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: Oxidative stress , inflammation , and increased cholesterol levels are all mechanisms that have been associated with Alzheimer ’s disease ( AD ) pathology . Several epidemiologic studies have reported a decreased risk of AD with fish consumption . This pilot study was design ed to evaluate the effects of supplementation with omega-3 fatty acids alone ( ω-3 ) or omega-3 plus alpha lipoic acid ( ω-3 + LA ) compared to placebo on oxidative stress biomarkers in AD . The primary outcome measure was peripheral F2-isoprostane levels ( oxidative stress measure ) . Secondary outcome measures included performance on : Mini-Mental State Examination ( MMSE ) , Activities of Daily Living/Instrumental Activities of Daily Living ( ADL/IADL ) , and Alzheimer Disease Assessment Scale-cognitive subscale ( ADAS-cog ) . Thirty-nine AD subjects were r and omized to one of three groups : 1 ) placebo , 2 ) ω-3 , or 3 ) ω-3 + LA for a treatment duration of 12 months . Eighty seven percent ( 34/39 ) of the subjects completed the 12-month intervention . There was no difference between groups at 12 months in peripheral F2-isoprostane levels ( p = 0.83 ) . The ω-3 + LA and ω-3 were not significantly different than the placebo group in ADAS-cog ( p = 0.98 , p = 0.86 ) and in ADL ( p = 0.15 , p = 0.82 ) . Compared to placebo , the ω-3+LA showed less decline in MMSE ( p < 0.01 ) and IADL ( p= 0.01 ) and the ω-3 group showed less decline in IADL ( p < 0.01 ) . The combination of ω-3+LA  slowed cognitive and functional decline in AD over 12 months . Because the results were generated from a small sample size , further evaluation of the combination of omega-3 fatty acids plus alpha-lipoic acid as a potential treatment in AD is warranted Background : To test whether supplementary antioxidants and n–3 fatty acids , alone or in combination , could improve functional status in stroke survivors . Methods : We performed a r and omized , double-blind , placebo-controlled clinical trial in 72 stroke patients ( 47 males ; age 65.3 ± 12.9 years ) admitted to a rehabilitation hospital for sequelae of first-ever ischemic stroke , and divided them into 4 subgroups . Group 1 patients received daily oral antioxidants , group 2 received n–3 polyunsaturated fatty acids , group 3 both supplements , and group 4 placebo , all for 12 months . No difference at baseline was observed among groups in neurological severity or in disability . All measures were repeated after 6 and 12 months of treatment . All major clinical events were recorded . Results : At baseline , 25 % of the patients had a low plasma vitamin status , and 48.5 % was at risk of undernutrition . At the 1-year follow-up , we observed a trend for lower mortality ( p = 0.060 ) in subgroups treated with n–3 fatty acids , but without significant differences in rehabilitation result status among groups . Conclusions : Malnutrition is widely observed in patients admitted to a rehabilitative hospital for stroke rehabilitation , and dietary supplementation , even if not able to improve rehabilitation results , is likely to reduce mortality at the 1-year follow-up BACKGROUND Rapid aging of the population worldwide necessitates a heightened concern about preventing cognitive decline . OBJECTIVE We investigated the effects of B vitamins and omega-3 ( n-3 ) fatty acid supplementation on cognition in a high-risk population . DESIGN This was an ancillary study of the SU.FOL.OM3 ( SUpplementation with FOLate , vitamins B-6 and B-12 and /or OMega-3 fatty acids ) secondary prevention trial conducted in France between 2003 and 2009 . The present sample included 1748 men and women aged 45 - 80 y with a history of myocardial infa rct ion , unstable angina , or ischemic stroke and who were recruited via a network of 417 physicians . With the use of block r and omization with stratification by sex , age , prior cardiovascular disease , and city of residence , participants were assigned in a 2 × 2 factorial design to 1 of 4 groups : 1 ) 5-methyltetrahydrofolate ( folate , 0.56 mg ) and vitamins B-6 ( 3 mg ) and B-12 ( 0.02 mg ) , 2 ) eicosapentaenoic and docosahexaenoic acids ( 600 mg ) in a 2:1 ratio , 3 ) B vitamins and omega-3 fatty acids , or 4 ) placebo .  