***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: CONTEXT The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging . However , evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning . OBJECTIVE To determine whether G. biloba slows the rates of global or domain-specific cognitive decline in older adults . DESIGN , SETTING , AND PARTICIPANTS The Ginkgo Evaluation of Memory ( GEM ) study , a r and omized , double-blind , placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years , conducted in 6 academic medical centers in the United States between 2000 and 2008 , with a median follow-up of 6.1 years . INTERVENTION Twice-daily dose of 120-mg extract of G. biloba ( n = 1545 ) or identical-appearing placebo ( n = 1524 ) . MAIN OUTCOME MEASURES Rates of change over time in the Modified Mini-Mental State Examination ( 3MSE ) , in the cognitive subscale of the Alzheimer Disease Assessment Scale ( ADAS-Cog ) , and in neuropsychological domains of memory , attention , visual-spatial construction , language , and executive functions , based on sums of z scores of individual tests . RESULTS Annual rates of decline in z scores did not differ between G. biloba and placebo groups in any domains , including memory ( 0.043 ; 95 % confidence interval [ CI ] , 0.034 - 0.051 vs 0.041 ; 95 % CI , 0.032 - 0.050 ) , attention ( 0.043 ; 95 % CI , 0.037 - 0.050 vs 0.048 ; 95 % CI , 0.041 - 0.054 ) , visuospatial abilities ( 0.107 ; 95 % CI , 0.097 - 0.117 vs 0.118 ; 95 % CI , 0.108 - 0.128 ) , language ( 0.045 ; 95 % CI , 0.037 - 0.054 vs 0.041 ; 95 % CI , 0.033 - 0.048 ) , and executive functions ( 0.092 ; 95 % CI , 0.086 - 0.099 vs 0.089 ; 95 % CI , 0.082 - 0.096 ) . For the 3MSE and ADAS-Cog , rates of change varied by baseline cognitive status ( mild cognitive impairment ) , but there were no differences in rates of change between treatment groups ( for 3MSE , P = .71 ; for ADAS-Cog , P = .97 ) . There was no significant effect modification of treatment on rate of decline by age , sex , race , education , APOE*E4 allele , or baseline mild cognitive impairment ( P > .05 ) . CONCLUSION Compared with placebo , the use of G. biloba , 120 mg twice daily , did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00010803 Soybean-derived phosphatidylserine ( Soy-PS ) is a phosphatidylserine made from soybean lecithin by enzymatic reaction with L-serine . A double-blind , r and omized controlled study was conducted to investigate the effects of Soy-PS on the cognitive functions of the elderly Japanese subjects with memory complaints . Seventy-eight elderly people with mild cognitive impairment ( 50–69 years old ) were r and omly allocated to take Soy-PS ( 100 mg , 300 mg/day ) or placebo for 6 months . As a result , there was no difference in blood markers and vital signs during Soy-PS treatment and any side effect caused by Soy-PS treatment was not observed . Neuropsychological test scores were similarly increased in all groups including placebo group . However , in the subjects with relatively low score at baseline , the memory scores  in PS treated groups were significantly increased against the baseline , while those of placebo group remained unchanged . And the memory improvements in Soy-PS-treated groups were mostly attributed to the increase in delayed verbal recall , a memory ability attenuated in the earliest stage of dementia . In conclusion , Soy-PS used in this study is considered as safety food ingredient and 6 months of Soy-PS supplementation could improve the memory functions of the elderly with memory complaints BACKGROUND Despite widespread use of multivitamin supplements , their effect on cognitive health-a critical issue with aging-remains inconclusive . To date , no long-term clinical trials have studied multivitamin use and cognitive decline in older persons . OBJECTIVE To evaluate whether long-term multivitamin supplementation affects cognitive health in later life . DESIGN R and omized , double-blind , placebo-controlled trial of a multivitamin from 1997 to 1 June 2011 . The cognitive function sub study began in 1998 . Up to 4 repeated cognitive assessment s by telephone interview were completed over 12 years . ( Clinical Trials.gov : NCT00270647 ) SETTING : The Physicians ' Health Study II . PATIENTS 5947 male physicians aged 65 years or older . INTERVENTION Daily multivitamin or placebo . MEASUREMENTS A global composite score averaging 5 tests of global cognition , verbal memory , and category fluency . The secondary end point was a verbal memory score combining 4 tests of verbal memory , which is a strong predictor of Alzheimer disease . RESULTS No difference was found in mean cognitive change over time between the multivitamin and placebo groups or in the mean level of cognition at any of the 4 assessment s. Specifically , for the global composite score , the mean difference in cognitive change over follow-up was -0.01 SU ( 95 % CI , -0.04 to 0.02 SU ) when treatment was compared with placebo . Similarly , cognitive performance did not differ between the multivitamin and placebo groups on the secondary outcome , verbal memory ( mean difference in cognitive change over follow-up , -0.005 SU [ CI , -0.04 to 0.03 SU ] ) . LIMITATION Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin . CONCLUSION In male physicians aged 65 years or older , long-term use of a daily multivitamin did not provide cognitive benefits . PRIMARY FUNDING SOURCE National Institutes of Health , BASF , Pfizer , and DSM Nutritional Products BACKGROUND Prior investigations have reported a link between poor status of antioxidants , folate , and cobalamin result ing in elevated total plasma homocysteine ( tHcy ) and methylmalonic acid ( MMA ) concentrations with an increased risk for reduced cognitive performance . The aim of the study was to evaluate the effect of a 6-month multivitamin supplementation on the cognitive performance of female seniors and to assess cognitive functioning in relation to vitamin status , tHcy , and MMA values at baseline . METHODS The study was performed as a r and omized placebo-controlled double-blind trial . 220 healthy , free-living women ( aged 60 - 91 years ) were included .  