***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 Mild cognitive impairment encompasses the clinical continuum between physiologic age-related cognitive changes and dementia . A variety of medications , including herbal preparations ( in particular Ginkgo biloba and Panax ginseng ) , have been advocated as treatments for cognitive impairment in the elderly . In this study , we investigated the effect of an already marketed dietary supplement ( Memo ® ) combining 750 mg of lyophilized royal jelly with st and ardized extracts of G. biloba 120 mg and P. ginseng 150 mg on Mini-Mental State Examination ( MMSE ) scores in patients with mild cognitive impairment . Methods Sixty-six subjects presenting with forgetfulness and satisfying the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition , Text Revision ( DSM-IV-TR ) clinical criteria for mild cognitive impairment were r and omly divided into an experimental group treated with one Memo capsule before breakfast daily for 4 weeks and a control group who took placebo .  The mean change in MMSE score from baseline and reported adverse effects were compared between the two groups . Results The mean change in MMSE score in the group treated with Memo for 4 weeks was significantly greater than in the control group ( + 2.07 versus + 0.13 , respectively ) by the Student ’s t-test ( t = 6.485 , P < 0.0001 ) . This was also true after adjusting for age as a covariate and educational level as a factor nested within the treatment groups in a general linear model ( analysis of covariance , F = 9.675 [ corrected model ] , P < 0.0001 ) . Conclusion This combined triple formula may be beneficial in treating the cognitive decline that occurs during the aging process as well as in the early phases of pathologic cognitive impairment typical of insidious-onset vascular dementia and in the early stages of Alzheimer ’s disease . Larger-sized studies with longer treatment duration s are needed to confirm this Background To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment ( MCI ) , and identify biomarkers associated with improvement of cognitive functions . Methodology /Principal Findings Subjects were 100 older adults ( mean age , 75 years ) with MCI . The subjects were classified to an amnestic MCI group ( n = 50 ) with neuroimaging measures , and other MCI group ( n = 50 ) before the r and omization . Subjects in each group were r and omized to either a multicomponent exercise or an education control group using a ratio of 1∶1 . The exercise group exercised for 90 min/d , 2 d/wk , 40 times for 6 months . The exercise program was conducted under multitask conditions to stimulate attention and memory . The control group attended two education classes . A repeated- measures ANOVA revealed that no group × time interactions on the cognitive tests and brain atrophy in MCI patients . A sub- analysis of amnestic MCI patients for group × time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination ( p = .04 ) and logical memory scores ( p = .04 ) , and reducing whole brain cortical atrophy ( p<.05 ) compared to the control group . Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores ( p<.05 ) , and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores ( p<.05 ) . Conclusions / Significance The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI . Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI . Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI . Trial Registration UMIN-CTR UMIN000003662 ctr.cgi?function = brows&action = brows&type = summary & recptno = R000004436 & language = Objective : To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment ( MCI ) . Design : R and omised placebo-controlled trial . Setting : General community . Participants : Community-dwelling adults aged 70–80 with MCI . Interventions : The 152 participants were r and omly assigned to two interventions : ( 1 ) a twice-weekly , group-based , moderate-intensity walking programme ( WP , n = 77 ) or a low-intensity placebo activity programme ( n = 75 ) for one year ; and ( 2 ) daily vitamin pill containing 5 mg folic acid , 0.4 mg vitamin B-12 , 50 mg vitamin B-6 ( FA/B12/B6 , n = 78 ) or placebo pill ( n = 74 ) for one year . Outcome measures : Cognitive function , measured with neuropsychological tests at baseline and after six and 12 months . Results : Median session attendance at the exercise programmes ( 25th–75th percentile ) was 63 % ( 2%–81 % ) and median compliance with taking pills ( 25th–75th percentile ) was 100 % ( 99%–100 % ) . Gender was an effect modifier . Intention-to-treat analysis revealed no main intervention effect for either intervention . In women in the WP , attention ( Stroop combination task ) improved by 0.3 seconds ( p = 0.04 ) and memory ( auditory verbal learning test ) by 0.04 words ( p = 0.06 ) with each percentage increase in session attendance . In men attending at least 75 % of the sessions , the WP improved memory ( β 1.5 ( 95 % CI : 0.1 to 3.0 ) words ) . Conclusion : The walking programme and /or FA/B12/B6 supplementation were not effective in improving cognition within one year . The walking programme , however , was efficacious in improving memory in men and memory and attention in women with better adherence . Trial registration : International St and ard R and omised Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct OBJECTIVE To assess the effect of rivastigmine in patients with mild cognitive impairment ( MCI ) on the time to clinical diagnosis of Alzheimer 's disease ( AD ) and the rate of cognitive decline . METHODS The study was a double-blind , r and omised , placebo-controlled trial of up to 48 months . All patients had MCI operationally defined by having cognitive symptoms , a global clinical dementia rating stage of 0.5 , a score of less than 9 on the New York University delayed paragraph recall test , and by not meeting the diagnostic criteria for AD . Primary efficacy variables were time to clinical diagnosis of AD , and change in performance on a cognitive test battery . This study is registered with the US National Institutes of Health clinical trials data base ( Clinical Trials.gov ) , number NCT00000174 . FINDINGS Of 1018 study patients enrolled , 508 were r and omly assigned to rivastigmine and 510 to placebo ; 17.3 % of patients on rivastigmine and 21.4 % on placebo progressed to AD ( hazard ratio 0.85 [ 95 % CI 