***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 Stimulant medications appear effective at restoring simple alertness and psychomotor vigilance in sleep deprived individuals , but it is not clear whether these medications are effective at restoring higher order complex cognitive capacities such as planning , sequencing , and decision making . DESIGN After 44 hours awake , participants received a double-blind dose of one of 3 stimulant medications or placebo . After 45 - 50 hours awake , participants were tested on computerized versions of the 5-Ring Tower of Hanoi ( TOH ) , the Tower of London ( TOL ) , and the Wisconsin Card Sorting Test ( WCST ) .  SETTING In-residence sleep-laboratory facility at the Walter Reed Army Institute of Research . PARTICIPANTS Fifty-four healthy adults ( 29 men , 25 women ) , ranging in age from 18 to 36 years . INTERVENTIONS Participants were r and omly assigned to 1 of 3 stimulant medication groups , including caffeine , 600 mg ( n=12 ) , modafinil , 400 mg ( n=12 ) , dextroamphetamine , 20 mg ( n=16 ) , or placebo ( n=14 ) . MEASUREMENTS AND RESULTS At the doses tested , modafinil and dextroamphetamine groups completed the TOL task in significantly fewer moves than the placebo group , and the modafinil group demonstrated greater deliberation before making moves . In contrast , subjects receiving caffeine completed the TOH in fewer moves than all 3 of the other groups , although speed of completion was not influenced by the stimulants . Finally , the modafinil group outperformed all other groups on indices of perseverative responding and perseverative errors from the WCST . CONCLUSIONS Although comparisons across tasks can not be made due to the different times of administration , within-task comparisons suggest that , at the doses tested here , each stimulant may produce differential advantages depending on the cognitive dem and s of the task STUDY OBJECTIVES Although subjective complaints about daytime cognitive functioning are an essential symptom of chronic insomnia , abnormalities in functional brain activation have not previously been investigated . This study was design ed to investigate functional brain activation differences as a possible result of chronic insomnia , and the reversibility of these differences after nonmedicated sleep therapy . DESIGN Insomniacs and carefully matched controls underwent functional magnetic resonance imaging ( fMRI ) scanning during the performance of a category and a letter fluency task . Insomniacs were r and omly assigned to either a 6-week period of nonpharmacological sleep therapy or a wait list period , after which fMRI scanning was repeated using parallel tasks . Task-related brain activation and number of generated words were considered as outcome measures . SETTING The outpatient sleep clinic of the VU University Medical Center , Department of Clinical Neurophysiology ; fMRI was performed at the Department of Radiology . PARTICIPANTS Twenty-one patients suffering from chronic insomnia and 12 matched controls . INTERVENTIONS Nonpharmacological sleep therapy for 6 weeks , consisting of cognitive behavioral therapy , body temperature and bright light interventions , sleep hygiene , and physical activity counseling . MEASUREMENT AND RESULTS Compared to controls , insomnia patients showed hypoactivation of the medial and inferior prefrontal cortical areas ( Brodmann Area 9 , 44 - 45 ) , which recovered after sleep therapy but not after a wait list period . CONCLUSIONS Insomnia interferes in a reversible fashion with activation of the prefrontal cortical system during daytime task performance This individual differences study examined the separability of three often postulated executive functions-mental set shifting ( " Shifting " ) , information updating and monitoring ( " Updating " ) , and inhibition of prepotent responses ("Inhibition")- and their roles in complex " frontal lobe " or " executive " tasks . One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks : the Wisconsin Card Sorting Test ( WCST ) , Tower of Hanoi ( TOH ) , r and om number generation ( RNG ) , operation span , and dual tasking .  Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another , but are clearly separable . Moreover , structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks . Specifically , WCST performance was related most strongly to Shifting , TOH to Inhibition , RNG to Inhibition and Updating , and operation span to Updating . Dual task performance was not related to any of the three target functions . These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to study ing the organization and roles of executive functions STUDY OBJECTIVES The aims of this study were to ( 1 ) investigate the nature of cognitive impairment in individuals with insomnia , ( 2 ) document their clinical significance , ( 3 ) examine their correlates , and ( 4 ) explore differences among individuals with insomnia with and without cognitive complaints . DESIGN Participants underwent 3 consecutive nights of polysomnography . On the morning following the third night , they completed a battery of question naires and neuropsychological tests . PARTICIPANTS The sample included 25 adults with primary insomnia ( mean age : 44.4 ± 11.5 y , 56 % women ) and 16 controls ( mean age : 42.8 ± 12.9 y , 50 % women ) matched for sex , age , and education . INTERVENTION N/A. MEASUREMENT AND RESULTS Participants completed neuropsychological tests covering attention , memory , working memory , and executive functions , as well as question naires assessing the subjective perception of performance , depression , anxiety , fatigue , sleepiness , and hyperarousal . There were significant group differences for the attention and episodic memory domains . Clinical ly significant deficits were more frequent in the insomnia group . Within the insomnia group , individuals with cognitive complaints exhibited significantly poorer performance on a larger number of neuropsychological variables . All impaired aspects of performance were significantly associated with either subjective or objective sleep continuity , and some were also independently related to sleep microstructure ( i.e. , relative power for alpha frequencies ) or selected psychological variables ( i.e. , beliefs or arousal ) . CONCLUSIONS These findings suggest clinical ly significant alterations in attention and episodic memory in individuals with insomnia . Objective deficits were more pronounced and involved more aspects of performance in a subgroup of individuals with cognitive complaints . These deficits appear associated with sleep continuity , and may also be related to sleep microstructure and dysfunctional beliefs OBJECTIVES Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia . Existing measurement approaches to functional impact tend to rely on non-specific generic tools , non-vali date d scales , or ad hoc single scale items . Here we report the development and validation of the Glasgow Sleep Impact Index  ( GSII ) , a novel self-report measure which asks patients to generate , and assess , three domains of impairment unique to their own individual context . These three patient-generated areas of impairment are ranked in order of concern ( 1 - 3 ; i.e. 1=the most concerning impairment ) , and then rated on a visual analogue scale with respect to impact in the past two weeks . Patients re-rate these specified areas of impairment , post-intervention , permitting both individual and group-level analyses . METHODS One-hundred and eight patients ( 71 % female ; Mean age=45 yrs ) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII , result ing in the generation of 324 areas ( ranks ) of sleep-related daytime and quality of life impairment . Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy . The following psychometric properties were assessed : content validity of generated domains ; relationship between ranks of impairment ; and sensitivity to change post-behavioural intervention . RESULTS Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia ; with the most commonly cited areas reflecting impairments in energy/motivation , work performance , cognitive functioning , emotional regulation , health/well-being , social functioning and relationship/family functioning . Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity . The GSII was found to be sensitive to change , post-behavioural treatment ( p<0.001 ; Cohen 's d≥0.85 for all three ranks of impairment ) , and improvements were associated with reductions in insomnia severity in both correlational ( range of r=0.28 - 0.56 ) and responder versus non-responder analyses ( all p<0.05 ) . CONCLUSIONS The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way . Further psychometric and clinical evaluation is suggested Neural systems of the prefrontal cortex ( PFC ) involved in executive functions are particularly vulnerable to  sleep deprivation ( SD ) . In this study , we investigated whether SD selectively affects specific components of the executive control processes involved in task-switching performance . Two different tasks are performed in rapid and r and om succession in this procedure , so that the to-be-executed task may change from one trial to the next ( switch trial ) , or may be repeated ( repetition trial ) . Task-switches are usually slower than task repetitions , giving way to the ' switch cost ' . One hundred and eight university students were assigned r and omly to the sleep ( S ) or the SD group . Each of them was tested on a  task-switching paradigm before and after an experimental night ( S or SD ) , and after one recovery night . SD impaired both task-switching accuracy and speed . A higher proportion of errors and increased switch costs after