***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 Studies examining whether genetic risk information about common , complex diseases can motivate individuals to improve health behaviors and advance planning have shown mixed results . Examining the influence of different study recruitment strategies may help reconcile inconsistencies . Methods Secondary analyses were conducted on data from the REVEAL study , a series of r and omized clinical trials examining the impact of genetic susceptibility testing for Alzheimer ’s disease ( AD ) . We tested whether  self-referred participants ( SRPs ) were more likely than  actively recruited participants ( ARPs ) to report health behavior and advance planning changes after AD risk and APOE genotype disclosure . Results Of 795 participants with known recruitment status , 546 ( 69 % ) were self-referred and 249 ( 31 % ) had been actively recruited . SRPs were younger , less likely to identify as African American , had higher household incomes , and were more attentive to AD than ARPs ( all P < 0.01 ) . They also dropped out of the study before genetic risk disclosure less frequently ( 26 % versus 41 % , P < 0.001 ) . Cohorts did not differ in their likelihood of reporting a change to at least one health behavior 6 weeks and 12 months after genetic risk disclosure , nor in intentions to change at least one behavior in the future . However , interaction effects were observed where ε4-positive SRPs were more likely than ε4-negative SRPs to report changes specifically to mental activities ( 38 % vs 19 % , p < 0.001 ) and diets ( 21 % vs 12 % , p = 0.016 ) six weeks post-disclosure , whereas differences between ε4-positive and ε4-negative ARPs were not evident for mental activities ( 15 % vs 21 % , p = 0.413 ) or diets ( 8 % versus 16 % , P = 0.190 ) . Similarly , ε4-positive participants were more likely than ε4-negative participants to report intentions to change long-term care insurance among SRPs ( 20 % vs 5 % , p < 0.001 ) , but not ARPs ( 5 % versus 9 % , P = 0.365 ) . Conclusions Individuals who proactively seek AD genetic risk assessment are more likely to undergo testing and use results to inform behavior changes than those who respond to genetic testing offers . These results demonstrate how the behavioral impact of genetic risk information may vary according to the models by which services are provided , and suggest that how participants are recruited into translational genomics research can influence findings .Trial registration Clinical Trials.gov NCT00089882 and Purpose : Brief , effective models of patient genetic education are needed for common , complex diseases . Using Alzheimer disease as a model , we compared participants ’ risk knowledge and recall in extended versus condensed education protocol s. Methods : A four-site r and omized clinical trial enrolled 280 first-degree relatives of individuals with Alzheimer disease ( mean age = 58 years , 71 % female ) ; each received lifetime Alzheimer disease risk information ( range : 13–74 % ) that incorporated apolipoprotein E genotype . In the condensed protocol , participants received an educational brochure in place of an in-person education session . Outcomes were assessed at 6 weeks and 6 months following risk disclosure . Results : The condensed protocol required less clinician time than the extended protocol ( mean = 34 min vs. 77 min ) . The groups did not differ on recall of apolipoprotein E genotype or lifetime risk , and most participants in both groups recalled and retained this information over time . Both groups showed improvement from baseline in Alzheimer disease risk knowledge ( e.g. , underst and ing the magnitude of apolipoprotein E genotype effect on risk ) . Conclusion : A condensed protocol for communicating genetic risk for Alzheimer disease achieved similar educational results as an extended protocol in this study . Further research should explore the efficacy of brief genetic education protocol s for complex diseases in diverse population s . Genet Med 2012:14(8):742–748 BACKGROUND Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies . In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability ( FINGER ) , a proof-of-concept r and omised controlled trial , we aim ed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population . METHODS In a double-blind r and omised controlled trial we enrolled individuals aged 60 - 77 years recruited from previous national surveys . Inclusion criteria were CAIDE ( Cardiovascular Risk Factors , Aging and Dementia ) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age . We r and omly assigned participants in a 1:1 ratio to a 2 year multidomain intervention ( diet , exercise , cognitive training , vascular risk monitoring ) , or a control group ( general health advice ) . Computer-generated allocation was done in blocks of four ( two individuals r and omly allocated to each group ) at each site . Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation . The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery ( NTB ) Z score . Analysis was by modified intention to treat ( all participants with at least one post-baseline observation ) . This trial is registered at Clinical Trials.gov , number NCT01041989 . FINDINGS Between Sept 7 , 2009 , and Nov 24 , 2011 , we screened 2654 individuals and r and omly assigned 1260 to the intervention group ( n=631 ) or control group ( n=629 ) . 591 ( 94 % ) participants in the intervention group and 599 ( 95 % ) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis . Estimated mean change in NTB total Z score at 2 years was 0·20 ( SE 0·02 , SD 0·51 ) in the intervention group and 0·16 ( 0·01 , 0·51 ) in the control group . Between-group difference in the change of NTB total score per year was 0·022 ( 95 % CI 0·002 - 0·042 , p=0·030 ) . 153 ( 12 % ) individuals dropped out overall . Adverse events occurred in 46 ( 7 % ) participants in the intervention group compared with six ( 1 % ) participants in the control group ; the most common adverse event was musculoskeletal pain ( 32 [ 5 % ] individuals for intervention vs no individuals for control ) . INTERPRETATION Findings from this large , long-term , r and omised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population . FUNDING Academy of Finl and , La Carita Foundation , Alzheimer Association , Alzheimer 's Research and Prevention Foundation , Juho Vainio Foundation , Novo Nordisk Foundation , Finnish Social Insurance Institution , Ministry of Education and Culture , Salama bint Hamdan Al Nahyan Foundation , Axa Research Fund , EVO funding for University Hospitals of Kuopio , Oulu , and Turku and for Seinäjoki Central Hospital and Oulu City Hospital , Swedish Research Council , Swedish Research Council for Health , Working Life and Welfare , and af Jochnick Foundation Purpose : Alzheimer ’s disease , for which one form of the apolipoprotein E ( APOE ) genotype is a risk factor , provides a paradigm in which to examine response to susceptibility testing for common , complex diseases . This study ’s main purpose s were to estimate interest in such testing and to examine demographic predictors of study participation . Methods : In this 3-site , r and omized clinical trial ( RCT ) , the intervention was a risk assessment program wherein genetic counselors educated adult children of AD patients about lifetime risk of disease based on their gender , family history , and APOE genotype . Two groups of participants were followed from initial contact to RCT enrollment : those who were systematic ally contacted through research registries , and those who were self-referred . Results : Of 196 systematic ally contacted participants , 47 , or 24 % , progressed from initial contact to RCT enrollment . These participants were more likely to be below age 60 ( adjusted OR = 3.83 , P < 0.01 ) and college educated ( adjusted OR = 3.48 , P < 0.01 ) . Of 179 self-referred participants , 115 , or 64 % , progressed from initial contact to RCT enrollment . Most self-referred participants had a college education and were female ( 79 % ) . Conclusions : In the first RCT to examine genetic susceptibility testing for AD , uptake rates were sufficiently high to merit concern that future test dem and may strain available education and counseling re sources . Findings suggest that susceptibility testing for AD may be of particular interest to women , college educated persons , and persons below age 60 This study explored the extent to which recipients of genetic susceptibility testing for Alzheimer 's disease ( AD )  communicated their results to others . It also examined demographic characteristics , along with beliefs about AD , associated with such communication . Participants ( N = 271 ) in a r and omized clinical trial involving genetic testing for Apolipoprotein E ( APOE ) gene variants among first-degree relatives of AD patients reported their communication behaviors 6 weeks after the results disclosure . Information on beliefs about AD and genetic testing was collected at baseline . Eighty-two percent of participants receiving APOE genotype information shared their