***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 : Cognitive decline leads to disability and increased health care expenditures . Methods : Effectiveness of an intervention to stimulate multiple cognitive domains was determined using a format combining traditional and computer-based activities ( Integrated Cognitive Stimulation and Training Program ) , 45 minutes a day , 2 days a week , for 6 weeks . Nonimpaired , mildly , and moderately-impaired participants > age 65 ( n = 32 ) were r and omly allocated into a control or experimental group . Using a repeated measures design participants were tested again postintervention and at 8 weeks follow-up . Results : Statistically significant improvement on Dementia Rating Scale scores occurred for mildly and moderately impaired treatment participants ( n = 15 ) . Statistical significance was demonstrated on subscales of the WMS-III : Logical Memory I and Logical Memory II . Conclusion : Blending computer-based with traditional cognitive stimulation activities shows promise in preserving cognitive function in elders . Future studies to explore efficacy in larger , more diverse sample s are needed Background Spaced retrieval training ( SRT ) is a nonpharmacological intervention for mild cognitive impairment ( MCI ) and dementia that trains the learning and retention of target information by recalling it over increasingly long intervals . We recently developed the Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training ( USMART ) program as a convenient , self-administered tablet-based SRT program . We also demonstrated the utility of USMART for improving memory in individuals with MCI through an open-label uncontrolled trial . Methods This study had an open-label , single-blind , r and omized , controlled , two-period crossover design . Fifty patients with MCI were r and omized into USMART – usual care and usual care – USMART treatment sequences .  USMART was completed or usual care was provided biweekly over a 4-week treatment period with a 2-week washout period between treatment periods . Primary outcome measures included the Word List Memory Test , Word List Recall Test ( WLRT ) , and Word List Recognition Test . Outcomes were measured at baseline , week 5 , and week 11 by raters who were blinded to intervention type . An intention-to-treat analysis and linear mixed modeling were used . Results Of 50 r and omized participants , 41 completed the study ( 18 % dropout rate ) . The USMART group had larger improvements in WLRT score ( effect size = 0.49 , p = 0.031 ) than the usual care group . There were no significant differences in other primary or secondary measures between the USMART and usual care groups . Moreover , no USMART-related adverse events were reported . Conclusions The 4-week USMART modestly improved information retrieval in older people with MCI , and was well accepted with minimal technical support . Trial registration Clinical Trials.gov NCT01688128 . Registered 12 September 2012 The results of a r and omized controlled trial of repetition-lag training in older adults with amnestic mild cognitive impairment ( aMCI ) are reported . A modified repetition-lag training procedure with extended encoding time and strategy choice was used . The training required discriminating studied words from non-studied lures that were repeated at varying intervals during the test phase . Participants were assessed pre/post using untrained measures of cognition and self-report question naires . Primary outcome measures were recall of unrelated word pairs both immediately following presentation and following a delay . Secondary outcomes were a measure of attention , cognitive flexibility , and visual working memory . Participants were also asked to report on the frequency of cognitive failures and mood before and after training . Participants ( N = 31 ) were r and omized into either the treatment or a no-contact control group  and attended the clinic twice per week over a four week period . Twenty-four participants completed the study ( twelve in each group ) . Results indicated that the training group improved at recalling unrelated word pairs after a delay . There were no significant effects of training on other outcomes , self-reported cognitive failures or mood . The results are discussed along with suggestions for future research OBJECTIVE This study evaluates the efficacy at 12 months of a computer-based cognitive training ( CBCT ) program , adjunctive to traditional cognitive training ( TCT ) , on the basis of pen- and -paper exercises . METHODS Sixty patients with multi-domain mild cognitive impairment and mild Alzheimer 's disease who were already receiving cognitive training , recruited from a day hospital , were assigned into two groups following a simple r and omization procedure ( computerized r and om numbers ) : ( i ) a group that received CBCT during 3 months and TCT ( CBCT + TCT ) , n = 37 , and ( ii ) a group that received only TCT , n = 23 . Patients were assessed at baseline and after 3 and 12 months of treatment by a neuropsychologist blinded to group assignment , with a neuropsychological battery ( primary outcomes ) and measures of decision making , memory complaints , and emotional disturbances . RESULTS With the use of repeated- measures analyses of covariance , the CBCT + TCT group showed less anxiety symptoms ( F = 5.13 , p = 0.03 , d = 1.12 ) and less disadvantageous choices ( F = 4.70 , p = 0.04 , d = 0.89 ) in decision making than the TCT group at 12 months . No significant improvement or worsening was observed in the other measures examined . However , positive effect sizes favoring the CBCT + TCT group were observed in all variables . CONCLUSIONS The addition of a CBCT program was effective in anxiety and decision making but had no significant effects on outcomes in basic cognitive functions in patients who were already receiving cognitive training , possibly due to a ceiling effect . Future studies should compare the efficacy of CBCT with TCT in naïve patients We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy ( MCET ) consisting of cognitive training , cognitive stimulations , reality orientation , physical therapy , reminiscence therapy , and music therapy in combination in older people with mild cognitive impairment ( MCI ) or mild dementia . This study was a multi-center , double-blind , r and omized , placebo-controlled , two-period cross-over study ( two 8-week treatment phases separated by a 4-week wash-out period ) . Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were r and omized to the MCET group or the mock-therapy ( placebo ) group .  Outcomes were measured at baseline , week 9 , and week 21 . Fifty-five patients completed the study .  