***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 evaluate the performance of the 4 ‘ A ’s Test ( 4AT ) in screening for delirium in older patients . The 4AT is a new test for rapid screening of delirium in routine clinical practice . Design : prospect i ve study of consecutively admitted elderly patients with independent 4AT and reference st and ard assessment s. Setting : an acute geriatrics ward and a department of rehabilitation . Participants : two hundred and thirty-six patients ( aged ≥70 years ) consecutively admitted over a period of 4 months . Measurements : in each centre , the 4AT was administered by a geriatrician to eligible patients within 24 h of admission . Reference st and ard delirium diagnosis ( DSM-IV-TR criteria ) was obtained within 30 min by a different geriatrician who was blind to the 4AT score . The presence of dementia was assessed using the Alzheimer 's Question naire and the informant section of the Clinical Dementia Rating scale . The main outcome measure was the accuracy of the 4AT in diagnosing delirium . Results : patients were 83.9 ± 6.1 years old , and the majority were women ( 64 % ) . Delirium was detected in 12.3 % ( n = 29 ) , dementia in 31.2 % ( n = 74 ) and a combination of both in 7.2 % ( n = 17 ) . The 4AT had a sensitivity of 89.7 % and specificity 84.1 % for delirium . The areas under the receiver operating characteristic curves for delirium diagnosis were 0.93 in the whole population , 0.92 in patients without dementia and 0.89 in patients with dementia . Conclusions : the 4AT is a sensitive and specific method of screening for delirium  in hospitalised older people . Its brevity and simplicity support its use in routine clinical practice AIM To use the King-Devick ( KD ) test and Sports Concussion Assessment Tool 2 ( SCAT2 ) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation . METHODS A prospect i ve observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zeal and . Every player completed a pre-competition question naire on concussion history , a baseline PCSS and two trials of the KD before they participated in any match activities . RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player . There were 22 concussive incidents recorded over the duration of the competition ( 46 per 1000 match hours ) . Five concussive incidents were witnessed ( 11 per 1000 match hours ) and 17 unrecognised concussive incidents were identified with the KD ( 37 per 1000 match hours ) . Witnessed concussions recorded , on average , a longer KD on the day of injury ( 5.5±2.4s ) than unrecognised concussions ( 4.4±0.9s ) when compared with their baseline KD . DISCUSSION The KD was able to identify players that had not shown , or reported , any signs or symptoms of a concussion but who had meaningful head injury . The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates . This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union OBJECTIVES To determine the extent to which preoperative performance on tests of executive function and memory was associated with delirium after coronary artery bypass graft ( CABG ) surgery .  DESIGN Prospect i ve observational cohort study . SETTING Two academic medical centers and one Department of Veterans Affairs medical center in Massachusetts . PARTICIPANTS Eighty subjects without preoperative delirium undergoing CABG or CABG-valve surgery  completed baseline neuropsychological assessment s with vali date d measures of memory and executive function . MEASUREMENTS Beginning on postoperative Day 2 , a battery to diagnose delirium was administered daily . Confirmatory factor analysis ( CFA ) was used to define two cognitive domain composites ( memory and executive function ) . The loading pattern of neuropsychological measures onto the latent cognitive domains was determined a priori . Poisson regression was used to model the association between neuropsychological performance and cognitive domain composite scores and risk of postoperative delirium . The association was expressed as the difference between impaired ( 0.5 st and ard deviations ( SDs ) below mean ) and nonimpaired ( 0.5 SDs above mean ) performers . RESULTS Forty subjects ( 50 % ) developed delirium . Measures of memory function were not significantly related to delirium . Of the executive function measures , verbal fluency , category fluency , Hopkins Verbal Learning Test learning , and backward recounting of days and months were significantly related to delirium . Preoperative mental status was a strong predictor of postoperative delirium . After controlling for age , sex , education , medical comorbidity , mental status , and the other cognitive domain , CFA cognitive domain