results with someone . Specifically , 64 % shared with family members , 51 % with spouse or significant others , 35 % with friends , and 12 % with health care professionals . Greater AD treatment optimism was associated with communicating results to family ( OR = 1.43 ) , spouse ( OR = 1.62 ) , friends ( OR = 1.81 ) , and health care professionals ( OR = 2.20 ) . Lower perceived risk ( OR = 0.98 ) and higher perceived importance of genetics in the development of AD ( OR = 1.93 ) were associated with results communication in general . Lower perceived drawbacks of AD genetic testing  was associated with results communication to friends ( OR = 0.65 ) . Beliefs about AD risks and causes , genetic testing , and development of treatments partly may determine the interpersonal communication patterns of genetic susceptibility test results & NA ; Advances in genetic research have provided a basis for susceptibility testing for Alzheimer disease ( AD ) . Prior surveys have examined attitudes toward genetic testing for AD in hypothetical scenarios , but it is unclear what reasons would motivate people to seek testing in real‐life situations . This study presents data from the first r and omized trial to evaluate genetic susceptibility testing for asymptomatic adult children of people with AD . We examined ( 1 ) reasons endorsed as motivations for seeking testing , ( 2 ) demographic characteristics associated with these reasons , and ( 3 ) how these reasons related to the eventual decision to pursue testing . Eligible participants were 206 adult children of people with AD ( mean age 53 years ; 72 % female ; 93 % white ) , 77.7 % of whom ( n = 160 ) went on to seek testing . Participants endorsed numerous reasons for seeking susceptibility testing ( mean 7.2 ) , encompassing a range of motivations . The most commonly endorsed reasons were as follows : ( 1 ) to contribute to research ( 93.9 % ) , ( 2 ) to arrange personal affairs ( 87.4 % ) , and ( 3 ) the hope that effective treatment will be developed ( 86.8 % ) . Women strongly endorsed more reasons for seeking testing than men ( p < 0.05 ) . The best predictor of actual pursuit of testing was strong endorsement of the need to prepare family members for AD ( odds ratio = 3.3 , p < 0.01 ) . Findings suggest that genetic susceptibility testing is of interest to individuals at risk for AD for a variety of reasons , even in the relative absence of available treatments BACKGROUND Genetic susceptibility testing for Alzheimer disease ( AD ) with APOE genotype disclosure is not recommended for clinical use but is available through direct-to-consumer ( DTC ) genetic testing companies . Little is known about whether APOE genotype disclosure would actually prompt changes in nutrition behaviors among at-risk individuals . OBJECTIVE We studied the effect of APOE genotype disclosure for AD risk assessment on dietary supplement use in adults with a family history of AD . DESIGN As part of a secondary analysis of data from the second Risk Evaluation and Education for Alzheimer 's Disease Study , we examined the effect of genotype disclosure on health-behavior changes among 272 unaffected first-degree relatives of persons with AD . RESULTS Overall , 16 % of all participants reported a change in dietary supplement use after AD risk assessment . Participants who learned that they had at least one copy of the risk-increasing epsilon4 allele ( epsilon4 + ) had 4.75 times the odds of reporting a change in dietary supplement use than did their counterparts who had an absence of the risk-increasing epsilon4 allele ( epsilon4- ) ( 95 % CI : 2.23 , 10.10 ; P < 0.0001 ) after adjustment for age , sex , race , baseline supplement use , r and omization arm , and educational level . There were no significant differences between APOE epsilon4 + and epsilon4- participants in changes in overall diet , exercise , or medications . CONCLUSIONS In this sample of first-degree relatives receiving genetic susceptibility testing for AD , an APOE epsilon4 + genotype status was positively associated with dietary 
    Output:
    
Overall , there is evidence for a wish to gain knowledge about the own brain status and risk of dementia .
Psychological distress may occur and the subjective benefit-risk estimation may be modified after risk disclosure .
Effects on lifestyle and planning may occur .
Overall underst and ing and appraisal of information related to AD risk seem variable with several impacting factors .
In mild cognitive impairment ( MCI ) basic HL skill seem to be affected by cognitive dysfunction .