***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: Treatment with acetyl L-carnitine ( ALCAR ) has been shown to improve fatigue in patients with chronic fatigue syndrome , but there have been no trials on the effect of ALCAR for treating fatigue in multiple sclerosis ( MS ) . To compare the efficacy of ALCAR with that of amantadine , one of the drugs most widely used to treat MS-related fatigue , 36 MS patients presenting fatigue were enrolled in a r and omised , double-blind , crossover study . Patients were treated for 3 months with either amantadine ( 100 mg twice daily ) or ALCAR ( 1 g twice daily ) . After a 3-month washout period , they crossed over to the alternative treatment for 3 months . Patients were rated at baseline and every 3 months according to the Fatigue Severity Scale ( FSS ) , the primary endpoint of the study . Secondary outcome variables were : Fatigue Impact Scale ( FIS ) , Beck Depression Inventory ( BDI ) and Social Experience Checklist ( SEC ) .  Six patients withdrew from the study because of adverse reactions ( five on amantadine and one on ALCAR )  . Statistical analysis showed significant effects of ALCAR compared with amantadine for the Fatigue Severity Scale ( p = 0.039 ) . There were no significant effects for any of the secondary outcome variables . The results of this study show that ALCAR is better tolerated and more effective than amantadine for the treatment of MS-related fatigue Sixty senile subjects ( 60 - 80 years old ) with dysthymic disturbances as defined by DSM III ( Cat . 390.40 ) were r and omized into two homogeneous groups , one of which was given acetyl-L-carnitine ( 3 g/day per os ) while the other received a placebo . After a washout phase of one week , each patient was evaluated by scoring on the Hamilton Rating Scale for Depression and the Beck Depression Inventory , as well as the S and oz Clinical Assessment -Geriatric . These tests were administered at the beginning of the trial , prior to drug administration , and repeated during the treatment phase after 30 and 60 days . The results showed that treatment with acetyl-L-carnitine induced a significant reduction , as compared to the placebo ( p less than 0.002 ) , in the severity of depressive symptoms and also a significant improvement ( p less than 0.0027 ) in the items measuring the quality of life A single-blind clinical trial was carried out on 481 subjects enrolled in 44 geriatric and neurologic units following a strict selection criteria : age , Mini Mental State Examination ( MMSE ) Global Deterioration Scale and Geriatric Depression Scale ( GDS ) . After the initial screening and enrollment , the trial was run for 150 days in four phases : phase T0 ( placebo treatment for 30 days ) , phases T1 and T2 ( L-acetylcarnitine ( LAC ) 1500 mg/day for 90 days ) , phase T3 ( further 30 days of placebo treatment ) . Drug efficacy was evaluated according to changes occurring from the beginning to the end of the tests which evaluate either whole and specific cognitive performances , or emotional-affective and relational behaviour . The outcome of phase T3 enabled the authors to estimate the possible favourable effects persisting after termination of L-acetylcarnitine therapy . The cognitive sphere evaluated by MMSE showed a significant increase in the total score at the end of LAC treatment ( p < 0.0001 ) . The R and t Memory Test also revealed that LAC treatment improved the items tested : the total score and the memory index increased significantly and the favourable effect persisted after LAC was discontinued . The emotional-affective area showed a significant improvement in the total score of the GDS after LAC therapy , and the positive results were confirmed by the Hamilton Rating Scale ( p < 0.0001 ) . The behavioural-relational aspects evaluated by the Family Stress Scale showed a significant decrease in the total score after treatment ( p < 0.0004 ) ; the same trend was observed in the scores for instability and negative feeling . No significant adverse drug reaction occurred during the trial . In conclusion , the statistical analysis of the data from this single-blind , multicentre trial of mild mental impairment in the elderly showed a significant improvement of several performances during and after LAC treatment . Other reports indicate that this drug may be effective in the treatment of dementia OBJECTIVES To assess the longitudinal effects of acety-L-carnitine ( ALC ) on patients diagnosed with Alzheimer 's disease . DESIGN Longitudinal , double-blind , parallel-group , placebo-controlled . SETTING Twenty-four outpatient sites across the United States . PARTICIPANTS A total of 334 subjects diagnosed with probable Alzheimer 's disease by NINCDS-ADRDA criteria . These data were originally reported by Thal and colleagues ( 1996 ) . MEASUREMENTS Cognitive subscale of the Alzheimer Disease Assessment Scale ( ADAS ) given every 3 