human
***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 and Purpose In a prospect i ve , double-blind , placebo-controlled study , it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow . Methods Twenty-four stroke patients with aphasia were r and omly allocated to 2 groups : 12 patients received  2400 mg piracetam twice daily , 12 placebo . Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy , the patients were examined neuropsychologically and studied with H215O PET at rest and during activation with a word-repetition task .  Blood flow was analyzed in 14 language -activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images . Results Before treatment , both groups were comparable with respect to performance in language tasks and to type and severity of aphasia . In the piracetam group , increase of activation effect was significantly higher ( P < 0.05 ) in the left transverse temporal gyrus , left triangular part of inferior frontal gyrus , and left posterior superior temporal gyrus after the treatment period compared with the initial measures . The placebo group showed an increase of activation effect only in the left vocalization area . In the test battery , the piracetam group improved in 6 language functions , the placebo group only in 3 subtests . Conclusions Piracetam as an adjuvant to speech therapy improves recovery of various language functions , and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere Twenty-four carefully assessed patients with probable Alzheimer 's disease were enrolled in a double-blind , placebo-controlled treatment study of oxiracetam , a nootropic agent reported to improve memory performance in patients with dementia . A broad battery of neuropsychological tests failed to reveal any improvement in the treated group or in any treated patient when individual test scores were analyzed . These findings indicate that oxiracetam is ineffective in reducing cognitive impairment due to Alzheimer 's disease BACKGROUND Piracetam is widely used as a purported means of improving cognitive function in children with Down syndrome . Its efficacy , however , has not been rigorously assessed . OBJECTIVE To determine whether 4 months of piracetam therapy ( 80 - 100 mg/kg per day ) enhances cognitive function in children with Down syndrome . DESIGN A r and omized , double-blind , placebo-controlled crossover study . PARTICIPANTS AND METHODS Twenty-five children with Down syndrome ( aged 6.5 - 13 years ) and their caregivers participated . After undergoing a baseline cognitive assessment , children were r and omly assigned to 1 of 2 treatment groups : piracetam-placebo or placebo-piracetam . MAIN OUTCOME MEASURE The difference in performance while taking piracetam vs while taking placebo on tests assessing a wide range of cognitive functions , including attention , learning , and memory . RESULTS Eighteen children completed the study , 4 withdrew , and 3 were excluded at baseline . Piracetam therapy did not significantly improve cognitive performance over placebo use but was associated with central nervous system stimulatory effects in 7 children : aggressiveness ( n = 4 ) , agitation or irritability ( n = 2 ) , sexual arousal ( n = 2 ) , poor sleep ( n = 1 ) , and decreased appetite ( n = 1 ) . CONCLUSION Piracetam therapy did not enhance cognition or behavior but was associated with adverse effects In this study , the protective effect of piracetam on select aspects of cognitive function in patients undergoing bypass surgery was investigated . Male patients ( n = 64 ) with an indication for a surgical revascularization using artificial extracorporal circuits were r and omly assigned in a double-blind fashion to receive a single challenge of 12-g piracetam infusion or placebo ( sterile saline ) prior to the bypass surgery . A brief battery of neuropsychological tests for verbal and non-verbal short-term memory and attention was administered 1 day before and 3 days after the surgical intervention . There was a significant difference in short-term memory and attention , with the piracetam-treated patients producing a better level of performance 3 days after surgery compared to the placebo group . The overall postoperative cognitive function ( z-transformation of all 6 test results ) was more significantly ( p < 0.001 ) reduced in the placebo group than in the piracetam group ( z = -1.19 + /- 0.72 vs. -0.46 + /- 0.58 , respectively ) . A single challenge of 12-g piracetam infusion prior to surgical intervention might offer a short-term neuroprotective effect for patients undergoing cardiac bypass surgery . Whether this effect persists for a longer period of time requires further investigation OBJECTIVES Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass ( CPB ) during cardiac surgery . Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery , we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery . METHODS Patients scheduled for elective open heart surgery were r and omized to the piracetam or placebo group in a double-blind study . Patients received 12 g of piracetam or placebo at the beginning of the operation . Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer 's Disease Assessment Scale were performed preoperatively and on day 3 , postoperatively . To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery , we combined the six test-scores by principal component analysis . RESULTS A total of 88 patients with a mean age of 67 years were enrolled into the study . The mean duration of CPB was 110 minutes . Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups . The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups ( piracetam : preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38 , p < 0.0005 and placebo : preoperative -0.14 ± 0.98 vs. postoperative -1.35 ± 1.23 , p < 0.0005 ) . Patients taking piracetam did not perform better than those taking placebo , and both groups had the same decline of overall cognitive function ( p = 0.955 ) . CONCLUSION Piracetam had no cerebroprotective effect in patients undergoing open heart surgery . Unlike the patients who underwent coronary surgery , piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients Minimal hepatic encephalopathy ( MHE ) is characterized by disturbance of mental state and neuromuscular function . To assess the clinical efficacy of acetyl-l-carnitine ( ALC ) in the treatment of MHE , we performed a r and omized , double-blind , placebo-controlled study administering ALC in cirrhotic patients with this disease and evaluating their cognitive functions . One hundred and twenty-five cirrhotic patients , of whom 21 were infected by hepatitis B virus , 75 by hepatitis C virus and 29 with cryptogenic cirrhosis , were enrolled in our study . Patients were r and omly divided into two groups , and using double-blind administration , group A was treated with ALC and group B with placebo for 90 days . The two groups were similar in demographic characteristics , aetiology of cirrhosis , duration and Child-Pugh grade . Minimal hepatic encephalopathy was diagnosed with the Trail Making Test ( TMT ) , Symbol Digit Modalities Test ( SDMT ) and Auditory Verbal Learning Test ( AVL ) and cognitive function with the Mini Mental State Examination ( MMSE ) . After 90 days in group A treated with ALC , we observed a significant decrease in prothrombin time ( P < 0.001 ) , bilirubin serum levels ( P < 0.01 ) , AST ( P < 0.001 ) , fasting NH4 serum levels ( P < 0.001 ) , Trail Making Test-A ( P < 0.001 ) and Trail Making Test-B ( P < 0.001 ) , and a significant increase in albumin serum levels ( P < 0.005 ) , MMSE test ( P < 0.001 ) , Symbol Digit Modalities Test ( P < 0.001 ) , BDT ( P < 0.001 ) , AVL long-term test ( P < 0.001 ) and AVL total test ( P < 0.001 ) . No significant differences were observed in EEG in either group of patients treated with ALC or placebo . The benefits of ALC in comparison with placebo are demonstrated in greater reductions in serum ammonia levels , as well as in improvements of neuropsychological functioning The maintenance of the effects of Cerebrolysin , a peptidergic compound with neurotrophic activity , on cognitive performance and qEEG activity was investigated through a 12-week , open-label extension of a 4-week , r and omised , placebo-controlled pilot study . Thirty-three out of 41 patients with mild-to-moderate severe probable vascular dementia ( VaD ) according to NINDS-AIREN participating in the double-blind phase of the study were also assessed at the follow-up visit at week 16 . Patients received i.v . infusions of Cerebrolysin ( 10 or 30 mL ) or placebo ( saline ) 5 days/week for 4 weeks . Neuropsychological evaluations and qEEG recordings were done at baseline , week 4 and week 16 . The mean change in score from baseline in the ADAS-cog+ and the slow-to-fast qEEG power ratio ( PR ) , used as an index of qEEG slowing , were the two primary endpoints . Correlations between changes in cognition and qEEG induced by the treatment were also assessed . At the week 16 follow-up visit , Cerebrolysin improved ( p<0.05 ) cognitive performance at the 10-mL and 30-mL doses and reduced qEEG slowing significantly ( p<0.05 ) at the 30-mL dose with respect to the placebo . In addition , a significant ( p<0.05 ) positive correlation between the change from the baseline qEEG PR and ADAS-cog+ variables was observed at week 16 . These results indicate a persistence of the beneficial effects of Cerebrolysin on cognition and qEEG activity in VaD patients for at least 12 weeks after treatment cessation , and they suggest the potential utility of qEEG parameters as biomarkers for VaD clinical trials Rationale There is increasing evidence to suggest the possible efficacy of Crocus sativus ( saffron ) in the management of Alzheimer ’s disease ( AD ) . Objective The purpose of the present investigation was to assess the efficacy of C. sativus in the treatment of patients with mild-to-moderate AD . Methods Fifty-four Persian-speaking adults 55 years of age or older who were living in the community were eligible to participate in a 22-week , double-blind study of parallel groups of patients with AD . The main efficacy measures were the change in the Alzheimer ’s Disease Assessment Scale — cognitive subscale and Clinical Dementia