***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: An examination of test manuals and published research indicates that widely used memory tests ( e.g. , Verbal Paired Associates and Word List tests of the Wechsler Memory Scale , Rey Auditory Verbal Learning Test , and California Verbal Learning Test ) are afflicted by severe ceiling effects . In the present study , the true extent of memory ability in healthy young adults was tested by giving 208 college undergraduates  verbal paired-associate and verbal learning tests of various lengths ; the findings demonstrate that healthy adults can remember much more than is suggested by the normative data for the memory tests just mentioned . The findings highlight the adverse effects of low ceilings in memory assessment and underscore the severe consequences of ceiling effects on score distributions , means , st and ard deviations , and all variability-dependent indices , such as reliability , validity , and correlations with other tests . The article discusses the optimal test lengths for verbal paired-associate and verbal list-learning tests , shows how to identify ceiling-afflicted data in published research , and explains how proper attention to this phenomenon can improve future research and clinical practice Objective Our aim was to evaluate the association between adherence to the Mediterranean Diet ( MedDiet ) and cognitive function in 823 participants ( 62 ± 6 years at baseline ) from a Spanish prospect i ve cohort ( SUN project ) . Method A vali date d 136-item food frequency question naire was used to assess the adherence to the MedDiet at baseline . The 10-point ( 0 to 9 ) MedDiet Score was used to categorize adherence to MedDiet . Cognitive function was assessed twice at follow-up with a mean follow-up time between exposure and outcome assessment of 6 and 8y using the  Telephone Interview of Cognitive Status-modified ( TICS-m , range 0 to 54 points ) . ANCOVA models were used to assess the association between adherence to the MedDiet and cognitive decline . Results In the multivariable-adjusted analysis of 2-year changes , a higher cognitive decline was observed among participants with low or moderate baseline adherence to the MedDiet than among those with better adherence ( adjusted difference = −0.56 points in TICS-m , 95 % CI = −0.99 to −0.13 ) . Conclusion A higher adherence to the MedDiet  might be associated with better cognitive function . However , observed differences were of small magnitude and further studies are needed to confirm this finding OBJECTIVE To determine the validity and reliability of a rapidly administered neurocognitive screening battery consisting of 4 brief tests ( Enhanced Cued Recall , Temporal Orientation , Verbal Fluency , and Clock Drawing ) to distinguish between patients with probable Alzheimer 's disease ( AD ) and healthy control subjects . SUBJECTS Sixty successive referrals to the Memory Disorders Clinic at Southwestern Vermont Medical Center , Bennington , who were diagnosed as having probable AD and 60 community-dwelling volunteers of comparable age , sex distribution , and education . DESIGN Interrater and test-retest reliability , intergroup comparisons between patients with AD and control subjects on the 4 individual tests , and determination of probability of dementia for patients with AD and control subjects using the entire battery of tests . SETTING Outpatient care . MAIN OUTCOME MEASURE Comparison of the probability of dementia on the 7 Minute Screen  with the criterion st and ard of clinical diagnosis established by examination and laboratory studies . SECONDARY OUTCOME MEASURES Test-retest and interrater reliability ( correlation coefficients ) , time for administration . RESULTS Mean time of administration was 7 minutes 42 seconds . Mean scores for patients with AD and control subjects on all 4 individual tests were significantly different ( for each , P<.001 ) . When the 4 tests were combined in a logistic regression , the battery had a sensitivity of 100 % and a specificity of 100 % . A series of 1000 repeated r and om sample s of 30 patients with AD and 30 control subjects taken from the overall sample of 60 patients with AD and 60 control subjects had a mean sensitivity of 92 % and a mean specificity of 96 % . The battery was equally sensitive to patients with mild AD as demonstrated by correctly classifying all 13 patients with AD using Mini-Mental State Examination scores of 24 or higher . Neither age nor education was a statistically significant factor when added as a covariate . Test-retest reliabilities for individual tests ranged from 0.83 to 0.93 . Test-retest reliability for the entire battery was 0.91 . Interrater reliability for the entire battery was 0.92 . CONCLUSIONS The 7 Minute Screen appears highly sensitive to AD and may be useful in helping to make initial distinctions between patients experiencing cognitive changes related to the normal aging process and those experiencing cognitive deficits related to dementing disorders such as AD . It has reasonable interrater and test-retest reliability , can be administered in a brief period , and requires no clinical judgment and minimal training BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality CONTEXT Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases , but its association with cognitive decline is unclear . OBJECTIVE To investigate the association of a Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1410 adults ( > or = 65 years ) from Bordeaux , France , included in the Three-City cohort in 2001 - 2002 and reexamined at least once over 5 years .  