0.64 - 1.12 ] ; p=0.225 ) . There was no significant difference between the rivastigmine and placebo groups on the st and ardised Z score for the cognitive test battery measured as mean change from baseline to endpoint ( -0.10 [ 95 % CI -0.63 to 0.44 ] , p=0.726 ) . Serious adverse events were reported by 141 ( 27.9 % ) rivastigmine-treated patients and 155 ( 30.5 % ) patients on placebo ;  adverse events of all types were reported by 483 ( 95.6 % ) rivastigmine-treated patients and 472 ( 92.7 % ) placebo-treated patients . The predominant adverse events were cholinergic : the frequencies of nausea , vomiting , diarrhoea , and dizziness were two to four times higher in the rivastigmine group than in the placebo group . INTERPRETATION There was no significant benefit of rivastigmine on the progression rate to AD or on cognitive function over 4 years . The overall rate of progression from MCI to AD in this r and omised clinical trial was much lower than predicted . Rivastigmine treatment was not associated with any significant safety concerns BACKGROUND Mild cognitive impairment is a transitional state between the cognitive changes of normal aging and early Alzheimer 's disease . METHODS In a double-blind study , we evaluated subjects with the amnestic subtype of mild cognitive impairment . Subjects were r and omly assigned to receive 2000 IU of vitamin E daily , 10 mg of donepezil daily , or placebo for three years . The primary outcome was clinical ly possible or probable Alzheimer 's disease ; secondary outcomes were cognition and function . RESULTS A total of 769 subjects were enrolled , and possible or probable Alzheimer 's disease developed in 212 . The overall rate of progression from mild cognitive impairment to Alzheimer 's disease was 16 percent per year . As compared with the placebo group , there were no significant differences in the probability of progression to Alzheimer 's disease in the vitamin E group ( hazard ratio , 1.02 ; 95 percent confidence interval , 0.74 to 1.41 ; P=0.91 ) or the donepezil group ( hazard ratio , 0.80 ; 95 percent confidence interval , 0.57 to 1.13 ; P=0.42 ) during the three years of treatment . Prespecified analyses of the treatment effects at 6-month intervals showed that as compared with the placebo group , the donepezil group had a reduced likelihood of progression to Alzheimer 's disease during the first 12 months of the study ( P=0.04 ) , a finding supported by the secondary outcome measures . Among carriers of one or more apolipoprotein E epsilon4 alleles , the benefit of donepezil was evident throughout the three-year follow-up . There were no significant differences in the rate of progression to Alzheimer 's disease between the vitamin E and placebo groups at any point , either among all patients or among apolipoprotein E epsilon4 carriers . CONCLUSIONS Vitamin E had no benefit in patients with mild  cognitive impairment . Although donepezil therapy was associated with a lower rate of progression to Alzheimer 's disease during the first 12 months of treatment , the rate of progression to Alzheimer 's disease after three years was not lower among patients treated with donepezil than among those given placebo Background To examine the effects of a multicomponent exercise program on the cognitive function of older adults with amnestic mild cognitive impairment ( aMCI ) . Methods Design : Twelve months , r and omized controlled trial ; Setting : Community center in Japan ; Participants : Fifty older adults ( 27 men ) with aMCI ranging in age from 65 to 93 years ( mean age , 75 years ) ; Intervention : Subjects were r and omized into either a multicomponent exercise ( n = 25 ) or an education control group ( n = 25 ) . Subjects in the multicomponent exercise group exercised under the supervision of physiotherapists for 90 min/d , 2 d/wk , for a total of 80 times over 12 months . The exercises included aerobic exercises , muscle strength training , and postural balance retraining , and were conducted using multiple conditions to stimulate cognitive functions . Subjects in the control group attended three education classes regarding health during the 12-month period . Measurements were administered before , after the 6-month , and after the 12-month intervention period ; Measurements : The performance measures included the mini-mental state examination , logical memory subtest of the Wechsler memory scale-revised , digit symbol coding test , letter and categorical verbal fluency test , and the Stroop color word test . Results The mean adherence to the exercise program was 79.2 % . Improvements of cognitive function following multicomponent exercise were superior at treatment end ( group × time interactions for the mini-mental state examination ( P = 0.04 ) , logical memory of immediate recall ( P = 0.03 ) , and letter verbal fluency test ( P = 0.02 ) ) . The logical memory of delayed recall , digit symbol coding , and Stroop color word test showed main effects of time , although there were no group × time interactions . Conclusions This study indicates that exercise improves or supports , at least partly , cognitive performance in older adults with aMCI Rationale Epidemiological studies have suggested a beneficial effect of fish oil supplementation in halting the initial progression of Alzheimer ’s disease . However , it remains unclear whether fish oil affects cognitive function in older people with mild cognitive impairment ( MCI ) . Objectives This study investigated the effects of fish oil supplementation on cognitive function in elderly person with MCI . Methods This was a 12-month , r and omised , double-blind , placebo-controlled study using fish oil supplementation with concentrated docosahexaenoic acid ( DHA ) .  Thirty six low-socioeconomic-status elderly subjects with MCI were r and omly assigned to receive either concentrated DHA fish oil ( n = 18 ) or placebo ( n = 18 ) capsules . The changes of memory , psychomotor speed , executive function and attention , and visual-constructive skills were assessed using cognitive 
    Output:
    
INTERPRETATION Treatment of mild cognitive impairment with cholinesterase inhibitors showed no benefit when compared with a control group .
A small cognitive benefit was observed using behavioural therapies when compared with the control group .
However , the clinical significance of this small benefit remains uncertain .