***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: Based on research demonstrating associations between folate , B-12 and B-6 vitamins and cognition and mood , we investigated the effects of short-term supplementation in 211 healthy younger , middle-aged and older women who took either 750 microg of folate , 15 microg of vitamin B-12 , 75 mg of vitamin B-6 or a placebo daily for 35 d. In addition , we examined associations between dietary intake of these vitamins and cognition and mood . Usual dietary intake status was estimated using a retrospective , self-report , quantified food frequency question naire . Participants completed alternate forms of st and ardized tests of cognitive processing re sources , memory , executive function , verbal ability and self-report mood measures before and after supplementation . Supplementation had a significant positive effect on some measures of memory performance only , and no effect on mood . Dietary intake status was associated with speed of processing , recall and recognition and verbal ability BACKGROUND Frail elders are at risk of suboptimal micronutrient status , functional decline , and neurologic disorders . The influence of oral multimicronutrients in physiologic doses and of moderately intense physical exercise on homocysteine ( Hcy ) , methylmalonic acid ( MMA ) , and neurologic functioning have not yet been investigated . OBJECTIVE Our goal was to determine the effects of enriched foods and exercise on blood vitamins , Hcy , MMA , and neuropsychological functioning in the frail . DESIGN A 17-wk r and omized controlled intervention trial was used to study 1 ) enriched foods plus a social program , 2 ) regular foods plus exercise , 3 ) enriched foods plus exercise , and 4 ) regular foods plus a social program . Enriched foods contained multiple micronutrients ( 25 - 100 % of the Dutch recommended dietary allowances ) ; exercises focused on strength , coordination , flexibility , and endurance . Vitamin ( cobalamin , red blood cell folate , and pyridoxal 5'-phosphate ) , Hcy , and MMA concentrations were measured and 2 neuropsychological tests were conducted . RESULTS Vitamin concentrations were higher in the supplemented groups than in the unsupplemented groups ( P < 0.001 ; total n = 130 ) . Compared with baseline , cobalamin in the supplemented groups was increased by 22 % , plasma folate by 101 % , red blood cell folate by 87 % , and pyridoxal 5'-phosphate by 68 % . Concentrations in the unsupplemented groups changed by -2 % , -6 % , 1 % , and -13 % , respectively . Hcy decreased by 25 % and MMA by 30 % in the supplemented groups , compared with a small increase in Hcy ( 2 % ) and decrease in MMA ( 9 % ) in the unsupplemented groups . Exercise did not significantly affect vitamin , Hcy , or MMA concentrations . No significant effect of either intervention was observed on the neuropsychological tests . CONCLUSIONS The decrease in Hcy and MMA in frail elders confirms a sub clinical metabolic deficiency state . Enriched foods containing physiologic amounts of micronutrients have a beneficial effect on these metabolites . No effects of B vitamins on mental health were identified Paulinia cupana ( guarana ) is a Brazilian plant given great prestige in popular medicine , for example as being a potent stimulator of brain functions . The authors assessed the effects of the long-term administration of guarana on the cognition of normal , elderly volunteers . Forty-five volunteers were studied , with a r and om distribution in three experimental groups : placebo ( n = 15 ) , caffeine ( n = 15 ) , and guarana ( n = 15 ) , in a double-blind study . There were no significant cognitive alterations in these volunteers Objective : To determine the efficacy of acetyl-l-carnitine ( ALCAR ) on the rate of decline in early-onset AD patients . Methods : A 1-year , multicenter , double-blind , placebo-controlled , r and omized trial was conducted . Subjects were 45 to 65 years old , with a diagnosis of probable AD according to National Institute of Neurological Communicative Disorders – Alzheimer ’s Disease and Related Disorders Association criteria and had a Mini-Mental State Examination ( MMSE ) score between 12 and 26 . They were treated with ALCAR ( 1 g tid ) or placebo . Primary outcome measures were the Alzheimer ’s Disease Assessment Scale – Cognitive Component and the Clinical Dementia Rating Scale . Secondary measures included the ADAS Non-Cognitive Subscale , the MMSE , an Activities of Daily Living Scale ( ADL ) , and a Clinician-Based Impression of Change ( CIBIC ) . Results : Two-hundred twenty-nine patients were enrolled and r and omized to drug treatment , with 117 taking placebo  and 112 taking ALCAR . There were no significant differences between the two groups at baseline . For the primary outcome measures , there were no significant differences between the treatment groups on the change from baseline to endpoint in the intent-to-treat analysis . In the completer sample only , there was less deterioration in the MMSE for the ALCAR-treated subjects . There was no difference in rate of decline on the CIBIC and the ADL scale . There were no significant differences in the incidence of adverse events by treatment arm . Conclusion : Overall , in a prospect ively performed study in young-onset AD patients , ALCAR failed to slow decline . Less decline was seen on the MMSE in the completer sample only , with the difference being mediated by reducing decline in attention . A combination of ALCAR and a cholinesterase inhibitor should be tested for additivity OBJECTIVES To assess the longitudinal effects of acety-L-carnitine ( ALC ) on patients diagnosed with Alzheimer 's disease . DESIGN Longitudinal , double-blind , parallel-group , placebo-controlled . SETTING Twenty-four outpatient sites across the United States . PARTICIPANTS A total of 334 subjects diagnosed with probable Alzheimer 's disease by NINCDS-ADRDA criteria . These data were originally reported by Thal and colleagues ( 1996 ) . MEASUREMENTS Cognitive subscale of the Alzheimer Disease Assessment Scale ( ADAS ) given every 3 months for 1 year . RESULTS The average rate of change was estimated using the trilinear approach , which allows for periods of both change and stability . Both the ALC group and the placebo group exhibited the same mean rate