Cognitive function after 4 y of supplementation was assessed with the French version of the modified Telephone Interview for Cognitive Status . RESULTS No significant main effects of group assignment on cognitive function were found ; however , we found some evidence of disease history- and age-specific effects . In the subgroup with prior stroke , for example , participants assigned to receive B vitamins plus omega-3 fatty acids were significantly less likely to have a decreased score on the temporal orientation task than were those assigned to receive placebo ( odds ratio : 0.43 ; 95 % CI : 0.21 , 0.86 ) . CONCLUSIONS If present , dietary effects on cognition are likely group-specific . These results could be useful in interventions aim ed at preventing cognitive decline in high-risk individuals . This trial is registered at controlled-trials.com as IS RCT N41926726 Docosahexaenoic acid ( DHA ) is important for brain function , and higher DHA intake is inversely correlated with relative risk of Alzheimer 's disease . The potential benefits of DHA supplementation in people with mild cognitive impairment ( MCI ) have not been fully examined . Our study aim ed to determine the effect of DHA supplementation on cognitive function and hippocampal atrophy in elderly subjects with MCI . This was a r and omized , double-blind , placebo-controlled trial in Tianjin , China . 240 individuals with MCI aged 65 years and over were recruited and equalized r and omly allocated to the DHA or the placebo group . Participants received 12-month DHA supplementation ( 2 g/day ) or corn oil as placebo . Both global and specific subdomains of cognitive function and hippocampal volume were measured at baseline , 6 months , and 12 months . Both changes were analyzed by repeated-measure analysis of variance ( ANOVA ) . This trial has been registered : ChiCTR-IOR-15006058 . A total of 219 participants ( DHA : 110 , Placebo : 109 ) completed the trial . The change in mean serum DHA levels was greater in the intervention group ( + 3.85 % ) compared to the control group ( + 1.06 % ) . Repeated- measures analyses of covariance showed that , over 12 months , there was a significant difference in the Full-Scale Intelligence Quotient ( ηp2 = 0.084 ; p = 0.039 ) , Information ( ηp2 = 0.439 ; p = 0.000 ) , and Digit Span ( ηp2 = 0.375 ; p = 0.000 ) between DHA-treated versus the placebo group . In addition , there were significant differences in volumes of left hippocampus ( ηp2 = 0.121 , p = 0.016 ) , right hippocampus ( ηp2 = 0.757 , p = 0.008 ) , total hippocampus ( ηp2 = 0.124 , p = 0.023 ) , and global cerebrum ( ηp2 = 0.145 , p = 0.032 ) between the two groups . These findings suggest that DHA supplementation ( 2 g/day ) for 12 months in MCI subjects can significantly improve cognitive function and slow the progression of hippocampal atrophy . Larger , longer-term confirmatory studies are warranted Depressive symptoms may increase the risk of progressing from mild cognitive impairment ( MCI ) to dementia . Consumption of n-3 PUFA may alleviate both cognitive decline and depression . The aim of the present study was to investigate the benefits of supplementing a diet with n-3 PUFA , DHA and EPA , for depressive symptoms , quality of life ( QOL ) and cognition in elderly people with MCI . We conducted a 6-month double-blind , r and omised controlled trial . A total of fifty people aged > 65 years with MCI were allocated to receive a supplement rich in EPA ( 1·67 g EPA + 0·16 g DHA/d ; n 17 ) , DHA ( 1·55 g DHA + 0·40 g EPA/d ; n 18 ) or the n-6 PUFA linoleic acid ( LA ; 2·2 g/d ; n 15 ) . Treatment allocation was by minimisation based on age , sex and depressive symptoms ( Geriatric Depression Scale , GDS ) . Physiological and cognitive assessment s , question naires and fatty acid composition of erythrocytes were obtained at baseline and 6 months ( completers : n 40 ; EPA n 13 , DHA n 16 , LA n 11 ) . Compared with the LA group , GDS scores improved in the EPA ( P=0·04 ) and DHA ( P=0·01 ) groups and verbal fluency ( Initial Letter Fluency ) in the DHA group ( P=0·04 ) . Improved GDS scores were correlated with increased DHA plus EPA ( r 0·39 , P=0·02 ) . Improved self-reported physical health was associated with increased DHA . There were no treatment effects on other cognitive or QOL parameters . Increased intakes of DHA and EPA benefited mental health in older people with MCI . Increasing n-3 PUFA intakes may reduce depressive symptoms and the risk of progressing to dementia . This needs to be investigated in larger , depressed sample s with MCI BACKGROUND Docosahexaenoic acid ( DHA ) is important for brain function , and its status is dependent on dietary intakes . Therefore , individuals who consume diets low in omega-3 ( n-3 ) polyunsaturated fatty acids may cognitively benefit from DHA supplementation . Sex and apolipoprotein E genotype ( APOE ) affect cognition and may modulate the response to DHA supplementation . OBJECTIVES We investigated whether a DHA supplement improves cognitive performance in healthy young adults and whether sex and APOE modulate the response . DESIGN Healthy adults ( n = 176 ; age range : 18 - 45 y ; nonsmoking and with a low intake of DHA ) completed a 6-mo r and omized , placebo-controlled , double-blind intervention in which they consumed 1.16 g DHA/d or a placebo .  