Rating Scale — Sums of Boxes scores compared with baseline . Adverse events ( AEs ) were systematic ally recorded . Participants were r and omly assigned to receive a capsule saffron 30 mg/day ( 15 mg twice per day ) or donepezil 10 mg/day ( 5 mg twice per day ) . Results Saffron at this dose was found to be effective similar to donepezil in the treatment of mild-to-moderate AD after 22 weeks . The frequency of AEs was similar between saffron extract and donepezil groups with the exception of vomiting , which occurred significantly more frequently in the donepezil group . Conclusion This phase II study provides preliminary evidence of a possible therapeutic effect of saffron extract in the treatment of patients with mild-to-moderate Alzheimer ’s disease . This trial is registered with the Iranian Clinical Trials Registry ( I RCT 138711051556N1 ) The effectiveness of Oxiracetam ( 1600 mg/day ) versus placebo was assessed in a group of 96 out- patients suffering from cognitive disorders secondary to primary degenerative dementia . The study lasted twelve months and was performed in two stage , a ) double-blind ( 26 weeks ) and b ) open study ( 26 weeks ) . The assessment of the results obtained at two , six and twelve months was carried out following both the methodology based on neuropsychological tests and scales , and the study of the simple reaction time by any of a computerized portable tachystoscope . The patients treated with Oxiracetam showed a statistically significant improvement of simple reaction time and cognitive function detected by the Attention matrix . In the placebo group after twelve months a significant worsening of cognitive and global function was observed in comparison with baseline scores . The patients themselves appeared in favor of Oxiracetam . The drug tolerability proved to be very good for the whole duration of the treatment . The authors believe that Oxiracetam favorably acts on the symptoms of senile cerebral deterioration and can improve the capability of information processing , as suggested by the better performances obtained at the reaction time test and at the Attentional Matrix test BACKGROUND Cognitive deficits have been reported in patients after coronary artery bypass grafting  , but 
    Output:
    
agent
From the data reported in the literature , it emerges that nootropics may be an effective alternative for strengthening and enhancing cognitive performance in patients with a range of pathologies .
Although nootropics , and specifically the cholinergic precursors , already have a long history behind them , according to recent renewal of interest , they still seem to have a significant therapeutic role .
Drugs with regulatory indications for symptomatic treatment of Alzheimer 's disease , such as cholinesterase inhibitors and memantine , often have transient effects in dementia disorders .
***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 and Purpose In a prospect i ve , double-blind , placebo-controlled study , it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow . Methods Twenty-four stroke patients with aphasia were r and omly allocated to 2 groups : 12 patients received  2400 mg piracetam twice daily , 12 placebo . Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy , the patients were examined neuropsychologically and studied with H215O PET at rest and during activation with a word-repetition task .  Blood flow was analyzed in 14 language -activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images . Results Before treatment , both groups were comparable with respect to performance in language tasks and to type and severity of aphasia . In the piracetam group , increase of activation effect was significantly higher ( P < 0.05 ) in the left transverse temporal gyrus , left triangular part of inferior frontal gyrus , and left posterior superior temporal gyrus after the treatment period compared with the initial measures . The placebo group showed an increase of activation effect only in the left vocalization area . In the test battery , the piracetam group improved in 6 language functions , the placebo group only in 3 subtests . Conclusions Piracetam as an adjuvant to speech therapy improves recovery of various language functions , and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere Twenty-four carefully assessed patients with probable Alzheimer 's disease were enrolled in a double-blind , placebo-controlled treatment study of oxiracetam , a nootropic agent reported to improve memory performance in patients with dementia . A broad battery of neuropsychological tests failed to reveal any improvement in the treated group or in any treated patient when individual test scores were analyzed . These findings indicate that oxiracetam is ineffective in reducing cognitive impairment due to Alzheimer 's disease BACKGROUND Piracetam is widely used as a purported means of improving cognitive function in children with Down syndrome . Its efficacy , however , has not been rigorously assessed . OBJECTIVE To determine whether 4 months of piracetam therapy ( 80 - 100 mg/kg per day ) enhances cognitive function