***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 A recent Cochrane review of reality orientation therapy identified the need for large , well- design ed , multi-centre trials . AIMS To test the hypothesis that cognitive stimulation therapy ( CST ) for older people with dementia would benefit cognition and quality of life . METHOD A single-blind , multi-centre , r and omised controlled trial recruited 201 older people with dementia . The main outcome measures were change in cognitive function and quality of life . An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures . RESULTS One hundred and fifteen people were r and omised within centres to the  intervention group and 86 to the control group .  At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P=0.044 ) , the Alzheimer 's Disease Assessment Scale - Cognition ( ADAS-Cog ) ( P=0.014 ) and Quality of Life - Alzheimer 's Disease scales ( P=0.028 ) . Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group . CONCLUSION The results compare favourably with trials of drugs for dementia . CST groups may have worthwhile benefits for many people with dementia The efficacy of a cognitive intervention consisting of training in face-name associations , spaced retrieval , and cognitive stimulation was tested in a sample of 37 patients ( 16 men , 21 women ) with probable Alzheimer disease ( AD ) . Patients with AD were r and omly assigned to receive either the cognitive intervention or a mock ( placebo ) intervention for 5 weeks . The placebo group then crossed over to receive the intervention . During the intervention , AD patients showed significant improvement in recall of personal information , face-name recall , and performance on the Verbal Series Attention Test . Improvement did not generalize to additional neuropsychologic measures of dementia severity , verbal memory , visual memory , word generation , or motor speed , or to caregiver-assessed patient quality of life . Results suggest that although face-name training , spaced retrieval , and cognitive stimulation may produce small gains in learning personal information and on a measure of attention , improvement does not generalize to overall neuropsychologic functioning or patient quality of life OBJECTIVE The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease ( AD ) patients receiving a cholinesterase inhibitor . METHODS Twenty-five participants in the Cognitive Rehabilitation ( CR ) condition participated in two 45-minute sessions twice per week for 24 total sessions . CR training included face-name association tasks , object recall training , functional tasks ( e.g. , making change , paying bills ) , orientation to time and place , visuo-motor speed of processing , and the use of a memory notebook .  Nineteen participants in the Mental Stimulation ( MS ) condition had equivalent therapist contact and number of sessions , which consisted of interactive computer games involving memory , concentration , and problem-solving skills . RESULTS Compared with the MS condition , participants in CR demonstrated improved performance on tasks that were similar to those used in training . Gains in recall of face-name associations , orientation , cognitive processing speed , and specific functional tasks were present post-intervention and at a 3-month follow-up . CONCLUSION A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in mildly impaired AD patients OBJECTIVE --To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia . DESIGN -- Assessment and suitability of carers by question naire ; assessment of patients and carers in a hospital outpatient clinic ; allocation to groups according to date of application to study . Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes . Re assessment at three , six , 12 , and , for those in the " wait list " group , 18 months . SETTING --The programmes were conducted in the psychiatry unit of a Sydney teaching hospital . SUBJECTS -- Eligible patients were less than 80 years old , had mild to moderate dementia , and lived at home with their carer . Of the 96 patient-carer pairs in the study , 33 were in the dementia carers ' programme group  , 31 were in the memory retraining group , and 32 were in the wait list group . INTERVENTIONS --Carers in the dementia carers ' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining . In the memory retraining programme  patients were admitted and received the patient component of the carers ' programme while their carers had 10 days ' respite . In the wait list group carers waited six months before undertaking the carers ' programme . MAIN OUTCOME MEASURES --Effect of the programmes on carers ' general health question naire scores and the rate of placement of patients in institutions . RESULTS --At 12 months ' follow up the carers ' programme had result ed in significantly lower psychological stress among carers than the memory retraining programme ( mean ( SD ) general health question naire scores at 0 months were 6.31 ( 6.23 ) and 3.60 ( 6.25 ) respectively , and at 12 months were 4.69 ( 5.58 ) and 7.40 ( 9.39 ) ; p less than 0.05 . ) In the wait list group distress scores remained stable , even after the carers and patients had undertaken the carers ' programme . Patients deteriorated over 12 months regardless of group allocation , but at 30 months , allowing for patients who died and could not be included in the analysis , 65 % of patients in the carers ' programme group were still living at home compared with 26 % in the memory retraining programme group . CONCLUSION --The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer This r and omized study evaluated the combined effect of a cognitive-communication program plus an acetylcholinesterase inhibitor ( donepezil ; donepezil-plus-stimulation group ; n = 26 ) , as compared with donepezil alone ( donepezil-only  group ; n = 28 ) in 54 patients with mild to moderate Alzheimer 's disease ( AD ; Mini-Mental Status Examination score of 12- 28 ) ranging in age from 54 to 91 years . It was hypothesized that cognitive-communication stimulation in combination with donepezil would positively affect the following : ( a ) relevance of discourse , ( b ) performance of functional abilities , ( c ) emotional symptoms , ( d ) quality of life , and ( e ) overall global function , as measured by caregiver and participant report and st and ardized measures . Cognitive-communication , neuropsychiatric , functional performance , and quality of life evaluations were conducted at baseline and Month 4 , the month after the 2-month active stimulation period . Follow-up evaluations were performed at Months 8 and 12 . The stimulation program consisted of 12 hr of intervention over an 8-week period and involved participant-led discussion s requiring homework , interactive sessions about AD , and discussion s using salient life stories . Additive effects of active stimulation with donepezil were examined in 2 ways : ( 1 ) comparing mean group performance over time and ( 2 ) evaluating change scores from baseline . A Group x Time interaction was found for the donepezil-plus-stimulation group in the emotional symptoms of apathy and irritability as compared