Mini-Mental State Examination ( effect size = 0.47 , p = 0.013 ) and Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( effect size = 0.35 , p = 0.045 ) scores were significantly improved in the MCET compared with mock-therapy group . Revised Memory and Behavior Problems Checklist frequency ( effect size = 0.38 , p = 0.046 ) and self-rated Quality of Life - Alzheimer 's Disease ( effect size = 0.39 , p = 0.047 ) scores were significantly improved in the MCET compared with mock-therapy . MCET improved cognition , behavior , and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did BACKGROUND Subjects with a mild cognitive impairment ( MCI ) have a memory impairment beyond that expected for age and education yet are not demented . These subjects are becoming the focus of many prediction studies and early intervention trials . OBJECTIVE To characterize clinical ly subjects with MCI  cross-sectionally and longitudinally . DESIGN A prospect i ve , longitudinal inception cohort . SETTING General community clinic . PARTICIPANTS A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease ( AD ) , all from a community setting as part of the Mayo Clinic Alzheimer 's Disease Center/Alzheimer 's Disease Patient Registry , Rochester , Minn. MAIN OUTCOME MEASURES The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the  Mini-Mental State Examination , Wechsler Adult Intelligence Scale-Revised , Wechsler Memory Scale-Revised , Dementia Rating Scale , Free and Cued Selective Reminding Test , and Auditory Verbal Learning Test .  Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer 's Disease and Related Disorders Association criteria , respectively . RESULTS The primary distinction between control subjects and subjects with MCI was in the area of memory , while other cognitive functions were comparable . However , when the subjects with MCI were compared with the patients with very mild AD , memory performance was similar , but patients with AD were more impaired in other cognitive domains as well . Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD . CONCLUSIONS Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD . They appear to constitute a clinical entity that can be characterized for treatment interventions Abstract Background Cognitive training is effective in patients with mild cognitive impairment but does not typically address the motivational deficits associated with older population s with memory difficulties . Methods We conducted a r and omized controlled trial of cognitive training using a novel memory game on an iPad in 42 patients with a diagnosis of amnestic mild cognitive impairment assigned to either the  cognitive training ( n=21 ; 8 hours of gameplay over 4 weeks ) or control ( n=21 ; clinic visits as usual ) groups . Results Significant time-by-pattern-by-group interactions were found for cognitive performance in terms of the number of errors made and trials needed on the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning task ( P=.044 ; P=.027 ) . Significant time-by-group interactions were also found for the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning first trial memory score ( P=.002 ) , Mini-Mental State Examination ( P=.036 ) , the Brief Visuospatial Memory Test ( P=.032 ) , and the Apathy Evaluation Scale ( P=.026 ) . Within-group comparisons revealed highly specific effects of cognitive training on episodic memory . The cognitive training group maintained high levels of enjoyment and motivation to continue after each hour of gameplay , with self-confidence and self-rated memory ability improving over time . Conclusions Episodic memory robustly improved in the cognitive training group . “ Gamified ” cognitive training may also enhance visuospatial abilities in patients with amnestic mild cognitive impairment . Gamification maximizes engagement with cognitive training by increasing motivation and could complement pharmacological treatments for amnestic mild cognitive impairment and mild Alzheimer ’s disease . Larger , more controlled trials are needed to replicate and extend these findings ABSTRACT Objectives : Deficits in working memory ( WM ) are associated with age-related decline . We report findings from a clinical trial that examined the effectiveness of Cogmed , a computerized program that trains WM . We compare this program to a Sham condition in older adults with Mild Cognitive Impairment ( MCI ) . Methods : Older adults ( N = 68 ) living in the community were assessed . Participants reported memory impairment and met criteria for MCI , either by poor delayed memory or poor performance in other cognitive areas . The Repeatable Battery for the Assessment of Neuropsychological Status ( RBANS , Delayed Memory Index ) and the Clinical Dementia Rating scale ( CDR ) were utilized . All presented with normal Mini Mental State Exams ( MMSE ) and activities of daily living ( ADLs ) . Participants were r and omized to Cogmed or a Sham computer program . Twenty-five sessions were completed over five to seven weeks . Pre , post , and follow-up measures included a battery of cognitive measures ( three WM tests ) , a subjective memory scale , and a functional measure . Results : Both intervention groups improved over time . Cogmed significantly outperformed Sham on Span Board and exceeded in subjective memory reports at follow-up as assessed by the Cognitive Failures Question naire ( CFQ ) . The Cogmed group demonstrated better performance on the Functional Activities Question naire ( FAQ ) , a measure of adjustment and far transfer , at follow-up . Both groups , especially Cogmed , enjoyed the intervention . Conclusions : Results suggest that WM was enhanced in both groups of older adults with MCI . Cogmed was better on one core WM measure and had higher ratings of satisfaction . The Sham condition declined on adjustment ABSTRACT Cognitive rehabilitation for mild cognitive impairment ( MCI ) and early Alzheimer 's disease is readily available to the geriatric population . Initial evidence suggests that techniques incorporating motivational strategies to enhance treatment engagement may provide more benefit than computerised training alone . Seventy four adults with sub clinical cognitive decline were r and omly assigned to computerised cognitive training ( CCT ) , Cognitive Vitality Training ( CVT ) , or an Active Control Group ( ACG ) , and underwent neuropsychological evaluations at baseline and four-month follow-up . Significant differences were found in changes in performance on the Modified Mini Mental State Examination ( mMMSE ) and measures of verbal learning and memory across treatment groups . Experimental groups showed greater preservation of functioning on the mMMSE than the ACG group , the CVT group performed better than the ACG group on one measure of verbal learning and both measures of verbal memory , and the CCT group performed better than the ACG group on one measure of verbal learning and one measure of verbal memory . There were no significant group differences between the CVT and CCT groups on measures of 
    Output:
    
Statistical significance was reached in all domains apart from executive function .
This meta- analysis provides evidence that CCT  improves cognitive function in older people with MCI .