in children with Down syndrome . DESIGN A r and omized , double-blind , placebo-controlled crossover study . PARTICIPANTS AND METHODS Twenty-five children with Down syndrome ( aged 6.5 - 13 years ) and their caregivers participated . After undergoing a baseline cognitive assessment , children were r and omly assigned to 1 of 2 treatment groups : piracetam-placebo or placebo-piracetam . MAIN OUTCOME MEASURE The difference in performance while taking piracetam vs while taking placebo on tests assessing a wide range of cognitive functions , including attention , learning , and memory . RESULTS Eighteen children completed the study , 4 withdrew , and 3 were excluded at baseline . Piracetam therapy did not significantly improve cognitive performance over placebo use but was associated with central nervous system stimulatory effects in 7 children : aggressiveness ( n = 4 ) , agitation or irritability ( n = 2 ) , sexual arousal ( n = 2 ) , poor sleep ( n = 1 ) , and decreased appetite ( n = 1 ) . CONCLUSION Piracetam therapy did not enhance cognition or behavior but was associated with adverse effects In this study , the protective effect of piracetam on select aspects of cognitive function in patients undergoing bypass surgery was investigated . Male patients ( n = 64 ) with an indication for a surgical revascularization using artificial extracorporal circuits were r and omly assigned in a double-blind fashion to receive a single challenge of 12-g piracetam infusion or placebo ( sterile saline ) prior to the bypass surgery . A brief battery of neuropsychological tests for verbal and non-verbal short-term memory and attention was administered 1 day before and 3 days after the surgical intervention . There was a significant difference in short-term memory and attention , with the piracetam-treated patients producing a better level of performance 3 days after surgery compared to the placebo group . The overall postoperative cognitive function ( z-transformation of all 6 test results ) was more significantly ( p < 0.001 ) reduced in the placebo group than in the piracetam group ( z = -1.19 + /- 0.72 vs. -0.46 + /- 0.58 , respectively ) . A single challenge of 12-g piracetam infusion prior to surgical intervention might offer a short-term neuroprotective effect for patients undergoing cardiac bypass surgery . Whether this effect persists for a longer period of time requires further investigation OBJECTIVES Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass ( CPB ) during cardiac surgery . Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery , we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery . METHODS Patients scheduled for elective open heart surgery were r and omized to the piracetam or placebo group in a double-blind study . Patients received 12 g of piracetam or placebo at the beginning of the operation . Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer 's Disease Assessment Scale were performed preoperatively and on day 3 , postoperatively . To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery , we combined the six test-scores by principal component analysis . RESULTS A total of 88 patients with a mean age of 67 years were enrolled into the study . The mean duration of CPB was 110 minutes . Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups . The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups ( piracetam : preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38 , p < 0.0005 and placebo : preoperative -0.14 ± 0.98 vs. postoperative -1.35 ± 1.23 , p < 0.0005 ) . Patients taking piracetam did not perform better than those taking placebo , and both groups had the same decline of overall cognitive function ( p = 0.955 ) . CONCLUSION Piracetam had no cerebroprotective effect in patients undergoing open heart surgery . Unlike the patients who underwent coronary surgery , piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients Minimal hepatic encephalopathy ( MHE ) is characterized by disturbance of mental state and neuromuscular function . To assess the clinical efficacy of acetyl-l-carnitine ( ALC ) in the treatment of MHE , we performed a r and omized , double-blind , placebo-controlled study administering ALC in cirrhotic patients with this disease and evaluating their cognitive functions . One hundred and twenty-five cirrhotic patients , of whom 21 were infected by hepatitis B virus , 75 by hepatitis C virus and 29 with cryptogenic cirrhosis , were enrolled in our study . Patients were r and omly divided into two groups , and using double-blind administration , group A was treated with ALC and group B with placebo for 90 days . The two groups were similar in demographic characteristics , aetiology of cirrhosis , duration and Child-Pugh grade . Minimal hepatic encephalopathy was diagnosed with the Trail Making Test ( TMT ) , Symbol Digit Modalities Test ( SDMT ) and Auditory Verbal Learning Test ( AVL ) and cognitive function with the Mini Mental State Examination ( MMSE ) . After 90 days in group A treated with ALC , we observed a significant decrease in prothrombin time ( P < 0.001 ) , bilirubin serum levels ( P < 0.01 ) , AST ( P < 0.001 ) , fasting NH4 serum levels ( P < 0.001 ) , Trail Making Test-A ( P < 0.001 ) and Trail Making Test-B ( P < 0.001 ) , and a significant increase in albumin serum levels ( P < 0.005 ) , MMSE test ( P < 0.001 ) , Symbol Digit Modalities Test ( P < 0.001 ) , BDT ( P < 0.001 ) , AVL long-term test ( P < 0.001 ) and AVL total test ( P < 0.001 ) . No significant differences were observed in EEG in either group of patients treated with ALC or placebo . The benefits of ALC in comparison with placebo are demonstrated in greater reductions in serum ammonia levels , as well as in improvements of neuropsychological functioning The maintenance of the effects of Cerebrolysin , a peptidergic compound with neurotrophic activity , on cognitive performance and qEEG activity was investigated through a 12-week , open-label extension of a 4-week , r and omised , placebo-controlled pilot study . Thirty-three out of 41 patients with mild-to-moderate severe probable vascular dementia ( VaD ) according to NINDS-AIREN participating in the double-blind phase of the study were also assessed at the follow-up visit at week 16 . Patients received i.v . infusions of Cerebrolysin ( 10 or 30 mL ) or placebo ( saline ) 5 days/week for 4 weeks . Neuropsychological evaluations and qEEG recordings were done at baseline , week 4 and week 16 . The mean change in score from baseline in the ADAS-cog+ and the slow-to-fast qEEG power ratio ( PR ) , used as an index of qEEG slowing , were the two primary endpoints . Correlations between changes in cognition and qEEG induced by the treatment were also assessed . At the week 16 follow-up visit , Cerebrolysin improved ( p<0.05 ) cognitive performance at the 10-mL and 30-mL doses and reduced qEEG slowing significantly ( p<0.05 ) at the 30-mL dose with respect to the placebo . In addition , a significant ( p<0.05 ) positive correlation between the change from the baseline qEEG PR and ADAS-cog+ variables was observed at week 16 . These results indicate a persistence of the beneficial effects of Cerebrolysin on cognition and qEEG activity in VaD patients for at least 12 weeks after treatment cessation , and they suggest the potential utility of qEEG parameters as biomarkers for VaD clinical trials Rationale There is increasing evidence to suggest the possible efficacy of Crocus sativus ( saffron ) in the management of Alzheimer ’s disease ( AD ) . Objective The purpose of the present investigation was to assess the efficacy of C. sativus in the treatment of patients with mild-to-moderate AD . Methods Fifty-four Persian-speaking adults 55 years of age or older who were living in the community were eligible to participate in a 22-week , double-blind study of parallel groups of patients with AD . The main efficacy measures were the change in the Alzheimer ’s Disease Assessment Scale — cognitive subscale and Clinical Dementia Rating Scale — Sums of Boxes scores compared with baseline . Adverse events ( AEs ) were systematic ally recorded . Participants were r and omly assigned to receive a capsule saffron 30 mg/day ( 15 mg twice per day ) or donepezil 10 mg/day ( 5 mg twice per day ) . Results Saffron at this dose was found to be effective similar to donepezil in the treatment of mild-to-moderate AD after 22 weeks . The frequency of AEs was similar between saffron extract and donepezil groups with the exception of vomiting , which occurred significantly more frequently in the donepezil group . Conclusion This phase II study provides preliminary evidence of a possible therapeutic effect of saffron extract in the treatment of patients with mild-to-moderate Alzheimer ’s disease . This trial is registered with the Iranian Clinical Trials Registry ( I RCT 138711051556N1 ) The effectiveness of Oxiracetam ( 1600 mg/day ) versus placebo was assessed in a group of 96 out- patients suffering from cognitive disorders secondary to primary degenerative dementia . The study lasted twelve months and was performed in two stage , a ) double-blind ( 26 weeks ) and b ) open study ( 26 weeks ) . The assessment of the results obtained at two , six and twelve months was carried out following both the methodology based on neuropsychological tests and scales , and the study of the simple reaction time by any of a computerized portable tachystoscope . The patients treated with Oxiracetam showed a statistically significant improvement of simple reaction time and cognitive function detected by the Attention matrix . In the placebo group after twelve months a significant worsening of cognitive and global function was observed in comparison with baseline scores . The patients themselves appeared in favor of Oxiracetam . The drug tolerability proved to be very good for the whole duration of the treatment . The authors believe that Oxiracetam favorably acts on the symptoms of senile cerebral deterioration and can improve the capability of information processing , as suggested by the better performances obtained at the reaction time test and at the Attentional Matrix test BACKGROUND Cognitive deficits have been reported in patients after coronary artery bypass grafting  , but 
    Output:
    