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 A recent Cochrane review of reality orientation therapy identified the need for large , well- design ed , multi-centre trials . AIMS To test the hypothesis that cognitive stimulation therapy ( CST ) for older people with dementia would benefit cognition and quality of life . METHOD A single-blind , multi-centre , r and omised controlled trial recruited 201 older people with dementia . The main outcome measures were change in cognitive function and quality of life . An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures . RESULTS One hundred and fifteen people were r and omised within centres to the  intervention group and 86 to the control group .  At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P=0.044 ) , the Alzheimer 's Disease Assessment Scale - Cognition ( ADAS-Cog ) ( P=0.014 ) and Quality of Life - Alzheimer 's Disease scales ( P=0.028 ) . Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group . CONCLUSION The results compare favourably with trials of drugs for dementia . CST groups may have worthwhile benefits for many people with dementia BACKGROUND A recent r and omised controlled trial on Cognitive Stimulation Therapy ( CST ) identified the need to evaluate its more long-term benefits for people with dementia . This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care . METHOD Thirty-five people with dementia were included , following on from a seven-week twice-weekly study of  CST . The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks . Two control homes did not receive the maintenance intervention . RESULTS Using repeated measures ANOVAS , there was a continuous , significant improvement in cognitive function ( MMSE ) for those receiving MCST ( CST+maintenance CST sessions ) as compared to CST alone or no treatment ( p = 0.012 ) . There were no effects on quality of life , behaviour or communication following maintenance sessions . The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions . CONCLUSIONS The cognitive benefits of CST can be maintained by weekly sessions for around 6 months . A large-scale , multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia OBJECTIVE Given the rather limited knowledge on profiles of neuropsychiatric symptoms ( behavioural and psychological signs and symptoms of dementia , BPSD ) in several degenerative dementias , we design ed a prospect i ve study of which we here present the baseline data . METHODS Diagnosed according to strictly applied clinical diagnostic criteria , patients with probable Alzheimer 's disease ( AD ) ( n = 205 ) , frontotemporal dementia ( FTD ) ( n = 29 ) , mixed dementia ( MXD ) ( n = 39 ) and dementia with Lewy bodies ( DLB ) ( n = 23 ) were included . All patients underwent a neuropsychological examination and behavioural assessment by means of a battery of scales ( Middelheim Frontality Score ( MFS ) , Behave-AD , Cohen-Mansfield Agitation Inventory , Cornell Scale for Depression in Dementia ) . RESULTS In AD and MXD , activity disturbances and aggressiveness occurred in more than 80 % of the patients . With a prevalence of 70 % , apathy was very common whereas delusions and hallucinations were rare in FTD patients . Frequently used behavioural assessment scales like the Behave-AD systematic ally underestimated BPSD in FTD whereas the MFS displayed high sensitivity for frontal lobe symptoms . Hallucinations discriminated DLB patients from other dementias . A high prevalence of disinhibition ( 65 % ) in DLB pointed to frontal lobe involvement . CONCLUSIONS Behavioural assessment may help differentiating between different forms of dementia , further stressing the need for the development of new and more sensitive behavioural assessment scales . By means of the MFS , frontal lobe involvement was frequently observed in DLB . As 70 % of FTD patients displayed apathy , prevalence was about two times higher compared to the other disease groups , meanwhile indicating that apathy is frequently observed in dementia , irrespective of its etiology One of the effects of Alzheimer 's disease is a diminution in the ability to communicate . A r and omized , non-blinded two-group experimental study was undertaken to determine if planned walking has the capacity to improve the communication performance of patients with moderate to severe Alzheimer 's disease . Thirty subjects meeting NINCDS-ADRDA diagnostic criteria for probable Alzheimer 's disease , selected from two nursing homes , participated in the study . Intervention and comparison groups were each made up of subjects from both nursing homes . Subjects in one group were walked individually for 30 minutes three times a week for 10 weeks . Subjects in the comparison group were engaged in conversation for the same amount of time for 10 weeks . A multivariate analysis of variance ( MANOVA ) was performed on the communication data . Analysis of the data at post-testing indicated that communication performance improved significantly in the planned walking group over the conversation-only group ( f = 4.29 ; df = 2.28 ; P = 0.024 ) . The results suggest that a planned walking program has the capacity to improve the communication performance of patients with Alzheimer 's disease BACKGROUND Impairment of language skills affects the