Adherence to a Mediterranean diet ( scored as 0 to 9 ) was computed from a food frequency question naire and 24-hour recall . MAIN OUTCOME MEASURES Cognitive performance was assessed on 4 neuropsychological tests : the Mini-Mental State Examination ( MMSE ) , Isaacs Set Test ( IST ) , Benton Visual Retention Test ( BVRT ) , and Free and Cued Selective Reminding Test ( FCSRT ) . Incident cases of dementia ( n = 99 ) were vali date d by an independent expert committee of neurologists . RESULTS Adjusting for age , sex , education , marital status , energy intake , physical activity , depressive symptomatology , taking 5 medications/d or more , apolipoprotein E genotype , cardiovascular risk factors , and stroke , higher Mediterranean diet score was associated with fewer MMSE errors ( beta = -0.006 ; 95 % confidence interval [ CI ] , -0.01 to -0.0003 ; P = .04 for 1 point of the Mediterranean diet score ) . Performance on the IST , BVRT , or FCSRT over time was not significantly associated with Mediterranean diet adherence . Greater adherence as a categorical variable ( score 6 - 9 ) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort , but among individuals who remained free from dementia over 5 years , the association for the highest compared with the lowest group was significant ( adjusted for all factors , for MMSE : beta = -0.03 ; 95 % CI , -0.05 to -0.001 ; P = .04 ; for FCSRT : beta = 0.21 ; 95 % CI , 0.008 to 0.41 ; P = .04 ) . Mediterranean diet adherence was not associated with the risk for incident dementia ( fully adjusted model : hazard ratio , 1.12 ; 95 % CI , 0.60 to 2.10 ; P = .72 ) , although power to detect a difference was limited . CONCLUSIONS Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests . Higher adherence was not associated with risk for incident dementia To examine the association between dietary habits , cognitive functioning and brain volumes in older individuals , data from 194 cognitively healthy individuals who participated in the Prospect i ve Investigation of the Vasculature in Uppsala Seniors cohort were used . At age 70 , participants kept diaries of their food intake for 1week . These records were used to calculate a Mediterranean diet ( MeDi ) score ( comprising dietary habits traditionally found in Mediterranean countries , e.g. high intake of fruits and low intake of meat ) , with higher scores indicating more pronounced MeDi-like dietary habits . Five years later , participants ' cognitive capabilities were examined by the seven minute screening ( 7MS ) ( a cognitive test battery used by clinicians to screen for dementia ) , and their brain volumes were measured by volumetric magnetic resonance imaging . Multivariate linear regression analyses were constructed to examine the association between the total MeDi score and cognitive functioning and brain volumes . In addition , possible associations between MeDi 's eight dietary features and cognitive functioning and brain volumes were investigated . From the eight dietary features included in the MeDi score , pertaining to a low consumption of meat and meat products was linked to a better performance on the 7MS test ( P=0.001 ) and greater total brain volume ( i.e. the sum of white and gray matter , P=0.03 ) when controlling for potential confounders ( e.g. BMI ) in the analysis . Integrating all dietary features into the total MeDi score explained less variance in cognitive functioning and brain volumes than its single dietary component meat intake . These observational findings suggest that keeping to a low meat intake could prove to be an impact-driven public health policy to support healthy cognitive aging , when confirmed by longitudinal studies . Further , they suggest that the MeDi score is a construct that may mask possible associations of single MeDi features with brain health domains in elderly population Background : We previously reported that the Mediterranean diet ( MeDi ) is related to lower risk for Alzheimer disease ( AD ) . Whether MeDi is associated with subsequent AD course and outcomes has not been investigated . Objectives : To examine the association between MeDi and mortality in patients with AD . Methods : A total of 192 community-based individuals in New York who were diagnosed with AD were prospect ively followed every 1.5 years . Adherence to the MeDi ( 0- to 9-point scale with higher scores indicating higher adherence ) was the main predictor of mortality in Cox models that were adjusted for period of recruitment , age , gender , ethnicity , education , APOE genotype , caloric intake , smoking , and body mass index . Results : Eighty-five patients with AD ( 44 % ) died during the course of 4.4 ( ±3.6 , 0.2 to 13.6 ) years of follow-up . In unadjusted models , higher adherence to MeDi was associated with lower mortality risk ( for each additional MeDi point hazard ratio 0.79 ; 95 % CI 0.69 to 0.91 ; p = 0.001 ) . This result remained significant after controlling for all covariates ( 0.76 ; 0.65 to 0.89 ; p = 0.001 ) . In adjusted models , as compared with AD patients at the lowest MeDi adherence tertile , those at the middle tertile had lower mortality risk ( 0.65 ; 0.38 to 1.09 ; 1.33 years ' longer survival ) , whereas subjects at the highest tertile had an even lower risk ( 0.27 ; 0.10 to 0.69 ; 3.91 years ' longer survival ; p for trend = 0.003 ) . Conclusion : Adherence to the Mediterranean diet ( MeDi ) may affect not only risk for Alzheimer disease ( AD ) but also subsequent disease course : Higher adherence to the MeDi is associated with lower mortality in AD . The gradual reduction in mortality risk for higher MeDi adherence tertiles suggests a possible dose-response effect Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal 
    Output:
    
Among this group of studies , conflicting results and conclusions regarding the efficacy of the MedDiet as a therapeutic approach for age-related cognitive function were found .
This type of endeavor will enable the ability to vali date with greater confidence , whether or not adherence to a MedDiet does promote benefit for age-related cognitive function