***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 OBJECTIVES To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes . DESIGN Multisite r and omized controlled double-blind trial with two treatment groups . SETTING Communities in northern and southern California and Minnesota . PARTICIPANTS Community-dwelling adults aged 65 and older ( N=487 ) without a diagnosis of clinical ly significant cognitive impairment . INTERVENTION Participants were r and omized to receive a broadly-available brain plasticity-based computerized cognitive training program ( intervention ) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual ( active control ) . Duration of training was 1 hour per day , 5 days per week , for 8 weeks , for a total of 40 hours . MEASUREMENTS The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality ( RBANS Auditory Memory/Attention ) . Secondary measures were derived from performance on the experimental program , st and ardized neuropsychological assessment s of memory and attention , and participant-reported outcomes . RESULTS RBANS Auditory Memory/Attention improvement was significantly greater ( P=.02 ) in the experimental group ( 3.9 points , 95 % confidence interval (CI)=2.7 - 5.1 ) than in the control group ( 1.8 points , 95 % CI=0.6 - 3.0 ) . Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group ( word list total score , word list delayed recall , digits backwards , letter-number sequencing ; P<.05 ) , as did the participant-reported outcome measure ( P=.001 ) . No advantage for the experimental group was seen in narrative memory . CONCLUSION The experimental program improved generalized measures of memory and attention more than an active control program As video-game playing has become a ubiquitous activity in today 's society , it is worth considering its potential consequences on perceptual and motor skills . It is well known that exposing an organism to an altered visual environment often results in modification of the visual system of the organism . The field of perceptual learning provides many examples of training-induced increases in performance . But perceptual learning , when it occurs , tends to be specific to the trained task ; that is , generalization to new tasks is rarely found . Here we show , by contrast , that action-video-game playing is capable of altering a range of visual skills . Four experiments establish changes in different aspects of visual attention in habitual video-game players as compared with non-video-game players .  In a fifth experiment , non-players trained on an  action video game  show marked improvement from their pre-training abilities , thereby establishing the role of playing in this effect 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 Age-related deficits in cognitive and sensory function can result in increased distraction from background sensory stimuli . This r and omized controlled trial investigated the effects of a cognitive training intervention aim ed at helping healthy older adults suppress irrelevant auditory and visual stimuli . Sixty-six participants received 8 weeks of either the modality-specific attention training program or an educational lecture control program . Participants who completed the intervention program had larger improvements in modality-specific selective attention following training than controls . These improvements also correlated with reductions in bimodal integration during selective attention . Further , the intervention group showed larger improvements than the control group in non-trained domains such as processing speed and dual-task completion , demonstrating the utility of modality-specific attention training for improving cognitive function in healthy older adults Computer technology is pervasive in today 's society . Issues of training must be investigated to ensure that older individuals are capable of interacting with such technology . In the present research a simulated automatic teller machine ( ATM ) served as a prototypical technology for which issues of training and transfer could be investigated . The focus of the study was on the potential benefits of a r and om practice schedule ( wherein trial types are intermixed ) relative to a blocked practice schedule ( wherein trial types are grouped together ) . Both younger and older adults benefited from r and om practice for the acquisition of the ability to perform transactions on an ATM . Moreover , r and om practice was beneficial for both age groups in the transfer of learning to novel tasks on a novel ATM . These data have general implication s for theories of training and specific implication s for the development of training protocol s for older adults and new technologies The purpose of the present investigation was to examine the impact of speed of processing training on the cognitive and everyday abilities of older adults with initial processing speed or processing difficulty . Participants were r and omized to either a  speed of processing intervention or a social- and computer-contact control group . Results indicate that speed of processing training not only improves processing speed , as indicated by performance on the Useful Field of View test ( UFOV ® ) , but also transfers to certain everyday functions , as indicated by improved performance on Timed Instrumental Activities of Daily Living ( Timed IADL ) . Transfer of speed of processing training to other cognitive domains was not evident . This study provides additional evidence that  speed of processing training has the potential to enhance everyday functions that maintain independence and quality of life , particularly when the training is targeted toward individuals who most need it . Further study is needed to learn about the long-term effects of such training in relation to