composites suggest that risk for delirium is specific for executive functioning impairment ( relative risk ( RR ) = 2.77 , 95 % confidence interval ( CI ) = 1.12 - 6.87 ) but not for memory impairment ( RR = 0.49 , 95 % CI = 0.19 - 1.25 ) . CONCLUSION Worse preoperative performance in executive function was independently associated with greater risk of developing delirium after CABG Background Concussion is one of the most commonly occurring injuries in sport today . The Sport Concussion Assessment Tool ( SCAT ) is a commonly used paper neurocognitive tool . To date , little is known about SCAT baseline normative values in youth athletes . Objective The purpose of this study was to determine normative values on the SCAT for male and female youth hockey players . Methods This is a secondary data analysis of pooled data from three prospect i ve cohort studies examining the risk of injury in paediatric ice hockey players aged 9–17 years . A preseason baseline demographic and injury history question naire was completed by each player . Results A total of 4193 players completed SCATs at baseline and were included in the analysis . 781 players ( 18.6 % ) reported a previous history of concussion . Fatigue and low energy followed by headache were the most commonly reported symptoms in all players . The majority of youth players could recite all five words immediately but only three words when delayed . A smaller proportion of the males were able to report the months of the year in reverse order compared with females of a similar age . The median number of digits recited in reverse order was 4 . Conclusions Youth ratings varied between age groups , gender and from previously reported ratings of varsity athletes , possibly reflecting developmental and gender differences . An underst and ing of these differences in youth athletes is important to ensure appropriate performance expectations on the SCAT and when making clinical decisions following a concussion Objective : To develop a bedside mental status examination to assess the behavioural effects of damage to the frontal lobes . Design : A prospect i ve clinical comparison of patients with cerebral lesions of different locations . Subjects : A total of 118 subjects were examined : 27 patients with cerebral lesions confined to the frontal lobes , 25 patients with cerebral lesions without involvement of the frontal lobes , 18 patients with mixed frontal/nonfrontal lesions , and 48 normal control subjects . Measures : Twenty-three  mental status tests , clinical examinations and rating scales  that had been reported as indicative of frontal lobe function were brought together . By statistical analysis , 12 tests and a neurobehavioural rating scale were selected . These constitute the Frontal Lobe Score ( FLS ) . Results : The FLS detected pure frontal lesions with a sensitivity of 77.7 % . It discriminated patients with frontal lesions from normal control subjects with a specificity of 100 % . Differentiation from patients with nonfrontal lesions was obtained with a specificity of 84 % . Conclusion : The Frontal Lobe Score is a useful screening instrument for the clinical detection of effects of frontal lobe damage Objective To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions : the serial sevens test , the serial threes test , and recitation of months of year in reverse order ( MOYR ) . Participants High school student athletes in grade s 9 , 10 , 11 , and 12 having sports preparticipation physical examinations . The initial study tested 522 consecutive athletes . The follow-up study tested 109 consecutive athletes . InterventionThe athletes of the initial group were asked to perform a serial sevens test , followed by a serial threes test , and finally to recite the MOYR . The second group was asked to perform the same tests in a r and om order . Main Outcome Measures Participants were given 1-min time limits for each test , with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake . Results For the initial group , 51.3 % successfully performed serial sevens , 78.7 % successfully performed serial threes , and 89.5 % successfully recited the MOYR . For the second group , 52.7 % successfully performed serial sevens , 78.1 % success-fully performed serial threes , and 88.9 % successfully recited the MOYR . The pass rates were significantly different for both groups . The pass rates were similar for both sexes , all grade levels , and all sports in both test groups . Participants , both overall and in all subgroups , failed serial sevens more often than serial threes and MOYR ( p < 0.001 for the initial group ; p < 0.0001 for the second group ) . They failed serial threes more often than