SD have been observed , compared to normal sleep . Control analyses on switch and repetition trials showed that the SD group was significantly worse only on the switch trials . The effects of SD are reverted by one night of recovery sleep . It is concluded that the ability to adjust behaviour rapidly and flexibly to changing environmental dem and s , which relies on the functional integrity of the PFC , is impacted negatively by sleep loss Previous studies showing a relationship between nocturnal slow-wave sleep ( SWS )  and subsequent diurnal performance among young normal sleepers and older insomnia sufferers have provided limited support for the notion that this sleep stage serves a restorative role for neurocognitive functioning . The current study , which examined the relationship between SWS and reaction time performance among middle-aged adults with and without insomnia complaints , was conducted to further explore this possibility . A sample of 31 noncomplaining middle-aged ( ages 40 to 59 years ) normal sleepers and a like-aged sample of 27 insomnia sufferers , provided data for the current investigation . All participants underwent nocturnal sleep monitoring immediately prior to undergoing a battery of daytime tests that measured simple reaction time , vigilance/signal detection , and complex reaction time .  Results showed relationships between reaction time performances on some tasks and some SWS measures among both the normal sleepers and insomnia sufferers . Findings supported our prediction that the presence of sleep pathology ( e.g. , insomnia ) alters the SWS-performance relationship observed , but the results failed to show a consistent relationship between SWS and subsequent performance within either sample . The findings suggest that the specific performance dem and s of the task in question as well as physiological parameters other than SWS may determine performance as well . Findings for this and previous studies do provide some support for the contention that the neurocognitive restorative value of SWS may change across the lifespan . Possible implication s of the study 's findings are discussed and directions for future research are considered STUDY OBJECTIVES To examine the joint effect of insomnia and objective short sleep duration on neuropsychological performance . DESIGN Representative cross-sectional study . SETTING Sleep laboratory . PARTICIPANTS 1,741 men and women r and omly selected from central Pennsylvania . INTERVENTIONS None . MEASUREMENTS Insomnia ( n = 116 ) was defined by a complaint of insomnia with a duration > or = 1 year and the absence of sleep disordered breathing ( SDB ) , while normal sleep ( n = 562 ) was defined as the absence of insomnia , excessive daytime sleepiness , and SDB . Both groups were split according to polysomnographic sleep duration into 2 categories : > or = 6 h of sleep ( " normal sleep duration ") and < 6 h of sleep ( " short sleep duration ") . We compared the groups ' performance on a comprehensive neuropsychological battery that measured processing speed , attention , visual memory , and verbal fluency , while controlling for age , race , gender , education , body mass index , and physical and mental health . RESULTS No significant differences were detected between insomniacs and controls . However , the insomnia with short sleep duration group compared to the control with normal or short sleep duration groups showed poorer neuropsychological performance in variables such as processing speed , set-switching attention , and number of visual memory errors and omissions . In contrast , the insomnia with normal sleep duration group showed no significant deficits . CONCLUSIONS Insomnia with objective short sleep duration is associated with deficits in set-switching attentional abilities , a key component of the " executive control of attention . " These findings suggest that objective sleep duration may predict the severity of chronic insomnia , including its effect on neurocognitive function Insomniacs often complain of memory deficits , yet objective measures have not consistently corroborated their subjective impressions . A possible explanation for the partial gap between self-report and behavioral measures of memory impairment is that insomniacs recruit extra effort to compensate for the consequences of poor sleep . The present study investigated whether subjective insomnia severity would predict objective effort mobilization , as indexed by cardiovascular measures , in an easy memory task . Seventy-seven university students , mostly women , with a mean age of 22 years were asked to memorize four strings of four r and om letters in 5 min while cardiovascular measures were obtained . After taking an immediate recall 
    Output:
    
Conclusions : We gathered evidence supporting small to moderate deficits in EFs in individuals with insomnia .