Cognitive performance was assessed by using a computerized cognitive test battery . For all tests , z scores were calculated and clustered into cognitive domains as follows : episodic and working memory , attention , reaction time ( RT ) of episodic and working memory , and attention and processing speed . ANCOVA was conducted with sex and APOE as independent variables . RESULTS RTs of episodic and working memory improved with DHA compared with placebo [ mean difference ( 95 % CI ) : -0.18 SD ( -0.33 , -0.03 SD ) ( P = 0.02 ) and -0.36 SD ( -0.58 , -0.14 SD ) ( P = 0.002 ) , respectively ] . Sex × treatment interactions occurred for episodic memory ( P = 0.006 ) and the RT of working memory ( P = 0.03 ) . Compared with the placebo , DHA improved episodic memory in women [ 0.28 SD ( 0.08 , 0.48 SD ) ; P = 0.006 ] and RTs of working memory in men [ -0.60 SD ( -0.95 , -0.25 SD ) ; P = 0.001 ] . APOE did not affect cognitive function , but there were some indications of APOE × sex × treatment interactions . CONCLUSIONS DHA supplementation improved memory and the RT of memory  in healthy , young adults whose habitual diets were low in DHA  . The response was modulated by sex . This trial was registered at the New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au/default.aspx ) as ACTRN12610000212055 IMPORTANCE Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline , a strong risk factor for development of dementia . Epidemiologic studies suggest that a Mediterranean diet , an antioxidant-rich cardioprotective dietary pattern , delays cognitive decline , but clinical trial evidence is lacking . OBJECTIVE To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet . DESIGN , SETTING , AND PARTICIPANTS Parallel-group r and omized clinical trial of 447 cognitively healthy volunteers from Barcelona , Spain ( 233 women [ 52.1 % ] ; mean age , 66.9 years 
    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: Oxidative stress , inflammation , and increased cholesterol levels are all mechanisms that have been associated with Alzheimer ’s disease ( AD ) pathology . Several epidemiologic studies have reported a decreased risk of AD with fish consumption . This pilot study was design ed to evaluate the effects of supplementation with omega-3 fatty acids alone ( ω-3 ) or omega-3 plus alpha lipoic acid ( ω-3 + LA ) compared to placebo on oxidative stress biomarkers in AD . The primary outcome measure was peripheral F2-isoprostane levels ( oxidative stress measure ) . Secondary outcome measures included performance on : Mini-Mental State Examination ( MMSE ) , Activities of Daily Living/Instrumental Activities of Daily Living ( ADL/IADL ) , and Alzheimer Disease Assessment Scale-cognitive subscale ( ADAS-cog ) . Thirty-nine AD subjects were r and omized to one of three groups : 1 ) placebo , 2 ) ω-3 , or 3 ) ω-3 + LA for a treatment duration of 12 months . Eighty seven percent ( 34/39 ) of the subjects completed the 12-month intervention . There was no difference between groups at 12 months in peripheral F2-isoprostane levels ( p = 0.83 ) . The ω-3 + LA and ω-3 were not significantly different than the placebo group in ADAS-cog ( p = 0.98 , p = 0.86 ) and in ADL ( p = 0.15 , p = 0.82 ) . Compared to placebo , the ω-3+LA showed less decline in MMSE ( p < 0.01 ) and IADL ( p= 0.01 ) and the ω-3 group showed less decline in IADL ( p < 0.01 ) . The combination of ω-3+LA  slowed cognitive and functional decline in AD over 12 months . Because the results were generated from a small sample size , further evaluation of the combination of omega-3 fatty acids plus alpha-lipoic acid as a potential treatment in AD is warranted Background : To test whether supplementary antioxidants and n–3 fatty acids , alone or in combination , could improve functional status in stroke survivors . Methods : We performed a r and omized , double-blind , placebo-controlled clinical trial in 72 stroke patients ( 47 males ; age 65.3 ± 12.9 years ) admitted to a rehabilitation hospital for sequelae of first-ever ischemic stroke , and divided them into 4 subgroups . Group 1 patients received daily oral antioxidants , group 2 received n–3 polyunsaturated fatty acids , group 3 both supplements , and group 4 placebo , all for 12 months . No difference at baseline was observed among groups in neurological severity or in disability . All measures were repeated after 6 and 12 months of treatment . All major clinical events were recorded . Results : At baseline , 25 % of the patients had a low plasma vitamin status , and 48.5 % was at risk of undernutrition . At the 1-year follow-up , we observed a trend for lower mortality ( p = 0.060 ) in subgroups treated with n–3 fatty acids , but without significant differences in rehabilitation result status among groups . Conclusions : Malnutrition is widely observed in patients admitted to a rehabilitative hospital for stroke rehabilitation , and dietary supplementation , even if not able to improve rehabilitation results , is likely to reduce mortality at the 1-year follow-up BACKGROUND Rapid aging of the population worldwide necessitates a heightened concern about preventing cognitive decline . OBJECTIVE We investigated the effects of B vitamins and omega-3 ( n-3 ) fatty acid supplementation on cognition in a high-risk population . DESIGN This was an ancillary study of the SU.FOL.OM3 ( SUpplementation with FOLate , vitamins B-6 and B-12 and /or OMega-3 fatty acids ) secondary prevention trial conducted in France between 2003 and 2009 . The present sample included 1748 men and women aged 45 - 80 y with a history of myocardial infa rct ion , unstable angina , or ischemic stroke and who were recruited via a network of 417 physicians . With the use of block r and omization with stratification by sex , age , prior cardiovascular disease , and city of residence , participants were assigned in a 2 × 2 factorial design to 1 of 4 groups : 1 ) 5-methyltetrahydrofolate ( folate , 0.56 mg ) and vitamins B-6 ( 3 mg ) and B-12 ( 0.02 mg ) , 2 ) eicosapentaenoic and docosahexaenoic acids ( 600 mg ) in a 2:1 ratio , 3 ) B vitamins and omega-3 fatty acids , or 4 ) placebo .  Cognitive function after 4 y of supplementation was assessed with the French version of the modified Telephone Interview for Cognitive Status . RESULTS No significant main effects of group assignment on cognitive function were found ; however , we found some evidence of disease history- and age-specific effects . In the subgroup with prior stroke , for example , participants assigned to receive B vitamins plus omega-3 fatty acids were significantly less likely to have a decreased score on the temporal orientation task than were those assigned to receive placebo ( odds ratio : 0.43 ; 95 % CI : 0.21 , 0.86 ) . CONCLUSIONS If present , dietary effects on cognition are likely group-specific . These results could be useful in interventions aim ed at preventing cognitive decline in high-risk individuals . This trial is registered at controlled-trials.com as IS RCT N41926726 Docosahexaenoic acid ( DHA ) is important for brain function , and higher DHA intake is inversely correlated with relative risk of Alzheimer 's disease . The potential benefits of DHA supplementation in people with mild cognitive impairment ( MCI ) have not been fully examined . Our study aim ed to determine the effect of DHA supplementation on cognitive function and hippocampal atrophy in elderly subjects with MCI . This was a r and omized , double-blind , placebo-controlled trial in Tianjin , China . 240 individuals with MCI aged 65 years and over were recruited and equalized r and omly allocated to the DHA or the placebo group . Participants received 12-month DHA supplementation ( 2 g/day ) or corn oil as placebo . Both global and specific subdomains of cognitive function and hippocampal volume were measured at baseline , 6 months , and 12 months . Both changes were analyzed by repeated-measure analysis of variance ( ANOVA ) . This trial has been registered : ChiCTR-IOR-15006058 . A total of 219 participants ( DHA : 110 , Placebo : 109 ) completed the trial . The change in mean serum DHA levels was greater in the intervention group ( + 3.85 % ) compared to the control group ( + 1.06 % ) . Repeated- measures analyses of covariance showed that , over 12 months , there was a significant difference in the Full-Scale Intelligence Quotient ( ηp2 = 0.084 ; p = 0.039 ) , Information ( ηp2 = 0.439 ; p = 0.000 ) , and Digit Span ( ηp2 = 0.375 ; p = 0.000 ) between DHA-treated versus the placebo group . In addition , there were significant differences in volumes of left hippocampus ( ηp2 = 0.121 , p = 0.016 ) , right hippocampus ( ηp2 = 0.757 , p = 0.008 ) , total hippocampus ( ηp2 = 0.124 , p = 0.023 ) , and global cerebrum ( ηp2 = 0.145 , p = 0.032 ) between the two groups . These findings suggest that DHA supplementation ( 2 g/day ) for 12 months in MCI subjects can significantly improve cognitive function and slow the progression of hippocampal atrophy . Larger , longer-term confirmatory studies are warranted Depressive symptoms may increase the risk of progressing from mild cognitive impairment ( MCI ) to dementia . Consumption of n-3 PUFA may alleviate both cognitive decline and depression . The aim of the present study was to investigate the benefits of supplementing a diet with n-3 PUFA , DHA and EPA , for depressive symptoms , quality of life ( QOL ) and cognition in elderly people with MCI . We conducted a 6-month double-blind , r and omised controlled trial . A total of fifty people aged > 65 years with MCI were allocated to receive a supplement rich in EPA ( 1·67 g EPA + 0·16 g DHA/d ; n 17 ) , DHA ( 1·55 g DHA + 0·40 g EPA/d ; n 18 ) or the n-6 PUFA linoleic acid ( LA ; 2·2 g/d ; n 15 ) . Treatment allocation was by minimisation based on age , sex and depressive symptoms ( Geriatric Depression Scale , GDS ) . Physiological and cognitive assessment s , question naires and fatty acid composition of erythrocytes were obtained at baseline and 6 months ( completers : n 40 ; EPA n 13 , DHA n 16 , LA n 11 ) . Compared with the LA group , GDS scores improved in the EPA ( P=0·04 ) and DHA ( P=0·01 ) groups and verbal fluency ( Initial Letter Fluency ) in the DHA group ( P=0·04 ) . Improved GDS scores were correlated with increased DHA plus EPA ( r 0·39 , P=0·02 ) . Improved self-reported physical health was associated with increased DHA . There were no treatment effects on other cognitive or QOL parameters . Increased intakes of DHA and EPA benefited mental health in older people with MCI . Increasing n-3 PUFA intakes may reduce depressive symptoms and the risk of progressing to dementia . This needs to be investigated in larger , depressed sample s with MCI BACKGROUND Docosahexaenoic acid ( DHA ) is important for brain function , and its status is dependent on dietary intakes . Therefore , individuals who consume diets low in omega-3 ( n-3 ) polyunsaturated fatty acids may cognitively benefit from DHA supplementation . Sex and apolipoprotein E genotype ( APOE ) affect cognition and may modulate the response to DHA supplementation . OBJECTIVES We investigated whether a DHA supplement improves cognitive performance in healthy young adults and whether sex and APOE modulate the response . DESIGN Healthy adults ( n = 176 ; age range : 18 - 45 y ; nonsmoking and with a low intake of DHA ) completed a 6-mo r and omized , placebo-controlled , double-blind intervention in which they consumed 1.16 g DHA/d or a placebo .  Cognitive performance was assessed by using a computerized cognitive test battery . For all tests , z scores were calculated and clustered into cognitive domains as follows : episodic and working memory , attention , reaction time ( RT ) of episodic and working memory , and attention and processing speed . ANCOVA was conducted with sex and APOE as independent variables . RESULTS RTs of episodic and working memory improved with DHA compared with placebo [ mean difference ( 95 % CI ) : -0.18 SD ( -0.33 , -0.03 SD ) ( P = 0.02 ) and -0.36 SD ( -0.58 , -0.14 SD ) ( P = 0.002 ) , respectively ] . Sex × treatment interactions occurred for episodic memory ( P = 0.006 ) and the RT of working memory ( P = 0.03 ) . Compared with the placebo , DHA improved episodic memory in women [ 0.28 SD ( 0.08 , 0.48 SD ) ; P = 0.006 ] and RTs of working memory in men [ -0.60 SD ( -0.95 , -0.25 SD ) ; P = 0.001 ] . APOE did not affect cognitive function , but there were some indications of APOE × sex × treatment interactions . CONCLUSIONS DHA supplementation improved memory and the RT of memory  in healthy , young adults whose habitual diets were low in DHA  . The response was modulated by sex . This trial was registered at the New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au/default.aspx ) as ACTRN12610000212055 IMPORTANCE Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline , a strong risk factor for development of dementia . Epidemiologic studies suggest that a Mediterranean diet , an antioxidant-rich cardioprotective dietary pattern , delays cognitive decline , but clinical trial evidence is lacking . OBJECTIVE To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet . DESIGN , SETTING , AND PARTICIPANTS Parallel-group r and omized clinical trial of 447 cognitively healthy volunteers from Barcelona , Spain ( 233 women [ 52.1 % ] ; mean age , 66.9 years 
    Output:
    