***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: Long-term effects of multisensory stimulation were assessed using a “ Snoezelen ” room on older residents with dementia . Thirty patients were r and omly assigned to 3 groups : multisensory stimulation environment ( MSSE ) group , individualized activities ( activity ) group , and control group . The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks . Pre- , mid- , posttrial , and 8-week follow-up behavior , mood , cognitive , and functional impairment in basic activities of daily living were registered . Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group , with no significant differences between MSSE and control groups . The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory , verbal agitated behavior factor , and Neuropsychiatric Inventory – Nursing Home , with no significant differences between groups . The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 CONTEXT Cognitive decline , mood , behavioral and sleep disturbances , and limitations of activities of daily living commonly burden elderly patients with dementia and their caregivers . Circadian rhythm disturbances have been associated with these symptoms . OBJECTIVE To determine whether the progression of cognitive and noncognitive symptoms may be ameliorated by individual or combined long-term application of the 2 major synchronizers of the circadian timing system : bright light and melatonin . DESIGN , SETTING , AND PARTICIPANTS A long-term , double-blind , placebo-controlled , 2 x 2 factorial r and omized trial performed from 1999 to 2004 with 189 residents of 12 group care facilities in the Netherl and s ; mean ( SD ) age , 85.8 ( 5.5 ) years ; 90 % were female and 87 % had dementia . INTERVENTIONS R and om assignment by facility to long-term daily treatment with whole-day bright ( + /- 1000 lux ) or dim ( + /- 300 lux ) light and by participant to evening melatonin ( 2.5 mg ) or placebo for a mean ( SD ) of 15 ( 12 ) months ( maximum period of 3.5 years ) . MAIN OUTCOME MEASURES St and ardized scales for cognitive and noncognitive symptoms , limitations of activities of daily living , and adverse effects assessed every 6 months . RESULTS Light attenuated cognitive deterioration by a mean of 0.9 points ( 95 % confidence interval [ CI ] , 0.04 - 1.71 ) on the Mini-Mental State Examination or a relative 5 % . Light also ameliorated depressive symptoms by 1.5 points ( 95 % CI , 0.24 - 2.70 ) on the Cornell Scale for Depression in Dementia or a relative 19 % , and attenuated the increase in functional limitations over time by 1.8 points per year ( 95 % CI , 0.61 - 2.92 ) on the nurse-informant activities of daily living scale or a relative 53 % difference . Melatonin  shortened sleep onset latency by 8.2 minutes ( 95 % CI , 1.08 - 15.38 ) or 19 % and increased sleep duration by 27 minutes ( 95 % CI , 9 - 46 ) or 6 % . However , melatonin adversely affected scores on the Philadelphia Geriatric Centre Affect Rating Scale , both for positive affect ( -0.5 points ; 95 % CI , -0.10 to -1.00 ) and negative affect ( 0.8 points ; 95 % CI , 0.20 - 1.44 ) . Melatonin also increased withdrawn behavior by 1.02 points ( 95 % CI , 0.18 - 1.86 ) on the Multi Observational Scale for Elderly Subjects scale , although this effect was not seen if given in combination with light . Combined treatment also attenuated aggressive behavior by 3.9 points ( 95 % CI , 0.88 - 6.92 ) on the Cohen-Mansfield Agitation Index or 9 % , increased sleep efficiency by 3.5 % ( 95 % CI , 0.8%-6.1 % ) , and improved nocturnal restlessness by 1.00 minute per hour each year ( 95 % CI , 0.26 - 1.78 ) or 9 % ( treatment x time effect ) . CONCLUSIONS Light has a modest benefit in improving some cognitive and noncognitive symptoms of dementia . To counteract the adverse effect of melatonin on mood , it is recommended only in combination with light . TRIAL REGISTRATION controlled-trials.com/is rct n Identifier : IS RCT N93133646 Background / Aims : Behavioural and psychological symptoms ( BPSD ) are frequent in people with Alzheimer ’s disease and cause considerable stress to patients and their carers . Antipsychotics have been widely used as a first-line treatment , result ing in an estimated 1,800 excess strokes and 1,600 excess deaths in the UK alone . Safe and effective alternatives are urgently needed . Based upon preliminary evidence from clinical trials , aromatherapy with melissa oil may be such an alternative , but initial studies have been modest in size , and adequate blinding has been problematic . Our objective was to assess the efficacy of melissa aromatherapy in the treatment of agitation in people with Alzheimer ’s disease in an adequately powered and robustly blinded r and omized controlled trial comparing it with donepezil , an anticholinesterase drug used with some benefit to treat BPSD . Methods and Findings : The study was a double-blind parallel-group placebo-controlled r and omized trial across 3 specialist old age psychiatry centres in Engl and . Participants had probable or possible Alzheimer ’s disease , were resident in a care home , had clinical ly significant agitation ( defined as a score of 39 or above on the Cohen Mansfield Agitation Inventory ) and were free of antipsychotics and /or anticholinesterase for at least 2 weeks . Participants were allocated to 1 of 3 groups : placebo medication and active aromatherapy ; active medication and placebo aromatherapy or placebo of both . Main Outcome : The primary outcome measure was reduction in agitation as assessed by the Pittsburgh Agitation Scale ( PAS ) at 4 weeks . This is an observational scale , and raters were required to wear nose clips to ensure that full blinding was maintained . The PAS , Neuropsychiatric Inventory ( NPI ; another measure of BPSD ) and other outcome measures were completed at baseline , 4-week and 12-week follow-ups . 