***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 The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints . METHODS A r and omised controlled design was used involving 69 community dwelling individuals aged 55 years and older . Both objective and subjective measures were included to assess executive functioning . General linear model with repeated measures analysis of variance was used to examine the intervention effects . RESULTS After the intervention , the participants in the intervention group were significantly less annoyed by their cognitive failures , were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group . CONCLUSION These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning . PRACTICE IMPLICATION S Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable , the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults BACKGROUND On the basis of a multimodal model of working memory , cognitive load theory predicts that a multimedia-based instructional format leads to a better acquisition of complex subject matter than a purely visual instructional format . AIMS This study investigated the extent to which age and instructional format had an impact on training efficiency among both young and old adults . It was hypothesised that study ing worked examples that are presented as a narrated animation ( multimedia condition ) is a more efficient means of complex skill training than study ing visually presented worked examples ( unimodal condition ) and solving conventional problems . Furthermore , it was hypothesised that multimedia-based worked examples are especially helpful for elderly learners , who have to deal with a general decline of working-memory re sources , because they address both mode-specific working-memory stores . SAMPLE The sample consisted of 60 young ( mean age = 15.98 years ) and 60 old adults ( mean age = 64.48 years ) . METHODS Participants of both age groups were trained in either a conventional , a unimodal , or a multimedia condition . Subsequently , they had to solve a series of test problems . Dependent variables were perceived cognitive load during the training , performance on the test , and efficiency in terms of the ratio between these two variables . RESULTS Results showed that for both age groups multimedia-based worked examples were more efficient than the other training formats in that less cognitive load led to at least an equal performance level . CONCLUSION Although no difference in the beneficial effect of multimedia learning was found between the age groups , multimedia-based instructions seem promising for the elderly Cognitive training improves mental abilities in older adults , but the trainability of persons with memory impairment is unclear . We conducted a subgroup analysis of subjects in the Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) trial to examine this issue . ACTIVE enrolled 2802 non-demented , community-dwelling adults aged 65 years and older and r and omly assigned them to one of four groups : Memory training , reasoning training , speed-of-processing training , or no-contact control . For this study , participants were defined as memory-impaired if baseline Rey Auditory Verbal Learning Test ( AVLT ) sum recall score was 1.5 SD or more below predicted AVLT sum recall score from a regression-derived formula using age , education , ethnicity , and vocabulary from all subjects at baseline . Assessment s were taken at baseline ( BL ) , post-test , first annual ( A1 ) , and second annual ( A2 ) follow-up . One hundred and ninety-three subjects were defined as memory-impaired and 2580 were memory-normal .  Training gain as a function memory status ( impaired vs. normal ) was compared in a mixed effects model . Results indicated that memory-impaired participants failed to benefit from Memory training but did show normal training gains after reasoning and speed training . Memory function appears to mediate response to structured cognitive interventions in older adults The purpose of the present investigation was to examine the impact of speed of processing training on the cognitive and everyday abilities of older adults with initial processing speed or processing difficulty . Participants were r and omized to either a  speed of processing intervention or a social- and computer-contact control group . Results indicate that speed of processing training not only improves processing speed , as indicated by performance on the Useful Field of View test ( UFOV ® ) , but also transfers to certain everyday functions , as indicated by improved performance on Timed Instrumental Activities of Daily Living ( Timed IADL ) . Transfer of speed of processing training to other cognitive domains was not evident . This study provides additional evidence that  speed of processing training has the potential to enhance everyday functions that maintain independence and quality of life , particularly when the training is targeted toward individuals who most need it . Further study is needed to learn about the long-term effects of such training in relation to everyday abilities OBJECTIVE We evaluated the ability of the three cognitive training interventions ( memory , reasoning , or speed of processing ) fielded in the Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) multisite r and omized controlled trial to protect against two thresholds of extensive decline in health-related quality of life ( HRQoL ) at 2 and 5 years post-training . METHOD Adults aged 65 years or older ( 2802 ) were enrolled and r and omized to three cognitive interventions or a no-contact control group .  Data on 1804 participants were available at both the 2- and 5-year follow-ups . HRQoL was measured by the eight MOS 36-Item Short-Form Health Survey ( SF-36 ) scales . Clinical ly relevant decline on each scale was defined as a drop of > or = 0.5 st and ard deviations from baseline . Extensive HRQoL decline was defined as clinical ly relevant drops on ( i ) > or = 4 SF-36 scales , and ( ii ) > or = 3 SF-36 scales , and was assessed using multiple logistic regressions , weighted to adjust for potential attrition bias . Results . At 2 years post-training , 23.7 % and 36.6 % had clinical ly relevant drops on > or = 4 and > or = 3 SF-36 scales , respectively . At 5 years post-training , 32.9 % and 47.3 % had clinical ly relevant drops on > or = 4 and > or = 3 SF-36 scales , respectively . Participants in the speed of processing intervention arm were significantly less likely to have extensive HRQoL decline compared to participants in the control group regardless of the threshold or time period , whereas participants in the memory and reasoning intervention arms were significantly less like to have extensive HRQoL decline only at 5 years post-training and only at the lower threshold . Conclusion . The effect of the speed of processing intervention was stronger and evident earlier than those for the memory and reasoning interventions . This result stems from the speed of processing intervention being the most procedural intervention , operating through sensory-motor elaboration and repetition , bringing about a broader pattern of regional brain activation . At 5 years post-training , however , all three interventions were successful in protecting against a lower threshold of age-related extensive declines