***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: OBJECTIVES To investigate the effectiveness of snoezelen , integrated in 24-hour daily care , on the behavior and mood of demented nursing home residents . DESIGN Quasiexperimental pre- and posttest design . SETTING Twelve psychogeriatric wards of six nursing homes , spread over different parts of the Netherl and s. PARTICIPANTS One hundred twenty-five patients with moderate to severe dementia and care dependency were included in the pretest and 128 in the posttest ; 61 were completers ( included in both pre- and posttest ) . INTERVENTION Experimental subjects received an individual 24-hour snoezel program , based on family history taking and stimulus preference screening . Caregivers were trained , and ( organizational ) adaptations were made to fulfill the conditions for resident-oriented snoezel care . The control group received usual nursing home care . MEASUREMENTS Observations were made on the wards using subscales of the Dutch Behavior Observation Scale for Psychogeriatric In patients , the Dutch version of the Cohen-Mansfield Agitation Inventory , and the Cornell Scale for Depression in Dementia . Independent assessors observed video recordings of morning care and rated residents ' behavior and mood using INTERACT and FACE , respectively . RESULTS Residents receiving snoezel care  demonstrated a significant treatment effect with respect to their level of apathetic behavior , loss of decorum , rebellious behavior , aggressive behavior , and depression . During morning care , the experimental subjects showed significant changes in well-being ( mood , happiness , enjoyment , sadness ) and adaptive behavior ( responding to speaking , relating to caregiver , normal-length sentences ) . CONCLUSION Snoezel care particularly seems to have a positive effect on disturbing and withdrawn behavior . The results suggest that a 24-hour integrated snoezel program has a generalizing effect on the mood and behavior of demented residents CONTEXT Cognitive decline , mood , behavioral and sleep disturbances , and limitations of activities of daily living commonly burden elderly patients with dementia and their caregivers . Circadian rhythm disturbances have been associated with these symptoms . OBJECTIVE To determine whether the progression of cognitive and noncognitive symptoms may be ameliorated by individual or combined long-term application of the 2 major synchronizers of the circadian timing system : bright light and melatonin . DESIGN , SETTING , AND PARTICIPANTS A long-term , double-blind , placebo-controlled , 2 x 2 factorial r and omized trial performed from 1999 to 2004 with 189 residents of 12 group care facilities in the Netherl and s ; mean ( SD ) age , 85.8 ( 5.5 ) years ; 90 % were female and 87 % had dementia . INTERVENTIONS R and om assignment by facility to long-term daily treatment with whole-day bright ( + /- 1000 lux ) or dim ( + /- 300 lux ) light and by participant to evening melatonin ( 2.5 mg ) or placebo for a mean ( SD ) of 15 ( 12 ) months ( maximum period of 3.5 years ) . MAIN OUTCOME MEASURES St and ardized scales for cognitive and noncognitive symptoms , limitations of activities of daily living , and adverse effects assessed every 6 months . RESULTS Light attenuated cognitive deterioration by a mean of 0.9 points ( 95 % confidence interval [ CI ] , 0.04 - 1.71 ) on the Mini-Mental State Examination or a relative 5 % . Light also ameliorated depressive symptoms by 1.5 points ( 95 % CI , 0.24 - 2.70 ) on the Cornell Scale for Depression in Dementia or a relative 19 % , and attenuated the increase in functional limitations over time by 1.8 points per year ( 95 % CI , 0.61 - 2.92 ) on the nurse-informant activities of daily living scale or a relative 53 % difference . Melatonin  shortened sleep onset latency by 8.2 minutes ( 95 % CI , 1.08 - 15.38 ) or 19 % and increased sleep duration by 27 minutes ( 95 % CI , 9 - 46 ) or 6 % . However , melatonin adversely affected scores on the Philadelphia Geriatric Centre Affect Rating Scale , both for positive affect ( -0.5 points ; 95 % CI , -0.10 to -1.00 ) and negative affect ( 0.8 points ; 95 % CI , 0.20 - 1.44 ) . Melatonin also increased withdrawn behavior by 1.02 points ( 95 % CI , 0.18 - 1.86 ) on the Multi Observational Scale for Elderly Subjects scale , although this effect was not seen if given in combination with light . Combined treatment also attenuated aggressive behavior by 3.9 points ( 95 % CI , 0.88 - 6.92 ) on the Cohen-Mansfield Agitation Index or 9 % , increased sleep efficiency by 3.5 % ( 95 % CI , 0.8%-6.1 % ) , and improved nocturnal restlessness by 1.00 minute per hour each year ( 95 % CI , 0.26 - 1.78 ) or 9 % ( treatment x time effect ) . CONCLUSIONS Light has a modest benefit in improving some cognitive and noncognitive symptoms of dementia . To counteract the adverse effect of melatonin on mood , it is recommended only in combination with light . TRIAL REGISTRATION controlled-trials.com/is rct n Identifier : IS RCT N93133646 Background Agitation and passivity are behavioral symptoms exhibited by 90 % of nursing home residents with dementia . They account for many poor health outcomes , caregiver burden , and increased costs of long-term care . Objectives This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior ( NDB ) model : activities matched to skill level only ; activities matched to style of interest only ; and a combination of both ( NDB-derived ) for responding to the behavioral symptoms of dementia . Methods Thirty participants were r and omly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables . Trained research assistants , blind to condition match , implemented each condition for 12 consecutive days . Measures of engagement ( time on task and participation ) , affect , and behavioral symptoms ( agitation and passivity ) were taken from videotape recordings of each session . Mood was measured with the Dementia Mood Picture Test . The primary analysis method was mixed-model analysis of variance . Results Significantly more time on task , greater participation , more positive affect , and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline . Agitation and negative affect improved under all treatments compared with baseline . There was no significant change in mood . Discussion The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia . These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment This study sought to enhance the well-being of older nursing home residents who pace and w and er by enriching their nursing home environment . Visual , auditory , and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments : a home environment and an outdoor nature environment . Participants seemed to prefer the enhanced environments by choosing to spend more time in them , and by sitting on benches in those environments . There was a trend toward less trespassing , exit-seeking , and other agitated behaviors being exhibited in the enhanced environment , and residents were observed to manifest more pleasure in it . Staff members and family members definitely expressed a preference for the enhanced environment over the regular one . Although effects on residents were limited , this approach offers a low-cost method for making the nursing home environment a better place for those residents BACKGROUND Several studies have shown an improvement in depression , activities of daily living , and agitation in cognitively impaired subjects who undergo a long-term exercise program .  