everyday abilities CONTEXT Cognitive function in older adults is related to independent living and need for care . However , few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently . OBJECTIVE To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older , independent-living adults . DESIGN R and omized , controlled , single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001 . SETTING AND PARTICIPANTS Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing , community centers , and hospital/clinics in 6 metropolitan areas in the United States . INTERVENTIONS Participants were r and omly assigned to 1 of 4 groups : 10-session group training for memory ( verbal episodic memory ; n = 711 ) , or reasoning ( ability to solve problems that follow a serial pattern ; n = 705 ) , or speed of processing ( visual search and identification ; n = 712 ) ; or a no-contact control group ( n = 704 ) . For the 3 treatment groups , 4-session booster training was offered to a 60 % r and om sample 11 months later . MAIN OUTCOME MEASURES Cognitive function and cognitively dem and ing everyday functioning . RESULTS Thirty participants were incorrectly r and omized and were excluded from the analysis . Each intervention improved the targeted cognitive ability compared with baseline , durable to 2 years ( P<.001 for all ) . Eighty-seven percent of speed- , 74 % of reasoning- , and 26 % of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period . Booster training enhanced training gains in speed ( P<.001 ) and reasoning ( P<.001 ) interventions ( speed booster , 92 % ; no booster , 68 % ; reasoning booster , 72 % ; no booster , 49 % ) , which were maintained at 2-year follow-up ( P<.001 for both ) . No training effects on everyday functioning were detected at 2 years . CONCLUSIONS Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities . Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals . Because of minimal functional decline across all groups , longer follow-up is likely required to observe training effects on everyday function BACKGROUND Several reports suggest beneficial impacts of either physical or mental activity on cognitive function  in old age . However , the differential effects of complex mental and physical activities on cognitive performance in humans remain to be clarified . METHODS This r and omized controlled trial evaluates a cognitive and a physical st and ardized 6-month activity intervention ( 3 x 1.5 h/wk ) conducted in Berlin ( Germany ) . Two hundred fifty nine healthy women aged 70 - 93 years were r and omized to a computer course ( n = 92 ) , an exercise course ( n = 91 ) , or a control group ( n = 76 ) , of whom 230 completed the 6-month assessment . Group differences in change over a period of 6 months in episodic memory ( story recall , possible range , 0 - 21 ; word recall , possible range , 0 - 16 ) , executive control ( working memory , ie , time quotient of Trail Making Tests B/A ) , and verbal fluency were evaluated by analyses of covariance ( intention to treat ) adjusting for baseline , fluid intelligence , and educational level . RESULTS In contrast to the control group , both the exercise group , DeltaM ( SD ) = 2.09 ( 2.66 ) , p < .001 , and the computer group , DeltaM ( SD ) = 1.89 ( 2.88 ) , p < .001 , showed improved delayed story recall . They maintained performance in delayed word recall and working memory ( time measure ) as opposed to the control group that showed a decline , DeltaM ( SD ) = -0.91 ( 2.15 ) , p = .001 , and DeltaM ( SD ) = 0.24 ( 0.68 ) , p = .04 , respectively . CONCLUSIONS In healthy older women , participation in new stimulating activities contributes to cognitive fitness and might delay cognitive decline .  Exercise and computer classes seem to generate equivalent beneficial effects Normal aging is associated with progressive functional losses in perception , cognition , and memory . Although the root causes of age-related cognitive decline are incompletely understood , psychophysical and neuropsychological evidence suggests that a significant contribution stems from poorer signal-to-noise conditions and down-regulated neuromodulatory system function in older brains . Because the brain retains a lifelong capacity for plasticity and adaptive reorganization , dimensions of negative reorganization should be at least partially reversible through the use of an appropriately design ed training program . We report here results from such a training program targeting age-related cognitive decline . Data from a r and omized , controlled trial using st and ardized measures of neuropsychological function as outcomes are presented . Significant improvements in assessment s directly related to the training tasks and significant generalization of improvements to nonrelated st and ardized neuropsychological measures of memory ( effect size of 0.25 ) were documented in the group using the training program . Memory enhancement appeared to be sustained after a 3-month no-contact follow-up period . Matched active control and no-contact control groups showed no significant change in memory function after training or at the 3-month follow-up . This study demonstrates that intensive , plasticity-engaging training can result in an enhancement of cognitive function in normal mature adults Memory impairments constitute an increasing objective and subjective problem with advancing age . The aim of the present study 
    Output:
    
Most studies reported older adults did not need to be technologically savvy in order to successfully complete or benefit from training .
Overall , findings are comparable or better than those from review s of more traditional , paper- and -pencil cognitive training approaches suggesting that computerized training is an effective , less labor intensive alternative