months for 1 year . RESULTS The average rate of change was estimated using the trilinear approach , which allows for periods of both change and stability . Both the ALC group and the placebo group exhibited the same mean rate of change on the ADAS ( 0.68 points/month ) . However , a multiple regression analysis revealed a statistically significant Age x Drug interaction characterized by younger subjects benefiting more from ALC , significant , cutpoint for ALC benefit was 61 years of age . CONCLUSIONS ALC slows the progression of Alzheimer 's disease in younger subjects , and the use of the trilinear approach to estimate the average rate of change may prove valuable in pharmacological trials Twenty-eight patients aged between 70 and 80 years affected by depressive disturbance as defined by DSM III R ( cat . 300.40 ) were subdivided at r and om into two homogeneous groups of 14 each . One group was treated with 500 mg three times a day of L-acetylcarnitine ( LAC ) in tablet form , while the other received placebo . Each patient was evaluated by the Hamilton Rating Scale for Depression , the Beck Depression Inventory , the S and oz Clinical Assessment --Geriatric , and by clinical global impression . This investigation establishes that LAC is effective in counteracting symptoms of depression in the elderly . Relief of depressive symptomatology is expressed by decreased scores in the Hamilton Rating Scale for Depression and Beck Depression Inventory and by beneficial effects with regard to behavioural aspects A r and omized , double-blind , placebo-controlled , parallel-group clinical trial was carried out to compare 24-week periods of treatment with 1 g acetyl-l-carnitine twice daily and placebo in the treatment of patients with dementia of the Alzheimer type . A total of 36 patients entered the trial , of whom 20 patients ( 7 active , 13 placebo ) completed the full 24 weeks . Whilst several of the efficacy indices showed little change in either group during the trial , there was an apparent trend for more improvement in the acetyl-l-carnitine group in relation to the Names Learning Test and a computerized Digit Recall Test , both related to aspects of short-term memory . Similarly , there was a trend for reaction time in the computerized classification test to show less deterioration in the active treatment group . Changes within groups , and changes between groups , failed to reach statistical significance , at least partially because of the small number of patients available for analysis . Two indices of overall therapeutic benefit showed a trend for less deterioration in the active-treatment group than in the placebo group . Nausea and /or vomiting occurred in 5 patients in the acetyl-l-carnitine group . Laboratory tests revealed no signs of drug toxicity . The results suggest that acetyl-l-carnitine may have a beneficial effect on some clinical features of Alzheimer-type dementia , particularly those related to short-term memory In two double-blind , placebo-controlled clinical studies of the nootropic compound acetyl-L-carnitine on the electroencephalogram ( EEG ) and impaired brain functions of elderly out patients with mild to moderate cognitive decline of the organic brain syndrome , statistically significant effects could be detected after eight weeks ( on the EEG ) , and after 12 weeks of treatment ( on the physician 's clinical global impression and the patient-rated level of activities of daily living ) . Side-effects of acetyl-L-carnitine were generally minor and overall rare . Longer treatment periods and further specifications with regard to the aetiopathology and degree of cognitive impairment are recommended for further clinical studies of this promising compound Acetyl levocarnitine hydrochloride has been reported to retard dementia in patients with Alzheimer 's disease . In a double-blind , parallel design , placebo-controlled pilot study of 30 mild to moderately demented patients with probable Alzheimer 's disease , tests of memory , attention , language , visuospatial , and constructional abilities were administered , and the level of acetyl levocarnitine was measured in the cerebrospinal fluid . Patients were then r and omly assigned to receive acetyl levocarnitine hydrochloride ( 2.5 g/d for 3 months followed by 3 g/d for 3 months ) or placebo . After 6 months , the acetyl levocarnitine group demonstrated significantly less deterioration in timed cancellation tasks and Digit Span ( forward ) and a trend toward less deterioration in a timed verbal fluency task . No differences were found in any other neuropsychological test results . A subgroup with the lowest baseline scores , receiving acetyl levocarnitine , had significantly less deterioration on the verbal memory test and a significant increase in cerebrospinal fluid acetyl levocarnitine levels compared with those receiving placebo . These results suggest that acetyl