***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 Several studies on the effect of physical exercise on activities of daily living ( ADL ) for people with dementia exist ; yet , data concerning the specific context of acute psychiatric hospitals remain scant . This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward . METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals . Participants were r and omly allocated to either an experimental group ( EG ) or a control group ( CG ) . Members of the EG received 20 physical exercise sessions ( strengthening , balance , and walking ) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency , but without physical exercise . The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention , and two weeks later . RESULTS Hundred and sixty patients completed the program . Characteristics of participants of both groups were similar at the inception of the study . The mean ADL score of EG decreased slightly over time , whereas that of the CG significantly decreased compared to initial scores . Overall differences between groups were not significant ; however , significant differences were found for mobility-related items . CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization . An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores Background : Individuals with dementia often experience poor quality of life ( QOL ) due to behavioral and psychological symptoms of dementia ( BPSD ) . Music therapy can reduce BPSD , but most studies have focused on patients with mild to moderate dementia . We hypothesized that music intervention would have beneficial effects compared with a no-music control condition , and that interactive music intervention would have stronger effects than passive music intervention . Methods : Thirty-nine individuals with severe Alzheimer 's disease were r and omly and blindly assigned to two music intervention groups ( passive or interactive ) and a no-music Control group . Music intervention involved individualized music . Short-term effects were evaluated via emotional response and stress levels measured with the autonomic nerve index and the Faces Scale . Long-term effects were evaluated by BPSD changes using the Behavioral Pathology in Alzheimer 's Disease ( BEHAVE-AD ) Rating Scale . Results : Passive and interactive music interventions caused short-term parasympathetic dominance . Interactive intervention caused the greatest improvement in emotional state . Greater long-term reduction in BPSD was observed following interactive intervention , compared with passive music intervention and a no-music control condition . Conclusion : Music intervention can reduce stress in individuals with severe dementia , with interactive interventions exhibiting the strongest beneficial effects . Since interactive music intervention can restore residual cognitive and emotional function , this approach may be useful for aiding severe dementia patients ’ relationships with others and improving QOL . The registration number of the trial and the name of the trial registry are UMIN000008801 and “ Examination of Effective Nursing Intervention for Music Therapy for Severe Dementia Elderly Person ” respectively Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The Neuropsychiatric Inventory ( NPI ) is a vali date d clinical instrument for evaluating psychopathology in dementia . The authors developed a brief question naire form of the NPI ( NPI-Q ) , intended for use in routine clinical practice , and cross-vali date d it with the NPI in 60 Alzheimer 's patients .  Test-retest reliability of the NPI-Q was acceptable . The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 5 % ; moderate or severe symptom ratings differed by less than 2 % . The NPI-Q provides a brief , reliable , informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice Abstract Objectives To determine the respective efficacy of quetiapine and rivastigmine for agitation in people with dementia in institutional care and to evaluate these treatments with respect to change in cognitive performance . Design R and omised double blind ( clinician , patient , outcomes assessor ) placebo controlled trial . Setting Care facilities in the north east of Engl and . Participants 93 patients with Alzheimer 's disease , dementia , and clinical ly significant agitation . Intervention Atypical antipsychotic ( quetiapine ) , cholinesterase inhibitor ( rivastigmine ) , or placebo ( double dummy ) . Main outcome measures Agitation ( Cohen-Mansfield agitation inventory ) and cognition ( severe impairment battery ) at baseline and at six weeks and 26 weeks . The primary outcome was agitation inventory at six weeks . Results 31 patients were r and omised to each group , and 80 ( 86 % ) started treatment ( 25 rivastigmine , 26 quetiapine , 29 placebo ) , of whom 71 ( 89 % ) tolerated the maximum protocol dose ( 22 rivastigmine , 23 quetiapine , 26 placebo ) . Compared with placebo , neither group showed significant differences in improvement on the agitation inventory either at six weeks or 26 weeks . Fifty six patients scored > 10 on the severe impairment battery at baseline , 46 ( 82 % ) of whom were included in the analysis at six week follow up ( 14 rivastigmine , 14 quetiapine , 18 placebo ) . For quetiapine the change in severe impairment battery score from baseline was estimated as an average of -14.6 points ( 95 % confidence interval -25.3 to -4.0 ) lower ( that is , worse ) than in the placebo group at six weeks ( P = 0.009 ) and -15.4 points ( -27.0 to -3.8 ) lower at 26 weeks ( P = 0.01 ) . The corresponding changes with rivastigmine were -3.5 points ( -13.1 to 6.2 ) lower at six weeks ( P = 0.5 ) and -7.5 points ( -21.0 to 6.0 ) lower at 26 weeks ( P = 0.3 ) . Conclusions Neither quetiapine nor rivastigmine are effective in the treatment of agitation in people with dementia in institutional care . Compared with placebo , quetiapine is associated with significantly greater cognitive decline Objective : To determine whether an activity specific exercise program could improve ability to perform basic mobility activities in long-term care residents with Alzheimer disease ( AD ) . Design : R and omized , controlled , single-blinded clinical trial . Setting : Residents of 7 long-term care facilities . Participants : Eighty-two long-term care residents with mild to severe AD . Intervention : An activity specific exercise program was compared to a walking program and to an attention control . Measurements : Ability to perform bed mobility and transfers was assessed using the subscales of the Acute Care Index of Function ; functional mobility was measured using the 6-Minute Walk test . Results : Subjects receiving the activity specific exercise program improved in ability to perform transfers , whereas subjects in the other 2 groups declined CONTEXT Memantine is a low- to moderate-affinity , uncompetitive N-methyl-D-aspartate receptor antagonist . Controlled trials have demonstrated the safety and efficacy of memantine monotherapy for patients with moderate to severe Alzheimer disease ( AD ) but no controlled trials of memantine in patients receiving a cholinesterase inhibitor have been performed . OBJECTIVE To compare the efficacy and safety of memantine vs placebo in patients with moderate to severe AD already receiving stable treatment with donepezil . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blind , placebo-controlled clinical trial of 404 patients with moderate to severe AD and Mini-Mental State Examination scores of 5 to 14 , who received stable doses of donepezil , conducted at 37 US sites between June 11 , 2001 , and June 3 , 2002 . A total of 322 patients ( 80 % ) completed the trial . INTERVENTIONS Participants were r and omized to receive memantine ( starting dose 5 mg/d , increased to 20 mg/d , n = 203 ) or placebo ( n = 201 ) for 24 weeks . MAIN OUTCOME MEASURES Change from baseline on the Severe Impairment Battery ( SIB ) , a measure of cognition , and on a modified 19-item AD Cooperative Study -Activities of Daily Living Inventory ( ADCS-ADL19 ) . Secondary outcomes included a Clinician 's Interview-Based Impression of Change Plus Caregiver Input ( CIBIC-Plus ) , the Neuropsychiatric Inventory , and the Behavioral Rating Scale for Geriatric Patients ( BGP Care Dependency Subscale ) . RESULTS The change in total mean ( SE ) scores favored memantine vs placebo treatment for SIB ( possible score range , 0 - 100 ) , 0.9 ( 0.67 ) vs -2.5 ( 0.69 ) , respectively ( P<.001 ) ; ADCS-ADL19 ( possible score range , 0 - 54 ) , -2.0 ( 0.50 ) vs -3.4 ( 0.51 ) , respectively ( P = .03 ) ; and the CIBIC-Plus ( possible score range , 1 - 7 ) , 4.41 ( 0.074 ) vs 4.66 ( 0.075 ) , respectively ( P = .03 ) . All other secondary measures showed significant benefits of memantine treatment . Treatment discontinuations because of adverse events for memantine vs placebo were 15 ( 7.4 % ) vs 25 ( 12.4 % ) , respectively . CONCLUSIONS In patients with moderate to severe AD receiving stable doses of donepezil , memantine result ed in significantly better outcomes than placebo on measures of cognition , activities of daily living , global outcome , and behavior and was well tolerated . These results , together with previous studies , suggest that memantine represents a new approach for the treatment of patients with moderate to severe AD Objectives To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living ( ADLs ) and balance in older people with dementia and whether exercise effects differed between dementia types . Design Cluster-r and omized controlled trial : Umeå Dementia and Exercise ( UMDEX ) study . Setting Residential care facilities , Umeå , Sweden . Participants Individuals aged 65 and older with a dementia diagnosis , a Mini-Mental State Examination score of 10 or greater , and dependence in ADLs ( N = 186 ) . Intervention Ninety-three participants each were allocated to the high-intensity functional exercise program , comprising lower limb strength and balance exercises , and 93 to a seated control activity . Measurements Blinded assessors measured ADL independence using the Functional Independence Measure ( FIM ) and Barthel Index ( BI ) and balance using the Berg Balance Scale ( BBS ) at baseline and 4 ( directly after intervention completion ) and 7 months . Results Linear mixed models showed no between-group effect on ADL independence at 4 ( FIM=1.3 , 95 % confidence interval (CI)=−1.6–4.3 ; BI=0.6 , 95 % CI=−0.2–1.4 ) or 7 ( FIM=0.8 , 95 % CI=−2.2–3.8 ; BI=0.6 , 95 % CI=−0.3–1.4 ) months . A significant between-group effect on balance favoring exercise was observed at 4 months ( BBS=4.2 , 95 % CI=1.8–6.6 ) . In interaction analyses , exercise effects differed significantly between dementia types . Positive between-group exercise effects were found in participants with non-Alzheimer 's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months . Conclusion In older people with mild to moderate dementia living in residential care facilities , a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance , albeit only in participants with non-Alzheimer 's dementia BACKGROUND Although there is good evidence that interventions for carers of people with Alzheimer 's disease can reduce stress , no systematic studies have investigated psychotherapeutic intervention for patients themselves . This may be important in the earlier stages of Alzheimer 's disease , where insight is often preserved . AIMS The aim was to assess , in a r and omised controlled trial , whether psychotherapeutic intervention could benefit cognitive function , affective symptoms and global well-being . METHOD Individuals were r and omised to receive six sessions of psychodynamic interpersonal therapy or treatment as usual ;  cognitive function , activities of daily living , a global measure of change , and carer stress and coping were assessed prior to and after the intervention . RESULTS No improvement was found on the majority of outcome measures . There was a suggestion that therapy had improved the carers ' reactions to some of the symptoms . CONCLUSIONS There is no evidence to support the widespread introduction of brief psychotherapeutic approaches for those with Alzheimer 's disease . However , the technique was acceptable and helpful individually We undertook a r and omised controlled trial to assess whether a music therapy ( MT ) scheme of administration , including three working cycles of one month spaced out by one month of no treatment , is effective to reduce behavioural disturbances in severely demented patients . Sixty persons with severe dementia ( 30 in the experimental and 30 in the control group ) were enrolled . Baseline multidimensional assessment included demographics , Mini Mental State Examination ( MMSE ) , Barthel Index and 
    Output:
    
However , NPI were not effective in reducing agitation , anxiety , or overall , or improving cognitive function .
Albeit the number of studies was limited , NPI improved ADL and depression in PWMSD