***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 Participation in leisure activities has been associated with a lower risk of dementia .  It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the pre clinical phase of dementia . METHODS We examined the relation between leisure activities and the risk of dementia in a prospect i ve cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line . We examined the frequency of participation in leisure activities at enrollment and derived  cognitive-activity and physical-activity scales in which the units of measure were activity-days per week . Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities , with adjustment for age , sex , educational level , presence or absence of chronic medical illnesses , and base-line cognitive status . RESULTS Over a median follow-up period of 5.1 years ,  dementia  developed in 124 subjects ( Alzheimer 's disease in 61 subjects , vascular dementia in 30 , mixed dementia in 25 , and other types of dementia in 8) . Among leisure activities , reading , playing board games , playing musical instruments , and dancing were associated with a reduced risk of dementia . A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia ( hazard ratio , 0.93 [ 95 percent confidence interval , 0.90 to 0.97 ] ) , but a one-point increment in the physical-activity score was not ( hazard ratio , 1.00 ) . The association with the cognitive-activity score persisted after the exclusion of the subjects with possible pre clinical dementia at base line . Results were similar for Alzheimer 's disease and vascular dementia . In linear mixed models , increased participation in cognitive activities at base line was associated with reduced rates of decline in memory . CONCLUSIONS Participation in leisure activities is associated with a reduced risk of dementia , even after adjustment for base-line cognitive status and after the exclusion of subjects with possible pre clinical dementia . Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia Objective : To determine the usefulness of an interactive multimedia internet-based system ( IMIS ) for the cognitive stimulation of Alzheimer ’s disease . Methods : This is a 24-week , single-blind , r and omised pilot study conducted on 46 mildly impaired patients suspected of having Alzheimer ’s disease receiving stable treatment with cholinesterase inhibitors ( ChEIs ) .  The patients were divided into three groups : ( 1 ) those who received 3 weekly , 20-min sessions of IMIS in addition to 8 h/day of an integrated psychostimulation program ( IPP ) ; ( 2 ) those who received only IPP sessions ; and ( 3 ) those who received only ChEI treatment . The primary outcome measure was the Alzheimer ’s Disease Assessment Scale-Cognitive ( ADAS-Cog ) . Secondary outcome measures were : Mini-Mental State Examination ( MMSE ) , Syndrom Kurztest , Boston Naming Test , Verbal Fluency , and the Rivermead Behavioral Memory Test story recall subtest . Results : After 12 weeks , the patients treated with both IMIS and IPP had improved outcome scores on the ADAS-Cog and MMSE , which was maintained through 24 weeks of follow-up . The patients treated with IPP alone had better outcome than those treated with ChEIs alone , but the effects were attenuated after 24 weeks . All patients had improved scores in all of the IMIS individual tasks , attaining higher levels of difficulty in all cases . Conclusion : Although both the IPP and IMIS improved cognition in patients with Alzheimer ’s disease , the IMIS program provided an improvement above and beyond that seen with IPP alone , which lasted for 24 weeks Objective To determine if older men who use computers  have lower risk of developing dementia . Methods Cohort study of 5506 community-dwelling men aged 69 to 87 years followed for up to 8.5 years . Use of computers measured as daily , weekly , less than weekly and never . Participants also reported their use of email , internet , word processors , games or other computer activities . The primary outcome was the incidence of ICD-10 diagnosis of dementia as recorded by the Western Australian Data Linkage System . Results 1857/5506 ( 33.7 % ) men reported using computers and 347 ( 6.3 % ) received a diagnosis of dementia during an average follow up of 6.0 years ( range : 6 months to 8.5 years ) . The hazard ratio ( HR ) of dementia was lower among computer users than non-users ( HR = 0.62 , 95%CI = 0.47–0.81 , after adjustment for age , educational attainment , size of social network , and presence of depression or of significant clinical morbidity ) . The HR of dementia appeared to decrease with increasing