***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 To provide evidence regarding the clinical efficacy of cognitive rehabilitation ( CR ) in early-stage Alzheimer disease ( AD ) . DESIGN Single-blind r and omized controlled trial comparing CR with relaxation therapy and no treatment . SETTING Outpatient , community-based setting . PARTICIPANTS Sixty-nine individuals ( 41 women , 28 men ; mean age 77.78 years , st and ard deviation 6.32 , range = 56 - 89 ) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above , and receiving a stable dose of acetylcholinesterase-inhibiting medication . Forty-four family carers also contributed . INTERVENTION Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies , techniques for learning new information , practice in maintaining attention and concentration , and techniques for stress management . MEASUREMENTS The primary outcomes were goal performance and satisfaction , assessed using the Canadian Occupational Performance Measure . Question naires assessing mood , quality of life and career strain , and a brief neuropsychological test battery were also administered . A subset of participants underwent functional magnetic resonance imaging ( fMRI ) . RESULTS CR produced significant improvement in ratings of goal performance and satisfaction , whereas scores in the other two groups did not change . Behavioral changes in the CR group were supported by fMRI data for a subset of participants . CONCLUSIONS The findings support the clinical efficacy of CR in early-stage AD . CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition In this prospect i ve treatment study , the effects of two different occupational therapy strategies were compared in two sample s of long-term geriatric in patients ( n = 22 in each group ) with slight to moderate dementia according to DSM-III-R. Psychometric ratings after 12 weeks and 24 weeks of treatment have demonstrated that the application of a reactivating occupational therapy programme in addition to functional rehabilitation is significantly more efficient than the application of functional rehabilitation alone on levels of cognitive performance , psychosocial functioning , and the degree of contentedness with life . These results support the assumption that geriatric patients , if stimulated for a longer time , are able to mobilize latent re sources of cognitive and psychosocial performance .  Reactivating occupational therapy has a place in the treatment of long-term geriatric patients BACKGROUND Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer 's disease . AIMS To perform such an evaluation . METHOD We r and omly assigned 79 of 156 patients treated with donepezil  to receive a reality orientation programme . Caregivers of the treatment group were trained to offer the programme at home 3 days a week , 30 min/day , for 25 consecutive weeks , and were invited to stimulate and involve patients in reality-based communication . RESULTS The treatment group showed a slight improvement in Mini-Mental State Examination ( MMSE ) scores ( mean change + 0.2 , s.e.=0.4 ) compared with a decline in the control group ( mean change -1.1 , s.e.=0.4 ; P=0.02 ) . Similarly for the Alzheimer 's Disease Assessment Scale -- Cognition ( treatment group mean change + 0.4 , s.e.=0.8 ; control group -2.5 , s.e.=0.8 ; P=0.01 ) . The intervention had an equal effect on cognition in those with mild ( MMSE score > or = 20 ) and moderate ( score < 20 ) dementia . No significant effect was observed for behavioural and functional outcomes . CONCLUSIONS Reality orientation enhances the effects of donepezil on cognition in Alzheimer 's disease BACKGROUND A recent Cochrane review of reality orientation therapy identified the need for large , well- design ed , multi-centre trials . AIMS To test the hypothesis that cognitive stimulation therapy ( CST ) for older people with dementia would benefit cognition and quality of life . METHOD A single-blind , multi-centre , r and omised controlled trial recruited 201 older people with dementia . The main outcome measures were change in cognitive function and quality of life . An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures . RESULTS One hundred and fifteen people were r and omised within centres to the  intervention group and 86 to the control group .  At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P=0.044 ) , the Alzheimer 's Disease Assessment Scale - Cognition ( ADAS-Cog ) ( P=0.014 ) and Quality of Life - Alzheimer 's Disease scales ( P=0.028 ) . Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group . CONCLUSION The results compare favourably with trials of drugs for dementia . CST groups may have worthwhile benefits for many people with dementia One of the defining differences between mild cognitive impairment ( MCI ) and dementia is the degree of independence in everyday activities . Effecting memory-related behavioural change in MCI could help maintain daily function and prolong the time before onset of dependency . However , it is well known that changing previously well-established behaviours is difficult to achieve . We conducted a r and omised controlled trial to evaluate the effectiveness of a multidisciplinary group-based intervention programme in changing everyday memory behaviour in individuals with amnestic MCI . The intervention provided evidence d-based memory training and lifestyle education to optimise memory behaviour .  Fifty-four participants were r and omly assigned to treatment or waitlist-control conditions . Consistent with our primary goal , treatment participants showed an increase in memory- strategy knowledge and use from pre-test to immediate post-test , and these gains were maintained at three-month post-test relative to waitlist controls . There were no group differences in memory beliefs or on laboratory tests of objective memory performance . The increase in memory- strategy knowledge and use was associated with the degree of participation in the programme . Individuals with MCI , therefore , can acquire and maintain knowledge about memory strategies and , importantly , can change their everyday memory behaviour by putting this knowledge into practice . This incorporation of practical memory strategies into daily routines could potentially provide the means for maintaining functional independence by individuals with MCI , an issue to be addressed in future research Objective : To determine the usefulness of an interactive multimedia internet-based system ( IMIS ) for the cognitive stimulation of Alzheimer ’s disease . Methods : This is a 24-week , single-blind , r and omised pilot study conducted on 46 mildly impaired patients suspected of having Alzheimer ’s disease receiving stable treatment with cholinesterase inhibitors ( ChEIs ) .  The patients were divided into three groups : ( 1 ) those who received 3 weekly , 20-min sessions of IMIS in addition to 8 h/day of an integrated psychostimulation program ( IPP ) ; ( 2 ) those who received only IPP sessions ; and ( 3 ) those who received only ChEI treatment . The primary outcome measure was the Alzheimer ’s Disease Assessment Scale-Cognitive ( ADAS-Cog ) . Secondary outcome measures were : Mini-Mental State Examination ( MMSE ) , Syndrom Kurztest , Boston Naming Test , Verbal Fluency , and the Rivermead Behavioral Memory Test story recall subtest . Results : After 12 weeks , the patients treated with both IMIS and IPP had improved outcome scores on the ADAS-Cog and MMSE , which was maintained through 24 weeks of follow-up . The patients treated with IPP alone had better outcome than those treated with ChEIs alone , but the effects were attenuated after 24 weeks . All patients had improved scores in all of the IMIS individual tasks , attaining higher levels of difficulty in all cases . Conclusion : Although both the IPP and IMIS improved cognition in patients with Alzheimer ’s disease , the IMIS program provided an improvement above and beyond that seen with IPP alone , which lasted for 24 weeks We performed a pilot r and omized , controlled trial of intensive , computer-based cognitive training in 47 subjects with mild cognitive impairment . The intervention group performed exercises specifically design ed to improve auditory processing speed and accuracy for 100 min/d , 5 d/wk for 6 weeks ; the control group performed more passive computer activities ( reading , listening , visuospatial game ) for similar amounts of time . Subjects had a mean age of 74 years and 60 % were men ; 77 % successfully completed training . On our primary outcome , Repeatable Battery for Assessment of Neuropsychological Status total scores improved 0.36 st and ard deviations ( SD ) in the intervention group ( P=0.097 ) compared with 0.03 SD in the control group ( P=0.88 ) for a nonsignificant difference between the groups of 0.33 SD ( P=0.26 ) . On 12 secondary outcome measures , most differences between the groups were not statistically significant . However , we observed a pattern in which effect sizes for verbal learning and memory measures tended to favor the intervention group whereas effect sizes for language and visuospatial function measures tended to favor the control group , which raises the possibility that these training programs may have domain-specific effects . We conclude that intensive , computer-based mental activity is feasible in subjects with mild cognitive impairment and that larger trials are warranted OBJECTIVE To test whether the Tailored Activity Program ( TAP ) reduces dementia-related neuropsychiatric behaviors , promotes activity engagement , and enhances caregiver well-being . DESIGN Prospect i ve , two-group ( treatment , wait-list control ) , r and omized , controlled pilot study with 4 months as main trial endpoint . At 4 months , controls received the