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: OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy ( MCET ) consisting of cognitive training , cognitive stimulations , reality orientation , physical therapy , reminiscence therapy , and music therapy in combination in older people with mild cognitive impairment ( MCI ) or mild dementia . This study was a multi-center , double-blind , r and omized , placebo-controlled , two-period cross-over study ( two 8-week treatment phases separated by a 4-week wash-out period ) . Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were r and omized to the MCET group or the mock-therapy ( placebo ) group .  Outcomes were measured at baseline , week 9 , and week 21 . Fifty-five patients completed the study .  Mini-Mental State Examination ( effect size = 0.47 , p = 0.013 ) and Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( effect size = 0.35 , p = 0.045 ) scores were significantly improved in the MCET compared with mock-therapy group . Revised Memory and Behavior Problems Checklist frequency ( effect size = 0.38 , p = 0.046 ) and self-rated Quality of Life - Alzheimer 's Disease ( effect size = 0.39 , p = 0.047 ) scores were significantly improved in the MCET compared with mock-therapy . MCET improved cognition , behavior , and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did Aims : This study aim ed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program ( MCP ) on the cognitive function of older adults with moderate to severe Alzheimer 's disease ( AD ) . Methods : We included 33 participants with AD in a 6-month r and omized controlled trial . The intervention group participated in physical exercise and received a MCP . The control group received only the MCP . Before and after the intervention , cognitive outcomes were assessed using the Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( ADAS-cog ) , Mini-Mental State Examination , and the Clock Drawing Test . Physical performance was evaluated by exercise time , the number of pedal rotation , total load , grip strength , and the Berg Balance Scale ( BBS ) . Results : In all cognitive measures , there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis . However , the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value , age , sex , and education years . All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements . Conclusion : This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention Background Currently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia . Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care . Methods A r and omized , controlled , single-blind longitudinal trial was conducted with 98 patients ( follow-up : n = 61 ) with primary degenerative dementia in five nursing homes in Bavaria , Germany . The highly st and ardized intervention consisted of motor stimulation , practice in activities of daily living , and cognitive stimulation ( acronym MAKS ) . It was conducted in groups of ten patients led by two therapists for 2 hours , 6 days a week for 12 months . Control patients received treatment as usual .  Cognitive function was assessed using the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-Cog ) , and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living ( E-ADL test ) at baseline and after 12 months . Results Of the 553 individuals screened , 119 ( 21.5 % ) were eligible and 98 ( 17.7 % ) were ultimately included in the study . At 12 months , the results of the per protocol analysis ( n = 61 ) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients ( ADAS-Cog : adjusted mean difference : -7.7 , 95 % CI -14.0 to -1.4 , P = 0.018 , Cohen 's d = 0.45 ; E-ADL test : adjusted mean difference : 3.6 , 95 % CI 0.7 to 6.4 , P = 0.015 , Cohen 's d = 0.50 ) . The effect sizes for the intervention were greater in the subgroup of patients ( n = 50 ) with mild to moderate disease ( ADAS-Cog : Cohen 's d = 0.67 ; E-ADL test : Cohen 's d = 0.69 ) . Conclusions A highly st and ardized , non-pharmacological , multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months . Trial Registration http://www.is rct n.com Identifier : IS RCT The aim of the present report was to evaluate the effectiveness and impact of multisensory and cognitive stimulation on improving cognition in elderly persons living in long-term-care institutions ( institutionalized [ I ] ) or in communities with their families ( noninstitutionalized [ NI ] ) . We compared neuropsychological performance using language and Mini-Mental State Examination ( MMSE ) test scores before and after 24 and 48 stimulation sessions . The two groups were matched by age and years of schooling . Small groups of ten or fewer volunteers underwent the stimulation program , twice a week , over 6 months ( 48 sessions in total ) . Sessions were based on language and memory exercises , as well as visual , olfactory , auditory , and ludic stimulation , including music , singing , and dance . Both groups were assessed at the beginning ( before stimulation ) , in the middle ( after 24 sessions ) , and at the end ( after 48 sessions ) of the stimulation program . Although the NI group showed higher performance in all tasks in all time windows compared with I subjects , both groups improved their performance after stimulation . In addition , the improvement was significantly higher in the I group than the NI group . Language tests seem to be more efficient than the MMSE to detect early changes in cognitive status . The results suggest the impoverished environment of long-term-care institutions may contribute to lower cognitive scores before stimulation and the higher improvement rate of this group after stimulation . In conclusion , language tests should be routinely adopted in the neuropsychological assessment of elderly subjects , and long-term-care institutions need to include regular sensorimotor , social , and cognitive stimulation as a public health policy for elderly persons Objectives We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function . Methods Thirty-three patients with dementia , recruited from one nursing home , participated in this non-r and omized pilot study ( 25 women ; age = 85.2±4.9 years ; Mini Mental State Examination = 16.8±4.0 ) . In phase 1 of the study , seventeen patients in the Exercise group ( EG ) received a combined aerobic and strength training program for six weeks , five times per week , 30 minutes per session , in an individually supervised format and successfully concluded the pre and posttests . In phase 2 of the study , sixteen patients in the Social group ( SG ) received social visits at the same frequency , duration , and format and successfully concluded the pre and posttests . Results Indices of feasibility showed that the recruitment and adherence rate , respectively were 46.2 % and 86.3 % . All EG patients completed the exercise program according to protocol without adverse events . After the six-week program , no significant differences on cognitive function tests were found between the EG and SG . There was a moderate effect size in favor for the EG for the Visual Memory Span Forward ; a visual attention test . There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed ( p = .003 ) , Six-Minute Walk Test ( p = .031 ) , and isometric quadriceps strength ( p = .012 ) . Conclusions The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia . The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large r and omized clinical trials . Trial Registration trialregister.nl CONTEXT Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease ( AD ) , but prospect i ve data regarding an association are lacking . OBJECTIVE To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD . DESIGN Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years . PARTICIPANTS AND SETTING A total of 801 older Catholic nuns , priests , and brothers without dementia at enrollment , recruited from 40 groups across the United States . At baseline , they rated frequency of participation in common cognitive activities  ( eg , reading a newspaper ) , from which a previously vali date d composite measure of cognitive activity frequency was derived . MAIN OUTCOME MEASURES Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer 's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function , compared by cognitive activity score at baseline . RESULTS Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 ( mean , 3.57 ; SD , 0.55 ) , with higher scores indicating more frequent activity . During an average of 4.5 years of follow-up , 111 persons developed AD . In a proportional hazards model that controlled for age , sex , and education , a 1-point increase in cognitive activity score was associated with a 33 % reduction in risk of AD ( hazard ratio , 0.67 ; 95 % confidence interval , 0.49 - 0.92 ) . Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added . In r and om-effects models that controlled for age , sex , education , and baseline level of cognitive function , a 1-point increase in cognitive activity was associated with reduced decline in global cognition ( by 47 % ) , working memory ( by 60 % ) , and perceptual speed ( by 30 % ) . CONCLUSION These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 
    Output:
    
agent
***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: OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy ( MCET ) consisting of cognitive training , cognitive stimulations , reality orientation , physical therapy , reminiscence therapy , and music therapy in combination in older people with mild cognitive impairment ( MCI ) or mild dementia . This study was a multi-center , double-blind , r and omized , placebo-controlled , two-period cross-over study ( two 8-week treatment phases separated by a 4-week wash-out period ) . Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were r and omized to the MCET group or the mock-therapy ( placebo ) group .  Outcomes were measured at baseline , week 9 , and week 21 . Fifty-five patients completed the study .  Mini-Mental State Examination ( effect size = 0.47 , p = 0.013 ) and Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( effect size = 0.35 , p = 0.045 ) scores were significantly improved in the MCET compared with mock-therapy group . Revised Memory and Behavior Problems Checklist frequency ( effect size = 0.38 , p = 0.046 ) and self-rated Quality of Life - Alzheimer 's Disease ( effect size = 0.39 , p = 0.047 ) scores were significantly improved in the MCET compared with mock-therapy . MCET improved cognition , behavior , and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did Aims : This study aim ed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program ( MCP ) on the cognitive function of older adults with moderate to severe Alzheimer 's disease ( AD ) . Methods : We included 33 participants with AD in a 6-month r and omized controlled trial . The intervention group participated in physical exercise and received a MCP . The control group received only the MCP . Before and after the intervention , cognitive outcomes were assessed using the Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( ADAS-cog ) , Mini-Mental State Examination , and the Clock Drawing Test . Physical performance was evaluated by exercise time , the number of pedal rotation , total load , grip strength , and the Berg Balance Scale ( BBS ) . Results : In all cognitive measures , there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis . However , the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value , age , sex , and education years . All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements . Conclusion : This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention Background Currently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia . Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care . Methods A r and omized , controlled , single-blind longitudinal trial was conducted with 98 patients ( follow-up : n = 61 ) with primary degenerative dementia in five nursing homes in Bavaria , Germany . The highly st and ardized intervention consisted of motor stimulation , practice in activities of daily living , and cognitive stimulation ( acronym MAKS ) . It was conducted in groups of ten patients led by two therapists for 2 hours , 6 days a week for 12 months . Control patients received treatment as usual .  