with the donepezil-only group . Evaluation of change scores from baseline to 12 months revealed a positive effect for the donepezil-plus-stimulation group on discourse and functional abilities with a trend on apathy , irritability , and patient-reported quality of life . In sum , the research revealed benefits to the donepezil-plus-stimulation group in the areas of discourse abilities , functional abilities , emotional symptoms , and overall global performance . This study adds to growing evidence that active cognitive stimulation may slow the rate of verbal and functional decline and decrease negative emotional symptoms in AD when combined with acetylcholinesterase inhibitors , indicating a need to advance research in the area of cognitive treatments . The fact that AD is a progressive brain disease should not preclude ameliorative treatment The Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) trial is a r and omized , controlled , single-masked trial design ed to determine whether cognitive training interventions ( memory , reasoning , and speed of information processing ) , which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions , can affect cognitively based measures of daily functioning . Enrollment began during 1998 ; 2-year follow-up will be completed by January 2002 . Primary outcomes focus on measures of cognitively dem and ing everyday functioning , including financial management , food preparation , medication use , and driving . Secondary outcomes include health-related quality of life , mobility , and health-service utilization .  Trial participants ( n = 2832 ) are aged 65 and over , and at entry into the trial , did not have significant cognitive , physical , or functional decline .  Because of its size and the carefully developed rigor , ACTIVE may serve as a guide for future behavioral medicine trials of this nature To evaluate nonpharmacologic interventions , caregivers ( 65 women , 38 men ) and their dementia-diagnosed spouses ( patients ) were r and omized to one of four treatment programs ( cognitive stimulation , dyadic counseling , dual supportive seminar , and early-stage day care ) or to a wait-list control group . Assessment s occurred initially and at postintervention ( 3 months ) . Patients were evaluated on memory , verbal fluency , and problem-solving ability , and caregivers were assessed on marital interaction , emotional status , and physical health , along with stress , coping , and social support .  Caregivers also completed a program evaluation . Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes , and caregivers decreased in depressive symptoms . Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies , respectively . Although qualitatively derived benefits differed across groups , similarities in program content reduced the potential for quantitative differentiation among the groups The efficacy of a memory-training program to improve word-list recall and recognition was evaluated in 34 patients with probable Alzheimer 's disease ( AD ) . The patients , who were all taking donepezil throughout the 6-week intervention , were r and omly assigned to a cognitive intervention group or a control group . The Control group received didactic presentations but no formal memory training . Patients were assessed on neuropsychological tests before the 6-week training program , immediately after the training , and 8 weeks after completion of the training . Caregivers , who were blind to group assignment , completed activities of daily living ( ADLs ) and everyday memory question naires at all three timepoints . No significant main effects of group ( training vs. control ) or time were observed on any outcome measures , nor were any significant interactions found . In terms of " process " measures during the 6-week training program , the patients demonstrated modest improvement on recall and recognition of test material presented during the training sessions . These results suggest that although modest gains in learning and memory may be evident in AD patients who are taught specific strategies , the benefits do not generalize to other measures of neuropsychological functioning after a brief intervention A study was performed on patients with Alzheimer ’s disease ( AD ) in order to evaluate the efficacy of a combined treatment ( donepezil plus cognitive training ) in both cognitive processes and affective states . Eighty-six subjects , 25 men and 61 women , with an average age of 75.58 years , were studied . Almost all the subjects had a basic educational level .  Donezepil was administered at a dose of 10 mg daily along with cognitive treatment involving images of everyday life and reminiscent music ; the sessions took place on Monday to Friday and lasted three quarters of an hour . The study lasted 12 months . Subjects underwent test-retest with the following tests : Mini-Mental State Examination ( MMSE ) , the cognitive subscale of the Alzheimer ’s Disease Assessment Scale ( ADAS-cog ) ; the Geriatric Depression Scale ( GDS ) and the overall deterioration scale ( FAST ) . The results showed that subjects receiving the combined treatment had a better response than those who did not receive any cognitive training . These subjects ’ MMSE score decreased by 3.24 on average . The affective symptomatology of those receiving only drug treatment improved whereas the cognitive processes did not Awareness of difficulties may have an important impact on functioning and response to intervention in early-stage Alzheimer ’s disease ( AD ) . Clinical reports and retrospective studies suggest an association , but this has not previously been tested in a prospect i ve study . Using a new measure of awareness , the  Memory Awareness Rating Scale ( MARS ) , which was design ed to take account of method ological limitations identified in a review of previous studies , the present study explored the relationship between awareness of difficulties and outcome of a cognitive rehabilitation ( CR ) intervention in 12 participants with a diagnosis of early-stage Alzheimer ’s disease . The relationship between awareness and mood , behaviour and executive function was also assessed . The results provide the first demonstration in a prospect i ve study that higher levels of awareness are related to better CR outcomes . Awareness was associated with depression and reported behaviour problems , but not with performance on tests of executive function . These results suggest that variations in level of awareness in early-stage AD are influenced by psychological factors , and that explanatory models need to take these factors into account . Awareness of difficulties may serve as a useful predictor of the likely effectiveness of CR , and this may assist clinicians in selecting appropriate interventions for individuals with early-stage AD A cognitive remediation intervention was tested for its 
    Output:
    
MAIN RESULTS None of the six studies reporting cognitive training interventions demonstrated any statistically significant effects in any domain , although there were indications of some modest , non-significant effects in various domains of cognitive functioning .