***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 We studied a representative cohort of community-dwelling elderly persons to ( i ) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses , ( ii ) compare the cognitive status of participants who have and have not lost independence in these functional activities , and ( iii ) determine whether a hierarchical scale of functional loss is associated with declining cognitive status . METHODS A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed . At baseline and 5 years later ,  cognitive status with the Modified Mini-Mental State Examination ( 3MS ) and functional status with 14 Older American Re sources and Services ( OARS ) items were measured . For each OARS functional item , the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared . RESULTS For each functional item , the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent ( e.g. , ability to do finances ) , with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence . A hierarchy of functional items existed , with instrumental activities of daily living ( ADLs ) ( e.g. , shopping , banking , and cooking ) being lost at higher cognitive scores than basic ADL items ( e.g. , eating , dressing , and walking ) , although there was some overlap . CONCLUSIONS This is the first prospect i ve study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks . Clear cognitive thresholds at which development of dependency in OARS functional items occurred . By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items , a natural hierarchy of functional loss associated with cognitive decline emerged . For caregivers , clinicians , and health policy makers , this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition , potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning BACKGROUND Previous studies have indicated not only that cases of dementia are missed in primary care but also that many non-demented patients are referred for evaluation to secondary care . OBJECTIVES To measure frequency of cognitive test instrument use in primary care prior to patient referral to secondary care and to assess the relationship between instrument use and ultimate diagnosis . METHODS This was a prospect i ve study conducted in a Cognitive Function Clinic , Regional Neuroscience Centre setting . The referral letters for all patients seen in the clinic over a 2-year period ( n = 231 ) were examined for mention of cognitive test instrument use . Patients were evaluated by st and ard  clinical , neuropsychological  and  neuroimaging methods and diagnoses were made according to widely accepted diagnostic criteria for dementia and dementia subtype . Primary care cognitive test use and final diagnosis were then compared . RESULTS Evidence of  cognitive test use in primary care was found in 20 % of referrals . Patients evaluated with  cognitive test instruments  in primary care were more likely to receive a diagnosis of dementia , whereas those not tested were more likely to receive a diagnosis of ' not demented ' . CONCLUSIONS Use of simple cognitive test instruments  in primary care may improve dementia diagnosis and reduce the rate of referral of non-demented patients OBJECTIVES To assess the feasibility of cognitive screening in older veterans presenting for routine primary care . DESIGN Quality improvement initiative . SETTING Seven Veterans Affairs Medical Centers . PARTICIPANTS Veterans aged 70 and older without a prior diagnosis of cognitive impairment . MEASUREMENTS Scores from 16 different versions of the  Mini-Cog  , a 5-point cognitive screen consisting of three-word recall ( 0 - 3 points ) with a clock-drawing interference task ( 0 or 2 points ) . Five word lists were paired with three clock times and r and omly ordered for presentation with the original Mini-Cog version . The conventional dementia screening cut point was increased to maximize sensitivity ; to pass , patients had to draw the clock correctly and recall at least two of three words ( score 4 or 5/5 ) . RESULTS Administering the Mini-Cog took 90 to 180 seconds . Of 8,342 veterans approached , 8,063 ( 96.7 % ) agreed to be screened ; 2,081 ( 25.8 % ) scored less than 4 out of 5 . Scores declined with age , but age did not predict pass or fail . Different word lists produced different screen failure rates , ranging from 21.2 % to 33.4 % . Five dementia specialists were unable to distinguish harder from easier lists . Different clock times accounted for 2 % or less of the difference in failure rates . CONCLUSION The Mini-Cog was quick and well accepted by older veterans . Many with no prior documentation of cognitive impairment failed the screen . Failure rates varied with the word list used , revealing that even apparently minor changes in test items affect screen results . Additional study is needed to establish the value of cognitive screening in shaping primary care of older veterans OBJECTIVES To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure ( HF ) than in those with other diagnoses and whether medical teams recognized cognitive impairment . DESIGN One-year prospect i ve cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes . SETTING Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education . PARTICIPANTS Individuals aged 70 and older screened before home discharge ( 241 admission encounters ; 121 with HF as a primary diagnosis , 120 without ) . The HF cohort included individuals with preserved and reduced ejection fraction . Individuals who had undergone transplantation , ventricular assist device implantation , or hemodialysis or who had a primary oncology diagnosis or hospice referral were excluded . MEASUREMENTS  Mini-Cog  administered 48 hours or less before discharge , 30-day all-cause readmission rates , documentation of dementia or cognitive impairment , and caregiver education . RESULTS Mini-Cog scores were less than 4 ( indicating cognitive impairment ) in 157 encounters ( 82 ( 67.7 % ) with HF , 75 ( 62.5 % ) without ) . Mini-Cog scores were similar in rate and distribution between groups . Individuals with HF and cognitive impairment had a significantly higher 30-day readmission rate than did the other groups ( 26.8 % vs 13.2 % ; P = .01 ; HF , no cognitive impairment , 12.8 % ; no HF , no cognitive impairment , 13.3 % ; cognitive impairment , no HF , 13.3 % ) . In individuals with HF and cognitive impairment , those with documented caregiver education had lower readmission rates than those without ( 14.3 % vs 36.2 % ; P = .03 ) . Fewer than 9 % had documentation of cognitive impairment in the medical record . CONCLUSION Cognitive impairment , which is frequently undocumented , may