Cognitive function was assessed using the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-Cog ) , and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living ( E-ADL test ) at baseline and after 12 months . Results Of the 553 individuals screened , 119 ( 21.5 % ) were eligible and 98 ( 17.7 % ) were ultimately included in the study . At 12 months , the results of the per protocol analysis ( n = 61 ) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients ( ADAS-Cog : adjusted mean difference : -7.7 , 95 % CI -14.0 to -1.4 , P = 0.018 , Cohen 's d = 0.45 ; E-ADL test : adjusted mean difference : 3.6 , 95 % CI 0.7 to 6.4 , P = 0.015 , Cohen 's d = 0.50 ) . The effect sizes for the intervention were greater in the subgroup of patients ( n = 50 ) with mild to moderate disease ( ADAS-Cog : Cohen 's d = 0.67 ; E-ADL test : Cohen 's d = 0.69 ) . Conclusions A highly st and ardized , non-pharmacological , multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months . Trial Registration http://www.is rct n.com Identifier : IS RCT The aim of the present report was to evaluate the effectiveness and impact of multisensory and cognitive stimulation on improving cognition in elderly persons living in long-term-care institutions ( institutionalized [ I ] ) or in communities with their families ( noninstitutionalized [ NI ] ) . We compared neuropsychological performance using language and Mini-Mental State Examination ( MMSE ) test scores before and after 24 and 48 stimulation sessions . The two groups were matched by age and years of schooling . Small groups of ten or fewer volunteers underwent the stimulation program , twice a week , over 6 months ( 48 sessions in total ) . Sessions were based on language and memory exercises , as well as visual , olfactory , auditory , and ludic stimulation , including music , singing , and dance . Both groups were assessed at the beginning ( before stimulation ) , in the middle ( after 24 sessions ) , and at the end ( after 48 sessions ) of the stimulation program . Although the NI group showed higher performance in all tasks in all time windows compared with I subjects , both groups improved their performance after stimulation . In addition , the improvement was significantly higher in the I group than the NI group . Language tests seem to be more efficient than the MMSE to detect early changes in cognitive status . The results suggest the impoverished environment of long-term-care institutions may contribute to lower cognitive scores before stimulation and the higher improvement rate of this group after stimulation . In conclusion , language tests should be routinely adopted in the neuropsychological assessment of elderly subjects , and long-term-care institutions need to include regular sensorimotor , social , and cognitive stimulation as a public health policy for elderly persons Objectives We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function . Methods Thirty-three patients with dementia , recruited from one nursing home , participated in this non-r and omized pilot study ( 25 women ; age = 85.2±4.9 years ; Mini Mental State Examination = 16.8±4.0 ) . In phase 1 of the study , seventeen patients in the Exercise group ( EG ) received a combined aerobic and strength training program for six weeks , five times per week , 30 minutes per session , in an individually supervised format and successfully concluded the pre and posttests . In phase 2 of the study , sixteen patients in the Social group ( SG ) received social visits at the same frequency , duration , and format and successfully concluded the pre and posttests . Results Indices of feasibility showed that the recruitment and adherence rate , respectively were 46.2 % and 86.3 % . All EG patients completed the exercise program according to protocol without adverse events . After the six-week program , no significant differences on cognitive function tests were found between the EG and SG . There was a moderate effect size in favor for the EG for the Visual Memory Span Forward ; a visual attention test . There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed ( p = .003 ) , Six-Minute Walk Test ( p = .031 ) , and isometric quadriceps strength ( p = .012 ) . Conclusions The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia . The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large r and omized clinical trials . Trial Registration trialregister.nl CONTEXT Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease ( AD ) , but prospect i ve data regarding an association are lacking . OBJECTIVE To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD . DESIGN Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years . PARTICIPANTS AND SETTING A total of 801 older Catholic nuns , priests , and brothers without dementia at enrollment , recruited from 40 groups across the United States . At baseline , they rated frequency of participation in common cognitive activities  ( eg , reading a newspaper ) , from which a previously vali date d composite measure of cognitive activity frequency was derived . MAIN OUTCOME MEASURES Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer 's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function , compared by cognitive activity score at baseline . RESULTS Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 ( mean , 3.57 ; SD , 0.55 ) , with higher scores indicating more frequent activity . During an average of 4.5 years of follow-up , 111 persons developed AD . In a proportional hazards model that controlled for age , sex , and education , a 1-point increase in cognitive activity score was associated with a 33 % reduction in risk of AD ( hazard ratio , 0.67 ; 95 % confidence interval , 0.49 - 0.92 ) . Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added . In r and om-effects models that controlled for age , sex , education , and baseline level of cognitive function , a 1-point increase in cognitive activity was associated with reduced decline in global cognition ( by 47 % ) , working memory ( by 60 % ) , and perceptual speed ( by 30 % ) . CONCLUSION These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 
    Output:
    