***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: A placebo-controlled crossover design , with each treatment period lasting 6 weeks , was used to investigate effects of dronabinol in 15 patients with a diagnosis of probable Alzhemer 's disease who were refusing food . Eleven patients completed both study periods ; one patient who died of a heart attack 2 weeks before the end of the study was also included in the analysis . The study was terminated in 3 patients : one developed a gr and mal seizure and 2 developed serious intercurrent infections . Body weight of study subjects increased more during the dronabinol treatment than during the placebo periods . Dronabinol treatment decreased severity of disturbed behavior and this effect persisted during the placebo period in patients who received dronabinol first . Adverse reactions observed more commonly during the dronabinol treatment than during placebo periods included euphoria , somnolence and tiredness , but did not require discontinuation of therapy . These results indicate that dronabinol is a promising novel therapeutic agent which may be useful not only for treatment of anorexia but also to improve disturbed behavior in patients with Alzheimer 's disease BACKGROUND Despite recognition that weight loss is a problem in elderly persons with probable Alzheimer 's disease ( AD ) , increasing their food intake remains a challenge . To effectively enhance intake , interventions must work with individuals ' changing needs and intake patterns . Previously , the authors reported greater food consumption at breakfast , a high-carbohydrate meal , compared with dinner , and shifts toward carbohydrate preference at dinner in those with increased behavioral difficulties , low body mass index , or both . METHODS Thirty-four nursing home residents with probable AD who ate independently participated in a r and omized , crossover , nonblinded study of two nutrition interventions . The intervention described here included replacing 12 nonconsecutive " traditional " dinners with meals high in carbohydrate but comparable to traditional dinners in protein . Measures included weighed food intake , body weight , cognitive function ( as assessed using the Severe Impairment Battery and Global Deterioration Scale ) , behavioral disturbances ( as assessed using the Neuropsychiatric Inventory-Nursing Home Version ) , and behavioral function ( as assessed using the London Psychogeriatric Rating Scale ) . RESULTS Group mean dinner and 24-hour energy intake increased during the intervention phase compared with baseline , protein intake was unaffected , and carbohydrate intake increased . Increased dinner intake , attributable to intervention foods , was achieved in 20 of 32 of participants who completed the study and was associated with increased carbohydrate preference , poorer memory , and increased aberrant motor behavior . Those with low body mass indices were the most resistant to the intervention . CONCLUSIONS Providing a high-carbohydrate meal for dinner increases food intake in seniors at later stages of the disease who are experiencing cognitive and behavioral difficulties , possibly as a result of a shift in preference for high-carbohydrate foods OBJECTIVE to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation . DESIGN in a prospect i ve , r and omised , controlled study of 80 patients aged 75 or more , and at risk of undernutrition based on their initial Mini Nutritional Assessment score , patients were r and omised into a control group or one receiving oral supplementation . The intervention was a prescription of 200 ml sweet or salty sip feed twice daily ( 500 kcal , 21 g protein per day ) throughout hospitalisation and convalescence . Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record . RESULTS compliance with oral supplementation was good and daily extra energy intake was 407+/-184 kcal . On day 60 , significant weight loss from upon admission was observed in the control group ( -1.23+/-2.5 kg ; P=0.01 ) , but not in the supplemented group ( 0.28+/-3.8 kg ; NS ) . At the end of the study , Mini Nutritional Assessment scores were higher in the supplemented group than in the control group ( 23.5+/-3.9 versus 20.8+/-3.6 ; P<0.01 ) . CONCLUSION use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition BACKGROUND Weight loss among older patients is a severe problem , associated with an increased incidence of infections , decubiti , and death . Megestrol acetate ( MA ) causes weight gain in cachectic cancer and AIDS patients , but its effects in older cachectic patients are unknown . OBJECTIVE To compare the effects of MA oral suspension ( O.S. ) , 800 mg/day , versus placebo on weight in geriatric nursing home patients with weight loss or low body weight . DESIGN Twelve-week , r and omized , double-blind , placebo-controlled trial with a 13-week follow-up period . SETTING Veterans Administration Medical Center ( VMAC ) nursing