MOYR ( p < 0.001 for the initial group ; p < 0.01 for the second group ) . Conclusions The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion ; the test lacks specificity . The percentage of athletes passing the MOYR was greatest , perhaps making this a better sideline test than the traditional serial sevens test . However , testing needs to be done in injured athletes before clinical application can be recommended OBJECTIVE To evaluate the efficacy and reliability of a simple measure of central processing speed : the time to recite the months of the year in reverse order , from the Short Blessed Test of Orientation , Concentration , and Memory ( SBT ) . DESIGN Cross-sectional and longitudinal design s were used to establish validity and test-retest reliability . SETTING Participants ' homes and by telephone interview . PARTICIPANTS An age-stratified sample of 120 community-dwelling women , aged 67 - 94 , r and omly selected from Medicare recipients of the St. Louis Metropolitan Statistical Area . MEASUREMENTS Dependent variables were the  SBT , the Trail Making Test , computer-generated simple and choice reaction time , and time to say the months of the year backward ( TMYB ) . The independent variable was age . RESULTS Significant Pearson product-moment correlations were obtained for Trail Making and TMYB with a simple and choice reaction time after controlling for age and cognitive status . An exponential relationship was observed between age and TMYB , expressed both cross-sectionally and as rate of change . Test-retest reliability for TMYB was 0.90 . CONCLUSIONS TMYB is a valid and reliable measure of central processing speed that compares favorably to the more elaborate and time-consuming Trail Making B test . Because of its simplicity and ease of administration , this test provides the clinician with a practical measure of central processing speed . TMYB extends the utility of the widely used Short Blessed Test by measuring this additional and important domain of brain function Objective : To evaluate the ability of the Frontal Lobe Score ( FLS ) to differentiate patients with frontal lobe lesions from those with nonfrontal lesions and normal controls . Design : In a prospect i ve , blind setup , the sensitivity and specificity of the Frontal Lobe Score was compared with the Wisconsin Card Sorting Test ( WCST ) and the Stroop Test . Patients : A sample of 108 subjects ( 26 patients with cerebral lesions confined to the frontal lobes , 28 patients with cerebral lesions without involvement of the frontal lobes , 31 patients with mixed frontal/nonfrontal lesions , 23 controls without cerebral lesions ) was examined . Measures : Frontal Lobe Score , Wisconsin Card Sorting Test , Stroop Test .  Results : The Frontal Lobe Score detected pure frontal lesions with a sensitivity of 92.3 % . It discriminated patients with frontal lesions from normal controls with a specificity of 100 % ; differentiation from patients with nonfrontal lesions was obtained with a specificity of 75.0 % . For the WCST , sensitivity for detection of pure frontal lesions was 65.4 % , while specificity was 60.9 % compared with normal controls and 53.6 % compared with nonfrontal lesions . The Stroop Test showed a sensitivity of 30.8 % , a specificity compared with normal controls of 95.7 % and compared with nonfrontal lesions of 92.9 % . Conclusion : The Frontal Lobe Score has clinical usefulness for screening of effects of frontal lobe damage superior to that of the WCST and the Stroop Test 
    Output:
    
The majority of cognitively intact adults can complete the test without error such that any errors of omission are strongly suggestive of cognitive dysfunction .
Coverage of clinical population s , including those with significant cognitive difficulties is high with the majority of subjects able to engage with MBT procedures .
Performance correlates highly with other cognitive tests , especially of attention , including the digit span backwards , trailmaking test B , serial threes and sevens , tests of simple and complex choice reaction time , delayed story recall and st and ardized list learning measures .
Functional magnetic resonance imaging studies comparing the months forward test and MBT indicate greater involvement of more complex networks ( bilateral middle and inferior frontal gyri , the posterior parietal cortex and the left anterior cingulate gyrus ) for backwards cognitive processing .
Repeated testing can be used to identify deteriorating cognitive function over time .
The MBT is a simple , versatile tool that is sensitive to significant cognitive impairment .
Performance can be assessed according to accuracy and speed of performance .