TAP intervention and were reassessed 4 months later . SETTING Patients ' homes . PARTICIPANTS Sixty dementia patients and family caregivers . INTERVENTION The eight-session occupational therapy intervention involved neuropsychological and functional testing , selection , and customization of activities to match capabilities identified in testing , and instruction to caregivers in use of activities . MEASUREMENTS Behavioral occurrences , activity engagement , and quality of life in dementia patients ; objective and subjective burden and skill enhancement in caregivers . RESULTS At 4 months , compared with controls , intervention caregivers reported reduced frequency of problem behaviors , and specifically for shadowing and repetitive question ing , and greater activity engagement including the ability to keep busy . Fewer intervention caregivers reported agitation or argumentation . Caregiver benefits included fewer hours doing things and being on duty , greater mastery , self-efficacy , and skill enhancement . Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery .  Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers . CONCLUSIONS Tailoring activities to the capabilities of dementia patients and training families in activity use result ed in clinical ly relevant benefits for patients and caregivers . Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden . Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention The efficacy of a cognitive intervention consisting of training in face-name associations , spaced retrieval , and cognitive stimulation was tested in a sample of 37 patients ( 16 men , 21 women ) with probable Alzheimer disease ( AD ) . Patients with AD were r and omly assigned to receive either the cognitive intervention or a mock ( placebo ) intervention for 5 weeks . The placebo group then crossed over to receive the intervention . During the intervention , AD patients showed significant improvement in recall of personal information , face-name recall , and performance on the Verbal Series Attention Test . Improvement did not generalize to additional neuropsychologic measures of dementia severity , verbal memory , visual memory , word generation , or motor speed , or to caregiver-assessed patient quality of life . Results suggest that although face-name training , spaced retrieval , and cognitive stimulation may produce small gains in learning personal information and on a measure of attention , improvement does not generalize to overall neuropsychologic functioning or patient quality of life This study aim ed to determine the efficacy of cognitive training in a 10-week r and omised controlled study involving 22 individuals presenting with mild cognitive impairment of the amnestic type ( MCI-A ) . Participants in the experimental group ( n = 11 ) learned face – name associations using a paradigm combining errorless ( EL ) learning and spaced retrieval ( SR ) whereas participants in the control group ( n = 11 ) were trained using an errorful ( EF ) learning paradigm . Psycho-educational sessions on memory were also provided to all participants . After neuropsychological screening and baseline evaluations , the cognitive training took place in 6 sessions over a 3-week period . The post-training and follow-up evaluations , at one and four weeks respectively , were performed by research assistants blind to the participant 's study group . The results showed that regardless of the training condition , all participants improved their capacity to learn face – name associations . A significant amelioration was also observed in participant satisfaction regarding their memory functioning and in the frequency with which the participants used strategies to support memory functions in daily life . The absence of difference between groups on all variables might be partly explained by the high variability of scores within the experimental group . Other studies are needed in order to verify the efficacy of EL learning and SR over EF in BACKGROUND We evaluated the effects of cognitive training on self-rated health at 1 , 2 , 3 , and 5 years post-baseline . METHODS In the ACTIVE ( Advanced Cognitive Training for Independent and Vital Elderly ) r and omized controlled trial , 2,802 older adults ( > or=65 years ) were r and omly assigned to memory , reasoning , speed of processing , or no-contact control intervention groups . Complete data were available for 1,804 ( 64 % ) of the 2,802 participants 
    Output:
    
RESULTS Cognition-focused interventions confer small and inconsistent effects on trained cognitive skills which , according to some studies , translate into gains on general cognitive ability .
However , convincing evidence of clinical significance was only obtained from single trials in terms of delay of cognitive decline , improvement in activities of daily living , or enhanced attainment of personally relevant goals .