Blood drawings and cognitive tests were performed at the Institute of Food Science of the University of Hanover , Germany . Vitamin and cognitive status have been evaluated prior to and 6 months after supplementation . Plasma ascorbic acid , serum concentrations of alpha-tocopherol , beta-carotene , and coenzyme Q10 , serum and erythrocyte folate as well as serum cobalamin , serum MMA , and plasma tHcy concentrations were measured . Activity coefficient of erythrocyte alpha aspartic aminotransferase was used as functional index for vitamin B(6 ) status . The cognitive performance was assessed by the Symbol Search test , a subtest of the Wechsler Adult Intelligence Scale ( WAIS-III ) and the pattern-recognition test . Intelligence as assessed by the ' Kurztest für Allgemeine Intelligenz ' ( KAI ) was a further variable . RESULTS No significant differences in pattern-recognition and intelligence score were observed between vitamin and placebo group prior to and after multivitamin supplementation . In the Symbol Search test , the vitamin group exhibited better test results than the placebo group at both measure points . One-way ANOVA showed a marginally significant linear trend between the baseline tHcy concentration and the pattern-recognition score ( P = 0.051 ) in the total sample . Multiple backward regression revealed only a significant influence of the school graduation on baseline cognitive function test results . A general linear model showed that the changes in cognitive function scores could not be explained by the type of treatment or blood parameters . CONCLUSIONS Our data indicate that 6 months supplementation of physiological dosages of antioxidants and B vitamins have no effect on cognitive performance in presumedly healthy and well-nourished female seniors . An intervention period of only 6 months may be too short for improving cognitive performance in well-educated elderly women without dementia Background Observational studies have frequently reported an association between cognitive function and nutrition in later life but r and omised trials of B vitamins and antioxidant supplements have mostly found no beneficial effect . We examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older adults to assess the possibility that this could help to prevent cognitive decline . Methods The study was carried out as part of a r and omised double blind placebo controlled trial of micronutrient supplementation based in six primary care health centres in North East Scotl and . 910 men and women aged 65 years and over living in the community were recruited and r and omised : 456 to active treatment and 454 to placebo . The active treatment consisted of a single tablet containing eleven vitamins and five minerals in amounts ranging from 50–210 % of the UK Reference Nutrient Intake or matching placebo tablet taken daily for 12 months . Digit span forward and verbal fluency tests , which assess immediate memory and executive functioning respectively , were conducted at the start and end of the intervention period . Risk of micronutrient deficiency at baseline was assessed by a simple risk question naire . Results For digit span forward there was no evidence of an effect of supplements in all participants or in sub-groups defined by age or risk of deficiency . For verbal fluency there was no evidence of a beneficial effect in the whole study population but there was weak evidence for a beneficial effect of supplementation in the two pre-specified subgroups : in those aged 75 years and over ( n 290 ; mean difference between supplemented and placebo groups 2.8 ( 95 % CI -0.6 , 6.2 ) units ) and in those at increased risk of micronutrient deficiency assessed by the risk question naire ( n 260 ; mean difference between supplemented and placebo groups 2.5 ( 95 % CI -1.0 , 6.1 ) units ) . Conclusion The results provide no evidence for a beneficial effect of daily multivitamin and multimineral supplements on these domains of cognitive function in community-living people over 65 years . However , the possibility of beneficial effects in older people and those at greater risk of nutritional deficiency deserves further attention Is it possible to prevent atrophy of key brain regions related to cognitive decline and Alzheimer ’s disease ( AD ) ? One approach is to modify nongenetic risk factors , for instance by lowering elevated plasma homocysteine using B vitamins . In an initial , r and omized controlled study on elderly subjects with increased dementia risk ( mild cognitive impairment according to 2004 Petersen criteria ) , we showed that high-dose B-vitamin treatment ( folic acid 0.8 mg , vitamin B6 20 mg , vitamin B12 0.5 mg ) slowed shrinkage of the whole brain volume over 2 y. Here , we go further by demonstrating that B-vitamin treatment reduces , by as much as seven fold , the cerebral atrophy in those gray matter ( GM ) regions specifically vulnerable to the AD process , including the medial temporal lobe . In the placebo group , higher homocysteine levels at baseline are associated with faster GM atrophy , but this deleterious effect is largely prevented by B-vitamin treatment . We additionally show that the beneficial effect of B vitamins is confined to participants with high homocysteine ( above the median , 11 µmol/L ) and that , in these participants , a causal Bayesian network analysis indicates the following chain of events : B vitamins lower homocysteine , which directly leads to a decrease in GM atrophy , thereby slowing cognitive decline . Our results show that B-vitamin supplementation can slow the atrophy of specific brain regions that are a key component of the AD process and that are associated with cognitive decline . Further B-vitamin supplementation trials focusing on elderly subjets with high homocysteine levels are warranted to see if progression to dementia can be prevented Background — Cardiovascular factors are associated with  cognitive decline .  Antioxidants may be beneficial . Methods and Results — The Women ’s Antioxidant Cardiovascular Study was a trial of vitamin E ( 402 mg every other day ) , beta carotene ( 50 mg every other day ) , and vitamin C ( 500 mg daily ) for the secondary prevention of cardiovascular disease . From 19 
    Output:
    
Overall , studies provided low-strength evidence suggesting that -3 fatty acids do not improve cognitive performance in adults with normal cognition compared with placebo .