frequency of computer use : 0.68 ( 95%CI = 0.41–1.13 ) , 0.61 ( 95%CI = 0.39–0.94 ) and 0.59 ( 95%CI = 0.40–0.87 ) for less than weekly , at least weekly and daily . The HR of dementia was 0.66 ( 95%CI = 0.50–0.86 ) after the analysis was further adjusted for baseline cognitive function , as measured by the Mini-Mental State Examination . Conclusion Older men who use computers  have lower risk of receiving a diagnosis of dementia up to 8.5 years later . R and omised trials are required to determine if the observed associations are causal Background Improving the quality of care for people with dementia and their carers has become a national priority in many countries . Cognitive Stimulation Therapy ( CST ) groups can be beneficial in improving cognition and quality of life for people with dementia . The aim of the current study is to develop and evaluate a home-based individual Cognitive Stimulation Therapy ( iCST ) programme for people with dementia which can be delivered by their family carer . Methods This multi-centre , pragmatic r and omised controlled trial ( RCT ) will compare the effectiveness and cost-effectiveness of iCST for people with dementia with a treatment as usual control group . The intervention consists of iCST sessions delivered by a carer for 30 minutes , 3 times a week over 25 weeks . For people with dementia the primary outcome measures are cognition assessed by the ADAS-Cog , and quality of life assessed by QoL-AD . For carers , quality of life using the SF-12 is the primary outcome measure . Using a 5 % significance level , comparison of 306 participants will yield 80 % power to detect an effect size of 0.35 for cognition as measured by the ADAS-Cog , and quality of life as measured by the QoL-AD . Quality of life for the carer will be measured using the SF-12 . The trial will include a cost-effectiveness analysis from a public sector perspective . Discussion The UK Department of Health has recently stressed that improving access to psychological therapies is a national priority , but many people with dementia are unable to access psychological interventions . The development of a home-based individual version of CST will provide an easy to use , widely available therapy package that will be evaluated for effectiveness and cost-effectiveness in a multi centre RCT Mild cognitive impairment ( MCI ) and cognitive impairment , no dementia ( CIND ) might be the optimum stage at which to intervene with preventative therapies . This article review s recent work on the possible treatment and presents evidence ‐based recommendations approved at the meeting of the Third Consensus Conference on the Diagnosis and Treatment of Dementia held in Montreal in March , 2006 . A number of promising nonpharmacologic interventions have been examined . Associations exist with both cognitive and physical activity that suggest that both of these , together or separately , can delay progression to dementia . Similarly , case control studies as well as prospect i ve long‐term studies suggest a number of low toxicity interventions and supplements that might significantly impact on MCI progression ; folate , B6 , and B12 to lower homocysteine levels , omega‐fatty acids , and anti‐oxidants ( fruit juices or red wine ) are good examples . In selected genotypes such as individuals with APOE e4 , therapy with donepezil might slow progression . The concern , however , is that none of these therapies ( including cholinesterase inhibitors ) have demonstrated a clinical ly meaningful effect with r and omized , placebo‐controlled studies . Just as r and omized controlled studies have failed to support primary prevention of dementia by using estrogen or nonsteroidal anti‐inflammatory drugs ( NSAIDs ) , there exists the possibility that well‐ design ed r and omized controlled trials might fail to definitively demonstrate putative or promising mild cognitive impairment interventions .  Pharmacologic interventions and nonpharmacologic therapies , while tantalizing , are currently for the most part insufficiently proven to allow serious consideration by physicians . Recommendation were supported for a general “ healthy lifestyle ” including physical exercise , healthy nutrition , smoking cessation , and mental stimulation . Close monitoring and treatment of vascular risk factors are justified and were also supported OBJECTIVE The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease ( AD ) patients receiving a cholinesterase inhibitor . METHODS Twenty-five participants in the Cognitive Rehabilitation ( CR ) condition participated in two 45-minute sessions twice per week for 24 total sessions . CR training included face-name association tasks , object recall training , functional tasks ( e.g. , making change , paying bills ) , orientation to time and place , visuo-motor speed of processing , and the use of a memory notebook .  