level of functioning of an individual , interferes with effective communication and can result in development of disruptive behaviour . Social skills and capacity for self care may be compromised . Few studies have evaluated the impact of language problems on symptoms and socialization in people with dementia in care environments . METHOD 315 elderly residents with dementia ( 29 % living in nursing homes , 71 % in social care facilities ) were assessed using st and ardized psychiatric schedules including the Sheffield Screening Test for Acquired Language Disorders and Neuropsychiatric Inventory . Dementia Care Mapping was undertaken at r and om in at least 50 % of residents in each facility . RESULTS Expressive language impairment was associated with the presence of delusions even when severity of dementia was controlled for ( p=0.02 ) and showed a tendency of association with depression ( p=0.06 ) . Receptive language difficulties were strongly associated with presence of Aberrant Motor Behaviour , even controlling for severity of dementia ( p=0.04 ) . Decreased participation in social activities was correlated with both expressive ( p=0.048 ) and receptive aspects of language ( p<0.01 ) but social withdrawal was only correlated with receptive language difficulties ( p=0.01 ) . CONCLUSION Language disorders are associated with both behavioural and psychological symptoms of dementia even when severity of dementia is controlled for . Patients ' needs in communication skills should be addressed earlier to help them maintain social interactions and reduce the impact on behavioural problems and patients ' quality of life Behaviours , viewed by nurses as dem and ing , performed by patients with severe dementia were investigated during one year of intervention . Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward ( EW ) while another ward ( CW ) served as control . Each ward had 11 patients . At baseline and after 6 and 12 months of intervention structured interviews with the patients ' assigned nurses were conducted based on the Dem and ing Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale . At the EW there was a decreased frequency ( p=0.000 ) and a reduced occurrence of physical behaviours ( p=0.008 ) , a decreased frequency ( p=0.029 ) and a reduced occurrence of vocal behaviours ( p=0.002 ) . No significant changes were seen at the CW . Bearing the small sample size in mind , the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency , and /or effect the nurses ' attitude and interpretation of the patients ' behaviour as dem and ing . The findings , however , can only be seen as indications for further research , but point to the importance of including effect variables related to patients when intervening in nursing care An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses  was carried out on a ward for dementia care ( the experimental ward , EW ) . On a similar control ward ( CW ) , no changes were made . Observations of  nurse-patient  cooperation during morning care were collected at both wards , before and during the intervention . The observations ( N = 107 ) were analyzed blindly and sorted into already-developed categories . The distribution of the cooperation-style categories was then analyzed statistically . The patients who survived throughout the study period ( N = 18 ) were also compared over time . Nurse-patient cooperation at the EW improved significantly during the intervention period , whereas , at the CW , it deteriorated ( p = .02 ) . Status of surviving patients followed the same pattern ( p = .001 ) . The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care The purpose of this study was to investigate the effects of a walking/talking program on residents ' communication , ambulation , and level of function when there were two residents to one care provider ( 2:1 ) . A r and omized control trial design was used . Subjects were residents with Alzheimer disease in three geriatric long-term care facilities in Metropolitan Toronto . Residents who met the inclusion criteria were r and omly assigned to one of three groups : walk- and -talk group ( 30 min , 5 times per week for 16 weeks , walking/talking in pairs ) , talk-only group ( 30 min , 5 times per week for 16 weeks , talk only in pairs ) , or no intervention . The outcome measures were the Functional Assessment of Communication Skills for Adults , the 2-min walk test , and London Psychogeriatric Rating Scale .  Residents who received the walk- and -talk intervention did not demonstrate statistically significant differences in the outcome variables measured posttest when compared with residents who received the talk-only intervention or no intervention , even after controlling for individual differences . Variability in the outcomes measured posttest is explained by differences in the residents '  level of cognitive impairment before the study rather than by study group membership . These findings are contradictory to those of previous studies Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident , caregiver , and others in the environment . Behavioral interventions might ameliorate them and have a positive effect on residents ’ mood ( affect ) . Objectives This study tested two interventions —an activities of daily living and a psychosocial activity intervention— and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia . Methods The study had three treatment groups ( activities of daily living , psychosocial activity , and a combination ) and two control groups ( placebo and no intervention ) . Nursing assistants hired specifically for this study enacted the interventions under the direction of a master ’s prepared gerontological clinical nurse specialist . Nursing assistants employed at the nursing homes recorded the occurrence of  disruptive behaviors  . Raters analyzed videotapes filmed during the study to determine the interventions ’ influence on affect . Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups . Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors . Interventions much more precisely design ed than those employed in this study require development to quell disruptive behaviors . Nontargeted interventions might increase positive affect . Treatments that produce even a brief improvement in affect indicate improved quality of mental health as m and ated by federal law OBJECTIVES To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants . DESIGN A multi-site r and omized clinical trial with matched groups , and measurements at baseline and after seven months . SETTING Sixteen psychogeriatric wards in fourteen nursing homes in the Netherl and s. PARTICIPANTS One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer ( DAT ) type , mixed DAT and vascular dementia , and dementia syndrome ( NAO ) and 99 nursing assistants . INTERVENTIONS Integrated emotion-oriented care and usual care . MESUREMENTS : Demented elderly : Behaviour and mood related to adaptation to the illness and the institutionalization . Nursing assistants : General health as measured by feelings of stress , stress reactions , feeling of competence and illness . RESULTS Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks : maintaining an emotional balance ( less anxiety ) and preserving a positive self-image ( less dissatisfaction ) . In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training . CONCLUSION Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia . For the severely demented elderly we did not find this surplus value . This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes . With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them This article describes the development and evaluation of a Nursing Assistant Communication Skills Program ( NACSP ) . NACSP was design ed to help nursing assistants ( NAs ) interact more effectively with nursing home residents with moderate and severe dementia . In two skilled 
    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: BACKGROUND A recent Cochrane review of reality orientation therapy identified the need for large , well- design ed , multi-centre trials . AIMS To test the hypothesis that cognitive stimulation therapy ( CST ) for older people with dementia would benefit cognition and quality of life . METHOD A single-blind , multi-centre , r and omised controlled trial recruited 201 older people with dementia . The main outcome measures were change in cognitive function and quality of life . An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures . RESULTS One hundred and fifteen people were r and omised within centres to the  intervention group and 86 to the control group .  At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P=0.044 ) , the Alzheimer 's Disease Assessment Scale - Cognition ( ADAS-Cog ) ( P=0.014 ) and Quality of Life - Alzheimer 's Disease scales ( P=0.028 ) . Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group . CONCLUSION The results compare favourably with trials of drugs for dementia . CST groups may have worthwhile benefits for many people with dementia BACKGROUND A recent r and omised controlled trial on Cognitive Stimulation Therapy ( CST ) identified the need to evaluate its more long-term benefits for people with dementia . This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care . METHOD Thirty-five people with dementia were included , following on from a seven-week twice-weekly study of  CST . The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks . Two control homes did not receive the maintenance intervention . RESULTS Using repeated measures ANOVAS , there was a continuous , significant improvement in cognitive function ( MMSE ) for those receiving MCST ( CST+maintenance CST sessions ) as compared to CST alone or no treatment ( p = 0.012 ) . There were no effects on quality of life , behaviour or communication following maintenance sessions . The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions . CONCLUSIONS The cognitive benefits of CST can be maintained by weekly sessions for around 6 months . A large-scale , multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia OBJECTIVE Given the rather limited knowledge on profiles of neuropsychiatric symptoms ( behavioural and psychological signs and symptoms of dementia , BPSD ) in several degenerative dementias , we design ed a prospect i ve study of which we here present the baseline data . METHODS Diagnosed according to strictly applied clinical diagnostic criteria , patients with probable Alzheimer 's disease ( AD ) ( n = 205 ) , frontotemporal dementia ( FTD ) ( n = 29 ) , mixed dementia ( MXD ) ( n = 39 ) and dementia with Lewy bodies ( DLB ) ( n = 23 ) were included . All patients underwent a neuropsychological examination and behavioural assessment by means of a battery of scales ( Middelheim Frontality Score ( MFS ) , Behave-AD , Cohen-Mansfield Agitation Inventory , Cornell Scale for Depression in Dementia ) . RESULTS In AD and MXD , activity disturbances and aggressiveness occurred in more than 80 % of the patients . With a prevalence of 70 % , apathy was very common whereas delusions and hallucinations were rare in FTD patients . Frequently used behavioural assessment scales like the Behave-AD systematic ally underestimated BPSD in FTD whereas the MFS displayed high sensitivity for frontal lobe symptoms . Hallucinations discriminated DLB patients from other dementias . A high prevalence of disinhibition ( 65 % ) in DLB pointed to frontal lobe involvement . CONCLUSIONS Behavioural assessment may help differentiating between different forms of dementia , further stressing the need for the development of new and more sensitive behavioural assessment scales . By means of the MFS , frontal lobe involvement was frequently observed in DLB . As 70 % of FTD patients displayed apathy , prevalence was about two times higher compared to the other disease groups , meanwhile indicating that apathy is frequently observed in dementia , irrespective of its etiology One of the effects of Alzheimer 's disease is a diminution in the ability to communicate . A r and omized , non-blinded two-group experimental study was undertaken to determine if planned walking has the capacity to improve the communication performance of patients with moderate to severe Alzheimer 's disease . Thirty subjects meeting NINCDS-ADRDA diagnostic criteria for probable Alzheimer 's disease , selected from two nursing homes , participated in the study . Intervention and comparison groups were each made up of subjects from both nursing homes . Subjects in one group were walked individually for 30 minutes three times a week for 10 weeks . Subjects in the comparison group were engaged in conversation for the same amount of time for 10 weeks . A multivariate analysis of variance ( MANOVA ) was performed on the communication data . Analysis of the data at post-testing indicated that communication performance improved significantly in the planned walking group over the conversation-only group ( f = 4.29 ; df = 2.28 ; P = 0.024 ) . The results suggest that a planned walking program has the capacity to improve the communication performance of patients with Alzheimer 's disease BACKGROUND Impairment of language skills affects the level of functioning of an individual , interferes with effective communication and can result in development of disruptive behaviour . Social skills and capacity for self care may be compromised . Few studies have evaluated the impact of language problems on symptoms and socialization in people with dementia in care environments . METHOD 315 elderly residents with dementia ( 29 % living in nursing homes , 71 % in social care facilities ) were assessed using st and ardized psychiatric schedules including the Sheffield Screening Test for Acquired Language Disorders and Neuropsychiatric Inventory . Dementia Care Mapping was undertaken at r and om in at least 50 % of residents in each facility . RESULTS Expressive language impairment was associated with the presence of delusions even when severity of dementia was controlled for ( p=0.02 ) and showed a tendency of association with depression ( p=0.06 ) . Receptive language difficulties were strongly associated with presence of Aberrant Motor Behaviour , even controlling for severity of dementia ( p=0.04 ) . Decreased participation in social activities was correlated with both expressive ( p=0.048 ) and receptive aspects of language ( p<0.01 ) but social withdrawal was only correlated with receptive language difficulties ( p=0.01 ) . CONCLUSION Language disorders are associated with both behavioural and psychological symptoms of dementia even when severity of dementia is controlled for . Patients ' needs in communication skills should be addressed earlier to help them maintain social interactions and reduce the impact on behavioural problems and patients ' quality of life Behaviours , viewed by nurses as dem and ing , performed by patients with severe dementia were investigated during one year of intervention . Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward ( EW ) while another ward ( CW ) served as control . Each ward had 11 patients . At baseline and after 6 and 12 months of intervention structured interviews with the patients ' assigned nurses were conducted based on the Dem and ing Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale . At the EW there was a decreased frequency ( p=0.000 ) and a reduced occurrence of physical behaviours ( p=0.008 ) , a decreased frequency ( p=0.029 ) and a reduced occurrence of vocal behaviours ( p=0.002 ) . No significant changes were seen at the CW . Bearing the small sample size in mind , the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency , and /or effect the nurses ' attitude and interpretation of the patients ' behaviour as dem and ing . The findings , however , can only be seen as indications for further