indicate greater risk of readmission for individuals with HF than those without . Screening for cognitive impairment , adapting discharge for it , and involving family and caregivers in discharge education may help reduce readmissions OBJECTIVES To describe the baseline demographic , neuropsychiatric and neurological data of a large selected clinical sample of patients with dementia with Lewy Bodies ( DLB ) from an international multicentre trial with rivastigmine . To examine the usefulness of the Consensus Criteria for the diagnosis of DLB in different countries . METHODS Seventeen centres from Spain , the UK and Italy recruited patients diagnosed clinical ly as probable DLB according to recent Consensus Criteria ( McKeith et al. , 1996 ) . A st and ard clinical protocol including inclusion /exclusion criteria , collection of demographic and medical data , cognitive ( Mini Mental State Examination : MMSE ) , motor ( Unified Parkinson 's Disease Rating Scale : UPDRS ) and neuropsychiatric ( Neuropsychiatric Inventory : NPI ) examinations  , was applied after obtaining informed consent . Data were summarised and compared across countries with uni- and multivariate analyses . RESULTS One hundred and twenty patients were recruited : 56.7 % males , mean ( SD ) age 73.9 ( 6.4 ) years , range 57 - 87 years . Sixty percent fulfilled all three core diagnostic features of DLB , and 40 % only two ( ' parkinsonism ' 92.4 % , ' cognitive fluctuations ' 89.1 % , ' visual hallucinations ' 77.3 % ) . ' Systematised delusions ' ( 46 % ) and ' repeated falls ' ( 42 % ) were the most frequent supportive diagnostic features . There were no differences across countries in demographic , diagnostic or clinical features . Patients showed a wide range of psychopathology which was weakly correlated with cognitive impairment . Some mild extrapyramidal signs ( EPS ) were observed in most patients . CONCLUSIONS The Consensus Criteria for DLB can be consistently applied across many different sites for multicentre studies . ' Parkinsonism ' and ' cognitive fluctuations ' as core features and ' systematised delusions ' and ' repeated falls ' as supportive features are the most frequent diagnostic clues . Neuropsychiatric disturbances , in particular apathy , delusions , hallucinations and anxiety , and mild symmetric EPS are frequent in DLB and are only related weakly to cognitive impairment OBJECTIVES To study the subtle changes in instrumental activities of daily living ( IADLs ) over the 10 years preceding the clinical diagnosis of dementia . DESIGN Prospect i ve cohort design ed in 1988 to study cerebral and functional aging . SETTING Community-based study in southwestern France . PARTICIPANTS The sample included 104 incident cases of dementia at the 10-year follow-up ( T10 ) and 882 subjects free of dementia at the same visit , all forming part of the PAQUID Study . MEASUREMENTS Restriction in four IADLs  was studied  ( telephone , transportation , medication , and finances )  2 , 5 , 7 , and 10 years before the T10 visit . RESULTS The future dementia cases had greater IADL restrictions 10 years before the clinical diagnosis of dementia and more-rapid functional deterioration over time . Controlled for age , sex , and education , subjects restricted in at least two IADLs at baseline had a higher risk of dementia 10 years later ( odds ratio (OR)=2.59 , 95 % confidence interval (CI)=1.24 - 5.38 ) . In finances , difficulty at baseline was a predictor of dementia 10 years later ( OR=2.15 , 95 % CI=1.13 - 4.08 ) . CONCLUSION This study is the first to show that , 10 years before the clinical diagnosis of dementia , subjects who later developed dementia performed worse in complex activities of daily living , which may constitute an early marker of the disease . In practice , restriction in IADLs may be a simple and useful tool for screening subjects at risk of developing dementia in the long term Dementia is a substantial and increasing public health concern . Despite decades of research , a cure or effective preventative treatment for dementia remains elusive . We offer critical review of contemporary dementia research and discuss potential reasons why progress in the field has not been as rapid as in other disciplines . We adopt a broad approach in keeping with the broad nature of the topic . We cover the difficulties inherent in study ing dementia from ' bench ' to ' bedside ' to ' population ' . We make particular reference to issues of operationalisation of the dementia syndrome and our evolving underst and ing of dementia as a research ' outcome ' . We discuss contemporary ' hot topics ' in dementia research methodology focussing on dementia models , pre-dementia states and biomarkers . Recognising the importance of prospect i ve epidemiological cohorts and large-scale clinical trials we pay particular attention to these approaches and the challenges of generating results that have ' real world ' external validity . Based on our thoughts we end with suggestions for future dementia research . Our review is design ed to be critical but not unnecessarily negative . There is reason for cautious optimism in dementia research . The recent G8 summit on dementia and subsequent establishment of the World Dementia Council are examples of initiatives that reflect societal and political will to increase research efforts in dementia OBJECTIVES To test the Mini-Cog , a brief cognitive screening test , in an epidemiological study of dementia in older Americans . DESIGN A population -based post hoc examination of the sensitivity and specificity of the Mini-Cog for detecting dementia in an existing data set . SETTING The Monongahela Valley in Western Pennsylvania . PARTICIPANTS A r and om sample of 1,119 older adults enrolled in the Monongahela Valley Independent Elders Survey ( MoVIES ) . MEASUREMENTS The effectiveness of the Mini-Cog in detecting independently diagnosed dementia was compared with that of the Mini-Mental State Examination ( MMSE ) and a st and ardized neuropsychological battery .  RESULTS The  Mini-Cog , scored by an algorithm as " possibly impaired " or " probably normal , " and the  MMSE  , at a cutpoint of 25 , had similar sensitivity ( 76 % vs 79 % ) and specificity ( 89 % vs 88 % ) for dementia , comparable with that achieved 
    Output:
    
There is a limited number of studies evaluating the accuracy of the Mini-Cog  for the diagnosis of dementia in primary care setting s. Given the small number of studies , the wide range in estimates of the accuracy of the Mini-Cog , and method ological limitations identified in most of the studies , at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care .