These studies have not considered the short-term effects of exercise . OBJECTIVES The purpose of this study was to investigate the short-term effects of a limited , supervised exercise program on agitation , depression , and activities of daily living in cognitively impaired patients residing in the special needs unit of a nursing home . METHODS This study was a prospect i ve comparative study . A 3-week exercise program was implemented at the special needs units of 2 nursing homes . The exercise program involved 30 minutes of exercise ( 15 minutes of aerobic and 15 minutes of resistance ) , 3 days per week . There were 50 residents in this study ( 76 % female , 24 % male ) and they had a mean age of 79.2 + /- 9.7 years . The subjects had a mean SLUMS ( Saint Louis Mental Status Examination ) score of 1.5 + /- 2.1 ( SLUM score range 0 - 30 , 30 meaning full cognitive faculty ) . Each subject had his or her depression , agitation , activities of daily living , and 6-meter walk time measured before and after the 3-week exercise program . The Cornell Scale for Depression , Pittsburgh Agitation Scale (PAS)/Cohen-Mansfield Agitation Inventory , and ADCS-ADL ( Alzheimer 's disease cooperative study -activities of daily living ) were used to measure depression , agitation , and activities of daily living , respectively . Multiple paired t tests were calculated for each outcome measurement . RESULTS The post- study scales showed an improvement in the 6-meter walk test and , using the PAS ( 0 - 16 , 0 meaning no agitation ) , an improvement in agitation . The improvement in agitation in the entire population was P less than .05 ; mean PAS pre- study scores were 5.8 + /- 4.8 and mean PAS post study scores were 4.5 + /- 3.7 . Among the patients with PAS Pre-Exercise Program Scores greater than 3 , thus categorized as agitated , there was a greater decrease in agitation ; PAS Pre- Study Scores were 9.1 + /- 3.4 and PAS Study Scores were 6.1 + /- 3.4 ( P < .001 ) . There was also an improvement in 6-meter walk times ; pre- study times were 12.5 + /- 5.2 and post-exercise program times were 10.1 + /- 4.4 ( P < .001 ) . CONCLUSION There was an improvement in agitation scores and the 6-meter walk times in the subjects after their engagement in the 3-week exercise program . Further study is needed in order to exp and on these results OBJECTIVES To investigate short-term effects of Multi-Sensory Stimulation ( MSS ) on behaviour , mood and cognition of older adults with dementia , the generalization of effects to day hospital and home environments and the endurance of any effects over time . DESIGN A r and omized controlled trial comparing MSS with a credible control of one-to-one activities . METHODS Fifty patients with diagnoses of moderate to severe dementia were r and omized to either MSS or Activity groups . Patients participated in eight 30-minute sessions over a 4-week period . Ratings of behaviour and mood were taken before , during and after sessions to investigate immediate effects . Pre , mid , post-trial , and follow-up assessment s were taken to investigate any generalization of effects on cognition , behaviour at the day hospital and behaviour and mood at home and endurance of effects once sessions had ceased . RESULTS Immediately after MSS and Activity sessions patients talked more spontaneously , related better to others , did more from their own initiative , were less bored/inactive , and were more happy , active or alert . Both groups were more attentive to their environment than before , with a significantly greater improvement from the MSS group . At the day hospital , patients in the Activity group improved on their ' speech skills ' ( amount of speech ; initiation of speech ) , whereas the MSS group remained unchanged during the trial . The MSS group showed a significant improvement in mood and behaviour at home compared to the Activity group whose behaviour deteriorated . No longer-term benefits were shown ; indeed , behaviour declined sharply during the month follow-up period . CONCLUSIONS Both MSS and Activity sessions appear to be effective and appropriate therapies for people with dementia Neuropsychiatric behaviors are common in people with Alzheimer 's disease ( AD ) and make both professional and lay caregiving difficult . Light therapy has been somewhat successful in ameliorating disruptive behaviors . This r and omized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence , frequency , severity , and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD .  Light was administered for 1 hr daily ( Monday-Friday ) for 10 weeks . The Neuropsychiatric Inventory — Nursing Home was used to assess behavior at baseline and end of the intervention . Analyses revealed statistically significant differences between groups on agitation/aggression , depression/dysphoria , aberrant motor behavior , and appetite/eating disorders . The magnitude of change was small and may not represent clinical ly significant findings . Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness . Interventions that decrease the presence and /or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden Background : Dementia in the elderly is a common , debilitating condition . Residents in long-term care facilities present with a number of challenging behaviors . Pharmacological management is not always helpful . Alternative approaches are needed . Methods : Multisensory stimulation ( MSS ) was developed to address sensory stimulation imbalance . In this pilot 24-week single-blinded , r and omized controlled study , the authors examined the effect of MSS when given for 12 weeks in either 1 
    Output:
    
Positive results on the residents ' levels of physical activity were found for music , a homelike environment and functional modifications .
Predominantly positive results were also found for the small-scale group living concepts .
Mixed results were found for bright or timed light , the multisensory environment and differences in the building footprint