levocarnitine may retard the deterioration in some cognitive areas in patients with Alzheimer 's disease and stress the need for a larger study of this drug A 1-year , double-blind , placebo-controlled , r and omized , parallel-group study compared the efficacy and safety of acetyl-L-carnitine hydrochloride ( ALCAR ) with placebo in patients with probable Alzheimer 's disease ( AD ) . Subjects with mild to moderate probable AD , aged 50 or older , were treated with 3 g/day of ALCAR or placebo ( 1 g tid ) for 12 months . Four hundred thirty-one patients entered the study , and 83 % completed 1 year of treatment . The Alzheimer 's Disease Assessment Scale cognitive component and the Clinical Dementia Rating Scale were the primary outcome measures .Overall , both ALCAR- and placebo-treated patients declined at the same rate on all primary and most secondary measures during the trial . In a sub analysis by age that compared early-onset patients ( aged 65 years or younger at study entry ) with late-onset patients ( older than 66 at study entry ) , we found a trend for early-onset patients on ALCAR to decline more slowly than early-onset AD patients on placebo on both primary endpoints . In addition , early-onset patients tended to decline more rapidly than older patients in the placebo groups . Conversely , late-onset AD patients on ALCAR tended to progress more rapidly than similarly treated early-onset patients . The drug was very well tolerated during the trial . The study suggests that a subgroup of AD patients aged 65 or younger may benefit from treatment with ALCAR whereas older individuals might do more poorly . However , these preliminary findings are based on post hoc analyses . A prospect i ve trial of ALCAR in younger patients is underway to test the hypothesis that young , rapidly progressing subjects will benefit from ALCAR treatment . NEUROLOGY 1996;47 : 705 - In this paper the preliminary findings of a multicentre study on the effects of Acetyl-L-Carnitine on mildly impaired elderly are reported . Statistical analysis was carried out on 236 out of 469 subjects sample d in 42 different Italian geriatric or hospital units . Each subject was treated over 150 days , and a battery of tests ( investigating cognitive functioning , emotional-affective state and relational behavior ) was administered at the beginning on the treatment and the conclusion of each of its four phases . In the first and the last phases there was a 30 days placebo treatment ( aim ed respectively to wash-out the effects of previous drug and to assess the residual effects of the treatment ) , while in the second and the third ones ( both 45 days long ) the subjects took 1500 mg/day of Acetyl-L-carnitine . Repeated multivariate analysis of variance and of covariance ( taking as independent variables phases of treatment , age , gender , etiology and severity of mental impairment , as dependent variables the scores either of each test administered or of groups of items and as covariants the level of depression and the sensitivity to placebo effect ) showed that drug treatment significantly increased the effectiveness of performance on all the measures of cognitive functioning and of emotional-affective state and on some scores of the relational behavior . Age result ed significantly influential on cognitive functioning and relational behavior , but not on emotional-affective state . Severity of mental impairment significantly influenced also several measures of cognitive functioning and relational behavior , while less consistent results were shown for gender and etiology of mental impairment . The placebo effect , although significant for some cognitive processes , was lower than that of treatment . There findings suggest that Acetyl-L-carnitine treatment is effective against the outcomes of mental impairment in the cognitive ( in particular , for memory functioning and constructional thinking ) and emotional-affective domains , while its effects on relational behaviour are less consistent , probably because they are partly biased in the subjective evaluation of caregivers and relatives by factors such as age and levels of mental impairment and depression A double-blind cross-over study was carried out on the clinical effectiveness of acetyl-L- 
    Output:
    
Early studies suggested a beneficial effect of ALC on cognition and behaviour in aging subjects .
There was no evidence of benefit for ALC in the areas of cognition , severity of dementia , functional ability or Clinical Global Impression as a continuous measure .
REVIEW ER 'S CONCLUSIONS There is evidence for benefit of ALC on clinical global impression , but there was no evidence using objective assessment s in any other area of outcome .
At present there is no evidence to recommend its routine use in clinical practice .
However , the evidence does not suggest that ALC is likely to prove an important therapeutic agent .