research , but point to the importance of including effect variables related to patients when intervening in nursing care An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses  was carried out on a ward for dementia care ( the experimental ward , EW ) . On a similar control ward ( CW ) , no changes were made . Observations of  nurse-patient  cooperation during morning care were collected at both wards , before and during the intervention . The observations ( N = 107 ) were analyzed blindly and sorted into already-developed categories . The distribution of the cooperation-style categories was then analyzed statistically . The patients who survived throughout the study period ( N = 18 ) were also compared over time . Nurse-patient cooperation at the EW improved significantly during the intervention period , whereas , at the CW , it deteriorated ( p = .02 ) . Status of surviving patients followed the same pattern ( p = .001 ) . The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care The purpose of this study was to investigate the effects of a walking/talking program on residents ' communication , ambulation , and level of function when there were two residents to one care provider ( 2:1 ) . A r and omized control trial design was used . Subjects were residents with Alzheimer disease in three geriatric long-term care facilities in Metropolitan Toronto . Residents who met the inclusion criteria were r and omly assigned to one of three groups : walk- and -talk group ( 30 min , 5 times per week for 16 weeks , walking/talking in pairs ) , talk-only group ( 30 min , 5 times per week for 16 weeks , talk only in pairs ) , or no intervention . The outcome measures were the Functional Assessment of Communication Skills for Adults , the 2-min walk test , and London Psychogeriatric Rating Scale .  Residents who received the walk- and -talk intervention did not demonstrate statistically significant differences in the outcome variables measured posttest when compared with residents who received the talk-only intervention or no intervention , even after controlling for individual differences . Variability in the outcomes measured posttest is explained by differences in the residents '  level of cognitive impairment before the study rather than by study group membership . These findings are contradictory to those of previous studies Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident , caregiver , and others in the environment . Behavioral interventions might ameliorate them and have a positive effect on residents ’ mood ( affect ) . Objectives This study tested two interventions —an activities of daily living and a psychosocial activity intervention— and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia . Methods The study had three treatment groups ( activities of daily living , psychosocial activity , and a combination ) and two control groups ( placebo and no intervention ) . Nursing assistants hired specifically for this study enacted the interventions under the direction of a master ’s prepared gerontological clinical nurse specialist . Nursing assistants employed at the nursing homes recorded the occurrence of  disruptive behaviors  . Raters analyzed videotapes filmed during the study to determine the interventions ’ influence on affect . Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups . Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors . Interventions much more precisely design ed than those employed in this study require development to quell disruptive behaviors . Nontargeted interventions might increase positive affect . Treatments that produce even a brief improvement in affect indicate improved quality of mental health as m and ated by federal law OBJECTIVES To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants . DESIGN A multi-site r and omized clinical trial with matched groups , and measurements at baseline and after seven months . SETTING Sixteen psychogeriatric wards in fourteen nursing homes in the Netherl and s. PARTICIPANTS One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer ( DAT ) type , mixed DAT and vascular dementia , and dementia syndrome ( NAO ) and 99 nursing assistants . INTERVENTIONS Integrated emotion-oriented care and usual care . MESUREMENTS : Demented elderly : Behaviour and mood related to adaptation to the illness and the institutionalization . Nursing assistants : General health as measured by feelings of stress , stress reactions , feeling of competence and illness . RESULTS Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks : maintaining an emotional balance ( less anxiety ) and preserving a positive self-image ( less dissatisfaction ) . In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training . CONCLUSION Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia . For the severely demented elderly we did not find this surplus value . This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes . With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them This article describes the development and evaluation of a Nursing Assistant Communication Skills Program ( NACSP ) . NACSP was design ed to help nursing assistants ( NAs ) interact more effectively with nursing home residents with moderate and severe dementia . In two skilled 
    Output:
    