of change on the ADAS ( 0.68 points/month ) . However , a multiple regression analysis revealed a statistically significant Age x Drug interaction characterized by younger subjects benefiting more from ALC , significant , cutpoint for ALC benefit was 61 years of age . CONCLUSIONS ALC slows the progression of Alzheimer 's disease in younger subjects , and the use of the trilinear approach to estimate the average rate of change may prove valuable in pharmacological trials BACKGROUND There is evidence that medications or vitamins that increase the levels of brain catecholamines and protect against oxidative damage may reduce the neuronal damage and slow the progression of Alzheimer 's disease . METHODS We conducted a double-blind , placebo-controlled , r and omized , multicenter trial in patients with Alzheimer 's disease of moderate severity . A total of 341 patients received the selective monoamine oxidase inhibitor selegiline ( 10 mg a day ) , alpha-tocopherol ( vitamin E , 2000 IU a day ) , both selegiline and alpha-tocopherol , or placebo for two years . The primary outcome was the time to the occurrence of any of the following : death , institutionalization , loss of the ability to perform basic activities of daily living , or severe dementia ( defined as a Clinical Dementia Rating of 3 ) . RESULTS Despite r and om assignment , the baseline score on the Mini-Mental State Examination was higher in the placebo group than in the other three groups , and this variable was highly predictive of the primary outcome ( P<0.001 ) . In the unadjusted analyses , there was no statistically significant difference in the outcomes among the four groups . In analyses that included the base-line score on the Mini-Mental State Examination as a covariate , there were significant delays in the time to the primary outcome for the patients treated with selegiline ( median time , 655 days ; P=0.012 ) , alpha-tocopherol ( 670 days , P=0.001 ) or combination therapy ( 585 days , P=0.049 ) , as compared with the placebo group ( 440 days ) . CONCLUSIONS In patients with moderately severe impairment from Alzheimer 's disease , treatment with selegiline or alpha-tocopherol slows the progression of disease A r and omized , double-blind , placebo-controlled , parallel-group clinical trial was carried out to compare 24-week periods of treatment with 1 g acetyl-l-carnitine twice daily and placebo in the treatment of patients with dementia of the Alzheimer type . A total of 36 patients entered the trial , of whom 20 patients ( 7 active , 13 placebo ) completed the full 24 weeks . Whilst several of the efficacy indices showed little change in either group during the trial , there was an apparent trend for more improvement in the acetyl-l-carnitine group in relation to the Names Learning Test and a computerized Digit Recall Test , both related to aspects of short-term memory . Similarly , there was a trend for reaction time in the computerized classification test to show less deterioration in the active treatment group . Changes within groups , and changes between groups , failed to reach statistical significance , at least partially because of the small number of patients available for analysis . Two indices of overall therapeutic benefit showed a trend for less deterioration in the active-treatment group than in the placebo group . Nausea and /or vomiting occurred in 5 patients in the acetyl-l-carnitine group . Laboratory tests revealed no signs of drug toxicity . The results suggest that acetyl-l-carnitine may have a beneficial effect on some clinical features of Alzheimer-type dementia , particularly those related to short-term memory Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists In two double-blind , placebo-controlled clinical studies of the nootropic compound acetyl-L-carnitine on the electroencephalogram ( EEG ) and impaired brain functions of elderly out patients with mild to moderate cognitive decline of the organic brain syndrome , statistically significant effects could be detected after eight weeks ( on the EEG ) , and after 12 weeks of treatment ( on the physician 's clinical global impression and the patient-rated level of activities of daily living ) . Side-effects of acetyl-L-carnitine were generally minor and overall rare . Longer treatment periods and further specifications with regard to the aetiopathology and degree of cognitive impairment are recommended for further clinical studies of this promising compound Acetyl levocarnitine hydrochloride has been reported to retard dementia in patients with Alzheimer 's disease . In a double-blind , parallel design , placebo-controlled pilot study of 30 mild to moderately demented patients with probable Alzheimer 's disease , tests of memory , attention , language , visuospatial , and constructional abilities were administered , and the level of acetyl levocarnitine was measured in the cerebrospinal fluid . Patients were then r and omly assigned to receive acetyl levocarnitine hydrochloride ( 2.5 g/d for 3 months followed by 3 g/d for 3 months ) or placebo . After 6 months , the acetyl levocarnitine group demonstrated significantly less deterioration in timed cancellation tasks and Digit Span ( forward ) and a trend toward less deterioration in a timed verbal fluency task . No differences were found in any other neuropsychological test results . A subgroup with the lowest baseline scores , receiving acetyl levocarnitine , had significantly less deterioration on the verbal memory test and a significant increase in cerebrospinal fluid acetyl levocarnitine levels compared with those receiving placebo . These results suggest that acetyl levocarnitine may retard the deterioration in some cognitive areas in patients with Alzheimer 's disease and stress the need for a larger study of this drug This study evaluates the effects of vitamin B-6 supplementation ( 20 mg pyridoxine HCL daily for 3 months ) on mood and performance in 38 self-supporting healthy men , aged between 70–79 years . Effects were compared with 38 controls who received placebo  and were matched for age , plasma pyridoxal-5′-phosphate ( PLP ) concentration 
    Output:
    
Despite the heterogeneity in trial design , the results of this review suggest that nutritional supplements may improve the cognitive functioning of elderly persons and do no harm .