home . PATIENTS Nursing home patients with weight loss of > or = 5 % of usual body weight over the past 3 months , or body weight 20 % below their ideal body weight . INTERVENTIONS Patients were r and omly assigned to receive placebo or MA 800 mg/day for 12 weeks and were then followed for 13 weeks off treatment . MEASUREMENTS Primary outcome was measured by weight and appetite change . Secondary outcome measures included sense of well-being , enjoyment of life , change in depression scale , laboratory nutrition parameters , energy intake counts , body composition , and adverse events . RESULTS At 12 weeks there were no significant differences in weight gain between treatment groups , whereas MA-treated patients reported significantly greater improvement in appetite , enjoyment of life , and well-being . Body composition was not statistically different between the two groups . At Week 25 ( 3 months after treatment ) , 61.9 % of MA-treated patients had gained > or = 1.82 kg ( 4 lbs ) compared to 21.7 % of placebo patients . CONCLUSIONS In geriatric patients with weight loss or low body weight MA improves appetite and well-being after 12 weeks of treatment . During the 3 months of MA treatment , there was no statistically significant weight gain ( > or = 4 lbs ) . Three months after treatment , weight gain ( > or = 4 lbs ) was significantly increased in MA-treated patients OBJECTIVE Percutaneous endoscopic gastrostomy ( PEG ) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating , but the impact of PEG on patient outcomes is poorly understood . The objective of this study was to describe changes in nutrition , functional status , and health-related quality of life among older adults receiving PEG .  DESIGN A prospect i ve cohort study . SETTING A small community of approximately 60,000 residents served by two hospital systems . PARTICIPANTS One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community . MEASUREMENTS Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics , process of care data , physical and cognitive function , subjective health status , nutritional status , complications , and mortality . RESULTS Over a 14-month period , 150 patients received PEG tubes in the targeted community ; the mean age was 78.9 . The most frequent indications for the PEG were stroke ( 40.7 % ) , neurodegenerative disorders ( 34.7 % ) , and cancer ( 13.3 % ) . All measures of functional status , cognitive status , severity of illness , comorbidity , and quality of life demonstrated profound and life-threatening impairment ; 30-day mortality was 22 % and 1-year mortality was 50 % . Among patients surviving 60 days or more , at least 70 % had no significant improvement in functional , nutritional , or subjective health status . Serious complications were rare , but most patients experienced symptomatic problems that they attributed to the enteral tube feeding . CONCLUSIONS PEG tube feeding in severely and chronically ill older adults can be accomplished safely . However , there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional , nutritional , or subjective health status in this cohort of older adults . The issues raised in this descriptive study provide impetus for a r and omized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating AIMS To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer 's disease patients . METHODS Patients were r and omly assigned to two interventions : a whole formula diet based on lyophilised foods ( Treatment Group , n=24 ) or nutritional advice ( Control Group , n=29 ) . Energy intake , body weight , biochemistry , Mini Nutritional Assessment ( MNA ) and Pfeiffer 's tests were determined at baseline and at 3 months of treatment . RESULTS No differences were observed between groups at baseline . Energy intake tended to increase in the Treatment Group and to decrease in the Control Group , although differences were not significant . The improvement in MNA and Pfeiffer test scores was not significantly different between groups . Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group ( P=0.007 ) . The increases in albumin ( P=0.007 ) , haemoglobin ( P=0.002 ) and serum ferritin ( P=0.009 ) were higher in the Treatment Group than in controls . A similar rate of serious adverse events ( hospitalisation or death ) was observed in both groups . CONCLUSIONS Administration of this whole formula has a positive impact on nutritional status . The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12- 
    Output:
    
Studies provide moderate-strength evidence for high-calorie supplements , and low-strength evidence for appetite stimulants , assisted feeding , and modified foods to promote weight gain in people with dementia .
The few studies measuring function or survival showed no difference .
High-calorie supplements and other oral feeding options can help people with dementia with feeding problems to gain weight ; they are unlikely to improve other outcomes .