114 participants were r and omized , of whom 94 completed the week 4 assessment and 81 completed the week 12 assessment . Aromatherapy and donepezil were well tolerated . There were no significant differences between aromatherapy , donepezil and placebo at week 4 and week 12 , but importantly there were substantial improvements in all 3 groups with an 18 % improvement in the PAS and a 37 % improvement in the NPI over 12 weeks . Conclusion : When assessed using a rigorous design which ensures blinding of treatment arms , there is no evidence that melissa aromatherapy is superior to placebo or donepezil , in the treatment of agitation in people with Alzheimer ’s disease . However , the sizeable improvement in the placebo group emphasizes the potential non-specific benefits of touch and interaction in the treatment of agitation in people with Alzheimer ’s disease OBJECTIVES A series of pre clinical studies have suggested that selective serotonin reuptake inhibitor antidepressants not only stimulate neurogenesis but also have neuroprotective effects . The present study primarily aim ed to investigate whether escitalopram would decelerate the brain atrophy of patients with mild-to-moderate Alzheimer 's disease ( AD ) . We also assessed the effects of escitalopram on the cognitive function and neuropsychiatric symptoms of these participants . METHODS Seventy-four probable AD patients without major depression were recruited from four dementia clinics of university hospitals and r and omly assigned in a 1:1 ratio . Each group received 20 mg/day of escitalopram or placebo for 52 weeks . The primary outcome measures were the change rates of hippocampal and whole brain volume on magnetic resonance imaging for 52 weeks . The Alzheimer 's Disease Assessment Scale-cognitive subscale , Mini-Mental State Examination , Neuropsychiatric Inventory , and Cornell Scale for Depression in Dementia ( CSDD ) were also applied . RESULTS We did not find any significant differences in the changes of hippocampal or whole brain volume between the groups . Escitalopram showed significant beneficial effects on the CSDD score at 28 weeks compared with placebo ( t = -2.17 , df = 50.42 , p = 0.035 ) , but this finding did not persist throughout the study . CONCLUSION The findings of the present study do not support the role of escitalopram as a progression-delaying treatment for AD . However , the negative results of the present trial should be interpreted cautiously because of the relatively small sample size . Further large-scale escitalopram trials targeting the earlier stages of AD , even prodromal AD , are still needed . Copyright © 2015 John Wiley & Sons , Objective : To assess the impact and the social rating of an active music condition ( in which 10 patients with Alzheimer 's disease regulated their music input ) vs. a passive music condition . Method : In the active condition , the patients used a simple h and response and a microswitch to activate music stimulation periods . In the passive condition , music stimulation was prearranged and continued through the sessions . The active and passive stimulation sessions were preceded and followed by control ( non-stimulation ) sessions . Results : The active condition sessions showed an increase in the patients ’ indices of positive participation ( e.g. , singing or music-related movements , and smiles ) similar to that observed in the passive condition sessions . Social raters ( 140 psychology students ) favored the active condition on a six-item question naire dealing , among others , with conditions ’ suitability , respect of patients ’ dignity and independence , and practicality . Conclusion : An active music stimulation condition can be viable , effective , and socially preferable BACKGROUND Agitation is common in people with dementia , is distressing to patients and stressful to their carers . Drugs used to treat the 
    Output:
    
Strong evidence indicates that person-centered approaches can improve behavior .
Moderate evidence supports noise regulation , environmental design , unobtrusive visual barriers , and environmental relocation strategies to reduce problematic behaviors .
Evidence is insufficient for the effectiveness of mealtime ambient music , bright light , proprioceptive input , w and er gardens , optical strategies , and sensory devices in improving behavior or reducing w and ering and falls .