective serotonin reuptake inhibitors may help behavioural ( but not cognitive ) features ( B ) . Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias ( Parkinson ’s disease dementia and dementia with Lewy bodies ( DLB ) ) , especially for neuropsychiatric symptoms ( A ) . Cholinesterase inhibitors and memantine can produce cognitive improvements in DLB ( A ) . There is no clear evidence that any intervention can prevent or delay the onset of dementia . Although the consensus statement focuses on medication , psychological interventions can be effective in addition to pharmacotherapy , both for cognitive and non-cognitive symptoms . Many novel pharmacological approaches involving strategies to reduce amyloid and /or tau deposition are in progress . Although results of pivotal studies are awaited , results to date have been equivocal and no disease-modifying agents are either licensed or can be currently recommended for clinical use The efficacy and safety of donepezil as a treatment for patients with mild to moderate Alzheimer 's disease ( AD ) was investigated in a multicenter , double-blind study . Patients were r and omly assigned to treatment with placebo(n = 162 ) , 5 mg/d donepezil  ( n = 154 ) , or 10 mg/d donepezil  ( n = 157 ) for 24 weeks followed by a 6-week , single-blind placebo washout . The primary efficacy measures were the cognitive portion of the Alzheimer 's Disease Assessment Scale ( ADAS-cog ) and the Clinician 's Interview Based Assessment of Change-Plus ( CIBIC plus ) , with the  Mini-Mental State Examination ( MMSE ) , Clinical Dementia Rating Scale-Sum of the Boxes ( CDR-SB ) , and patient rated Quality of Life ( QoL ) used as secondary measures . Cognitive function , as measured by the ADAS-cog , was significantly improved in the 5- and 10-mg/d donepezil groups as compared with the placebo group at weeks 12 , 18 , and 24 . Clinician 's global ratings on the CIBIC plus also improved in both the 5- and 10-mg/d donepezil groups relative to placebo . At the end of the 6-week placebo washout phase , ADAS-cog scores and CIBIC plus ratings were not significantly different for the three groups . Significant treatment benefits were also observed consistently in both the 5- and 10-mg/d groups on the MMSE and the CDR-SB , but there was no consistent effect on the patient-rated QoL. Cholinergic side effects ( primarily diarrhea , nausea , and vomiting ) were reported more often in the 10-mg/d group than either the 5-mg/d or placebo groups . Side effects were transient and generally mild in severity . These data indicate that donepezil is a well-tolerated drug that improves cognition and global function in patients with mild to moderate AD Objectives To explore the efficacy of Chinese herbal formula compared with donepezil 5mg/day in patients with mild Alzheimer ’s disease ( AD ) . Methods Patients with mild AD meeting the criteria were r and omized into Chinese herbal formula Yishen Huazhuo decoction ( YHD ) group and donepezil hydrochloride ( DH ) group during the 24-week trial . The outcomes were measured by ADAS-cog , MMSE , ADL , and NPI with linear mixed-effect models . Results 144 patients were r and omized . The mean scores of ADAS-cog and MMSE in both YHD group and DH group both improved at the end of the 24-week treatment period . The results also revealed that YHD was better at improving the mean scores of ADAS-cog and MMSE than DH . Linear mixed-effect models with repeated measures showed statistical significance in time × group interaction effect of ADAS-cog and also in time × group interaction effect of MMSE . The data showed YHD was superior to DH in improving the scores and long term efficacy . Conclusions Our study suggests that Chinese herbal formula YHD is beneficial and effective for cognitive improvement in patients with mild AD and the mechanism might be through reducing amyloid-β ( Aβ ) plaque deposition in the hippocampus . Trial Registration Chinese Clinical Trial Registry The objectives here are to provide a systematic review of the current evidence concerning the use of Chinese herbs in the treatment of  Alzheimer 's disease ( AD ) and to underst and their mechanisms of action with respect to the pathophysiology of the disease . AD , characterized microscopically by deposition of amyloid plaques and formation of neurofibrillary tangles in the brain , has become the most common cause of senile dementia . The limitations of western medications have led us to explore herbal medicine . In particular , many Chinese herbs have demonstrated some interesting therapeutic properties . The following data bases were search ed from their inception : MEDLINE ( PUBMED ) , ALT HEALTH WATCH ( EBSCO ) , CINAH and Cochrane Central . Only single Chinese herbs are included . Two review ers independently extracted the data and performed quality assessment . The quality assessment of a clinical trial is based on the Jadad criteria . Seven Chinese herbs and six r and omized controlled clinical trials were identified under the predefined criteria . Ginkgo biloba , Huperzine A ( Lycopodium serratum ) and Ginseng have been assessed for their clinical efficacy with limited favorable evidence . No serious adverse events were reported . Chinese herbs show promise in the treatment of AD in terms of their cognitive benefits and more importantly , their mechanisms of action that deal with the fundamental pathophysiology of the disease . However , the current evidence in support of their use is inconclusive or inadequate . Future research should place emphasis on herbs that can treat the root of the disease Donepezil has been shown to be well tolerated and to improve cognition and global function in patients with mild to moderately severe Alzheimer ’s disease ( AD ) . The current trial was undertaken to investigate further the efficacy and safety of donepezil , in a multinational setting , in patients with mild to moderately severe AD . This 30-week , placebo-controlled , parallel-group study consisted of a 24-week , double-blind treatment phase followed by a 6-week , single-blind , placebo washout . Eight hundred and eighteen patients with mild to moderately severe AD were r and omly allocated to treatment with single , daily doses of 5 or 10 mg donepezil , or placebo . The two primary efficacy measures were : a cognitive performance test , the Alzheimer ’s Disease Assessment Scale-cognitive subscale ( ADAS-cog ) and a global evaluation , the Clinician ’s Interview-Based Impression of Change with caregiver input ( CIBIC plus ) . Secondary outcome measures included the Sum of the Boxes of the Clinical Dementia Rating Scale ( CDR-SB ) , a modified Interview for Deterioration in Daily living activities in Dementia ( IDDD ) and a patientrated quality of life assessment . Statistically significant improvements in cognitive and global function were observed , as evaluated by ADAS-cog and CIBIC plus , respectively , in both the 5 and 10 mg/day donepezil groups , compared 
    Output:
    
There were no significant differences between the TM and donepezil groups at 12 or 24 weeks for Alzheimer 's Disease Assessment Scale-cognitive subscale or MMSE .
Improvements over baseline were significant for MMSE at 12 and 24 weeks within the TM and donepezil groups and remained significant at 1 year .
At 24 weeks , donepezil 10 mg/d generally produced greater improvements in MMSE than 5 mg/d .
The results suggested that the clinical benefits of the TMs were not less than donepezil at comparable time points , with both groups showing improvements .
However , lack of blinding in most studies and other design and measurement issues are likely to have result ed in overestimation of effect sizes in both groups .