in OBJECTIVE The objective of this study was to determine the effects of a 14-day healthy longevity lifestyle program on cognition and cerebral metabolism in people with mild age-related memory complaints . METHODS Seventeen nondemented subjects , aged 35 - 69 years ( mean : 53 years , st and ard deviation : 10 ) with mild self-reported memory complaints but normal baseline memory performance scores were r and omly assigned to 1 ) the intervention group ( N = 8) : a program combining a brain healthy diet plan , relaxation exercises , cardiovascular conditioning , and mental exercise ( brain teasers and verbal memory training techniques ) ; or 2 ) the control group ( N = 9 ) : usual lifestyle routine . Pre- and postintervention measures included self- assessment s of memory ability , objective tests of cognitive performance , and determinations of regional cerebral metabolism during mental rest with [fluorine-18]fluorodeoxyglucose ( FDG ) positron emission tomography ( PET ) . RESULTS Subjects in the intervention group objective ly demonstrated greater word fluency . Concomitantly , their FDG-PET scans identified a 5 % decrease in activity in the left dorsolateral prefrontal cortex . The control group showed no significant change in any of the measures . CONCLUSIONS A short-term healthy lifestyle program combining mental and physical exercise , stress reduction , and healthy diet was associated with significant effects on cognitive function and brain metabolism . Reduced resting activity in left dorsolateral prefrontal cortex may reflect greater cognitive efficiency of a brain region involved in working memory CONTEXT Cognitive function in older adults is related to independent living and need for care . However , few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently . OBJECTIVE To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older , independent-living adults . DESIGN R and omized , controlled , single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001 . SETTING AND PARTICIPANTS Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing , community centers , and hospital/clinics in 6 metropolitan areas in the United States . INTERVENTIONS Participants were r and omly assigned to 1 of 4 groups : 10-session group training for memory ( verbal episodic memory ; n = 711 ) , or reasoning ( ability to solve problems that follow a serial pattern ; n = 705 ) , or speed of processing ( visual search and identification ; n = 712 ) ; or a no-contact control group ( n = 704 ) . For the 3 treatment groups , 4-session booster training was offered to a 60 % r and om sample 11 months later . MAIN OUTCOME MEASURES Cognitive function and cognitively dem and ing everyday functioning . RESULTS Thirty participants were incorrectly r and omized and were excluded from the analysis . Each intervention improved the targeted cognitive ability compared with baseline , durable to 2 years ( P<.001 for all ) . Eighty-seven percent of speed- , 74 % of reasoning- , and 26 % of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period . Booster training enhanced training gains in speed ( P<.001 ) and reasoning ( P<.001 ) interventions ( speed booster , 92 % ; no booster , 68 % ; reasoning booster , 72 % ; no booster , 49 % ) , which were maintained at 2-year follow-up ( P<.001 for both ) . No training effects on everyday functioning were detected at 2 years . CONCLUSIONS Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities . Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals . Because of minimal functional decline across all groups , longer follow-up is likely required to observe training effects on everyday function BACKGROUND Reported rates of  mild cognitive impairment ( MCI  ) range widely depending on method ologic differences , including specific sample characteristics , cognitive measures used , normative sample s used for neuropsychological tests , and diagnostic criteria . OBJECTIVES To operationalize diagnostic criteria for MCI and examine the frequency of MCI  in ethnically and linguistically diverse elders ( individuals older than 65 years ) . DESIGN Prospect i ve , community-based longitudinal cohort study . SETTING Northern Manhattan , New York , NY . PARTICIPANTS A cohort of 1315 nondemented elderly participants . MAIN OUTCOME MEASURE A diagnosis of MCI was assigned retrospectively on the basis of comprehensive neuropsychological , functional , and neurologic assessment s. Amnestic MCI , as well as forms of mild impairment with other cognitive characteristics , were classified . RESULTS The frequency of  amnestic MCI  was 5.0 % ( 95 % confidence interval , 3.8 - 6.2 ) . Other subtypes of MCI ranged in frequency from 2.1 % to 6.2 % . Mild cognitive impairment was more common among those older than 75 years compared with those aged 65 to 75 years . Individuals with fewer than 9 years of schooling were more likely to meet MCI criteria . Apolipoprotein ( APOE ) E4 allele was more frequent among those with amnestic MCI . CONCLUSIONS When proper normative values are used , only age and education , and not race or ethnicity , are associated with higher frequency of  MCI .  The proportion of nondemented elders with isolated memory deficits is smaller than the proportion with deficits in multiple cognitive domains . The strong association of the APOE E4 allele with only amnestic MCI suggests that there are likely to be multiple causes of cognitive impairment and differential rates of conversion to Alzheimer disease within the cognitive subtypes of MCI CONTEXT Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease ( AD ) , but prospect i ve data regarding an association are lacking . OBJECTIVE To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD . DESIGN Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years . PARTICIPANTS AND SETTING A total of 801 older Catholic nuns , priests , and brothers without dementia at enrollment , recruited from 40 groups across the United States . At baseline , they rated frequency of participation in common cognitive activities  ( eg , reading a newspaper ) , from which a previously vali date d composite measure of cognitive activity frequency was derived . MAIN OUTCOME MEASURES Clinical diagnosis of AD by a board-certified neurologist using National 
    Output:
    
Results showed that for healthy older adults , immediate and delayed verbal recall improved significantly through training compared to a no-treatment control condition .
We did not find any specific memory training effects though as the improvements observed did not exceed the improvement in the active control condition .
For individuals with mild cognitive impairment , our analyses demonstrate the same pattern .
Thus , there is currently little evidence on the effectiveness and specificity of memory interventions for healthy older adults and individuals with mild cognitive impairment .
AUTHORS ' CONCLUSIONS There is evidence that cognitive interventions do lead to performance gains but none of the effects observed could be attributable specifically to cognitive training , as the improvements observed did not exceed the improvement in active control conditions .
This does not mean that longer , more intense or different interventions might not be effective , but that those which have been reported thus far have only limited effect .