Nineteen participants in the Mental Stimulation ( MS ) condition had equivalent therapist contact and number of sessions , which consisted of interactive computer games involving memory , concentration , and problem-solving skills . RESULTS Compared with the MS condition , participants in CR demonstrated improved performance on tasks that were similar to those used in training . Gains in recall of face-name associations , orientation , cognitive processing speed , and specific functional tasks were present post-intervention and at a 3-month follow-up . CONCLUSION A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in mildly impaired AD patients Background Improving the situation in older adults with cognitive decline and evidence of cognitive rehabilitation is considered crucial in long-term care of the elderly . The objective of this study was to implement a computerized errorless learning-based memory training program ( CELP ) for persons with early Alzheimer ’s disease , and to compare the training outcomes of a CELP group with those of a therapist-led errorless learning program ( TELP ) group and a waiting-list control group . Methods A r and omized controlled trial with a single-blind research design was used in the study . Chinese patients with early Alzheimer ’s disease screened by the Clinical Dementia Rating ( score of 1 ) were recruited . The subjects were r and omly assigned to CELP ( n = 6 ) , TELP ( n = 6 ) , and waiting-list control ( n = 7 ) groups . Evaluation of subjects before and after testing , and at three-month follow-up was achieved using primary outcomes on the Chinese Mini-Mental State Examination , Chinese Dementia Rating Scale , Hong Kong List Learning Test , and the Brief Assessment of Prospect i ve Memory-Short Form . Secondary outcomes were the Modified Barthel Index , Hong Kong Lawton Instrumental Activities of Daily Living Scale , and Geriatric Depression Scale-Short Form . The data were analyzed using Friedman ’s test for time effect and the Kruskal-Wallis test for treatment effect . Results Positive treatment effects on cognition were found in two errorless learning-based memory groups ( ie , computer-assisted and therapist-led ) . Remarkable changes were shown in cognitive function for subjects receiving CELP and emotional/daily functions in those receiving TELP . Conclusion Positive changes in the cognitive function of Chinese patients with early Alzheimer ’s disease were initially found after errorless training through CELP . Further enhancement of the training program is recommended Objective : To study the efficacy of cognitive rehabilitation combined with acetylcholinesterase inhibitor ( AChE-I ) treatment in patients with mild Alzheimer 's disease and their relatives . Method : Thirteen patients with mild Alzheimer 's disease treated with rivastigmine 6 - 12 mg/day for more than two months started cognitive rehabilitation training .  Before and after the cognitive rehabilitation training patients were assessed through cognitive tests , activities of daily living scale , neuropsychological battery and scales to evaluate caregivers ' depressive and anxiety symptoms . Six patients were r and omized to a combined treatment group ( AChE-I plus cognitive rehabilitation and caregiver support ) and seven patients to a control group ( AChE-I only ) and followed up for five months . Results : Mini-Mental State Examination ( MMSE ) scores ( p=0.047 ) and backward digit span scores ( p=0.018 ) were significantly different between the groups on follow-up . The combined treatment group showed a better positive treatment effect on cognitive and neuropsychological tests applied to patients and reduction of psychiatric symptoms was observed in their caregivers ( nonsignificant ) . Conclusion : Cognitive rehabilitation associated with AChE-I treatment can potentially be useful to stabilize or improve cognitive and functional performance of patients with mild Alzheimer 's disease and can reduce caregivers ' psychiatric symptoms OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both 
    Output:
    
Conclusion : Computer-based cognitive interventions  have moderate effects in cognition , and anxiety and small effects in depression in PWD .
No significant effects were found on activities of daily living .
They led to superior results compared to non-computer-based interventions in cognition .