***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 Subjects with a mild cognitive impairment ( MCI ) have a memory impairment beyond that expected for age and education yet are not demented . These subjects are becoming the focus of many prediction studies and early intervention trials . OBJECTIVE To characterize clinical ly subjects with MCI  cross-sectionally and longitudinally . DESIGN A prospect i ve , longitudinal inception cohort . SETTING General community clinic . PARTICIPANTS A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease ( AD ) , all from a community setting as part of the Mayo Clinic Alzheimer 's Disease Center/Alzheimer 's Disease Patient Registry , Rochester , Minn. MAIN OUTCOME MEASURES The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the  Mini-Mental State Examination , Wechsler Adult Intelligence Scale-Revised , Wechsler Memory Scale-Revised , Dementia Rating Scale , Free and Cued Selective Reminding Test , and Auditory Verbal Learning Test .  Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer 's Disease and Related Disorders Association criteria , respectively . RESULTS The primary distinction between control subjects and subjects with MCI was in the area of memory , while other cognitive functions were comparable . However , when the subjects with MCI were compared with the patients with very mild AD , memory performance was similar , but patients with AD were more impaired in other cognitive domains as well . Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD . CONCLUSIONS Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD . They appear to constitute a clinical entity that can be characterized for treatment interventions OBJECTIVES To assess the sensitivity and specificity of a screening battery for detecting cognitive impairment after stroke . DESIGN A r and omized controlled trial . METHODS Stroke patients were recruited from hospitals in three centres . Patients were screened for cognitive impairment on the Mini-Mental State Examination , the Sheffield Screening Test for Acquired Language Disorders and Raven 's Coloured Progressive Matrices and received a further battery of assessment s of cognitive function .  Sensitivity and specificity values were calculated for the three screening measures for overall conclusions regarding cognitive impairment reached from a comprehensive assessment . Receiver Operating Characteristic Curves were plotted . CONCLUSION The Mini-Mental State Examination was not a useful screen for memory problems or overall cognitive impairment after stroke . The Sheffield Screening Test for Acquired Language Disorders was an appropriate screen for language problems . The Raven 's Coloured Progressive Matrices was appropriate as a screen for perceptual problems and visual inattention but not for executive deficits OBJECTIVES To investigate whether  mild cognitive impairment ( MCI )  with multiple impaired cognitive domains ( mcd-MCI ) is a prodromal manifestation of vascular dementia ( VaD ) . DESIGN Prospect i ve cohort study . SETTING Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico , Milan , Italy . PARTICIPANTS Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders . Subjects with MCI  were kept under observation for 3 years . MEASUREMENTS Subjects with MCI  were studied by applying a st and ardized clinical evaluation and a conducting a computed tomography brain scan .  Cognitive performance was assessed using the  Mini-Mental State Examination  , the  Clock Drawing Test  , and a  comprehensive battery of neuropsychological tests . Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography , echocardiography , and carotid color Doppler ultrasound . RESULTS MCI was found in 65 of the 400 community-dwelling subjects ; 31 were classified with amnestic MCI ( a-MCI ) and 34 with mcd-MCI . A dysexecutive syndrome characterized people with mcd-MCI , who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features , mood disorders , and behavioral symptoms than people with a-MCI . Twenty of the 65 subjects with MCI ( 31 % ) progressed to dementia within 3 years of follow-up : 11 subjects with Alzheimer 's disease ( AD ) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline , whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline . CONCLUSION All subjects who converted to subcortical VaD had been classified with mcd-MCI , suggesting that mcd-MCI might be an early stage of subcortical The current increase in aged individuals in number and proportionof the general population warrants dependable strategies to improve early detection of cognitive impairment . It was the goal of the present study to develop a triage for bedside testing and outpatient ser vices . In a prospect i ve clinical cohort study at the outpatient Memory Clinic , University of Ulm , Germany , 232 subjects were diagnosed with Alzheimer ’s disease [ AD ; NINCDS-ADRDA criteria ; n = 66 ; age 65.9 ± 7.3 years ( mean ± SD ) ; Mini Mental State Examination ( MMSE ) score 23.4 ± 4.1 ] , mild cognitive impairment ( MCI ; criteria of Petersen et al. ; n = 48 ; age 66.4 ± 7.1 years ; MMSE score 28.3 ± 1.5 ) , and major depressive disorder ( DSM-IV criteria ; n = 61 ; age 63.4 ± 8.0 years ; MMSE score 28.6 ± 1.6 ) . Diagnosis was secured with extensive neuropsychological , clinical , radiological , and laboratory investigations . Six brief screening tests including  the Memory Impairment Screen ( MIS ) , Letter Sorting Test ( LST ) , Verbal Fluency ( VF ) , and Clock Drawing Test ( CDT )  were assessed independently from the diagnostic procedure . We compared single items and composite scores . LST yielded a diagnostic accuracy of 0.81 and 0.62 for AD and MCI patients versus controls , respectively . With the MIS , diagnostic accuracy was 0.89 and 0.71 , respectively . With a combination of LST , MIS , VF , and CDT , a sensitivity for AD and MCI patients of 1.00 and 0.83 was achieved . Thus , single-item screening ( e.g. LST , VF ) taking little more than 1 min and suitable for bedside testing or brief screening in the general practitioner ’s office yields diagnostic accuracy comparable to st and ard laboratory tests for other diseases . A composite of screening tests suitable for application in general outpatient care in neurological and psychiatric services reliably detects patients with  AD and MCI OBJECTIVE To find out what difficulties general practitioners ( GPs ) experience with diagnosing and managing dementia . DESIGN Postal question naire to a r and om stratified sample of one in seven active Australian GPs ( 2182 of 14,932 ) . RESULTS 1473 GPs ( 67.5 % ) responded to the question naire . The results indicated reasonable knowledge about diagnostic features of dementia and good insight into common issues facing family carers . Even so , GPs had difficulties with diagnosis and management of dementia and wanted assessment protocol s and educational programs . A minority of GPs regularly screened elderly patients for cognitive impairment but the majority relied on passive means of diagnosing dementia . Although generally positive about Aged Care Assessment Teams ( ACATs ) and Aged Care Community Services ( ACCS ) , GPs expressed some concerns about these services . CONCLUSIONS Recommendations arising from the survey were : development of an assessment protocol and a screening instrument , regular cognitive check-ups for patients over 75 years , educational programs , improved coordination with Aged Care Assessment Teams and Community Services , inventories and registers of local community services and residential facilities , and appropriate Medicare rebates Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing , behavioural rating , and various combinations of simpler psychometric and behavioural evaluations . The  Clinical Dementia Rating ( CRD )  , a global rating device , was developed for a prospect i ve study of mild senile dementia -- Alzheimer type ( SDAT ) . Reliability , validity , and correlational data are discussed . The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function , from healthy to severely impaired PROBLEM Dementia is a significant public health problem that is underrecognized in primary care setting s. This study examined the usefulness of 3 brief screening tests in detecting dementia and mild cognitive impairment ( MCI ) in persons seeking consultation for memory complaints within a network of memory diagnostic clinics in Wisconsin . METHODS This prospect i ve study of consecutive referrals for memory diagnostic evaluation analyzed data for 364 patients > or = 50 years . Scores on 3 cognitive screening measures -the Mini-Mental State Examination ( MMSE ) , Clock Drawing , and Animal Naming --  were compared to clinical diagnosis of normal cognitive aging , MCI , or dementia . RESULTS Using the st and ard cut score of < 24 , the MMSE identified only 60 % of persons diagnosed with dementia . By contrast , using a recommended cut score of < 14 words per minute , Animal Naming identified 85 % of persons with dementia with a relatively low ( 12 % ) false positive rate . Clock Drawing was intermediate to the other 2 measures in screening effectiveness . CONCLUSIONS Animal Naming was moderately to highly effective in identifying dementia . The naming procedure is easy to administer and may have value as a brief initial dementia screen in busy practice setting s. More dem and ing cognitive measures may be needed to improve screening accuracy for MCI 
    Output:
    
CDT should not be used for MCI-screening