Three studies investigated the relevance of affect regulation, stressful life events, and congruence between explicit achievement orientation and implicit achievement motive for subjective well-being and symptom formation. According to personality systems interactions (PSI) theory, stressful life events were expected to reduce motive congruence when the ability to self-regulate affect was impaired (i.e., state orientation). Consistent with expectations, the State Orientation ϫ Stress interaction predicted incongruence in healthy participants (Studies 1 and 3) and in patients (Study 2). Furthermore, incongruence partially mediated the direct State Orientation ϫ Stress effect on subjective well-being (Studies 1 and 3) and the course of psychosomatic complaints over 3 months (Study 2). In Study 3, the experimental induction of threat reduced motive congruence in state-oriented participants compared with an acceptance condition. Findings underscore the importance of assessing motive congruence as a "hidden stressor" and validate a new operant multimotive test.

Objective: The study was conducted to explore the effects of EGb 761® (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) on neuropsychiatric symptoms (NPS) and cognition in patients with mild cognitive impairment (MCI). Methods: One hundred and sixty patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI) were enrolled in this double-blind, multi-center trial and randomized to receive 240 mg EGb 761 daily or placebo for a period of 24 weeks. Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory and the Geriatric Depression Scale. Further outcome measures were the Trail-Making Test (A/B) for cognition and global ratings of change. Statistical analyses followed the intention-to-treat principle. Results: The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761-treated group and by 5.5 ± 5.2 in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761 and in 55.7% of those receiving placebo (p = 0.002). Superiority of EGb 761 over placebo (p < 0.05) was also found for the State-Trait Anxiety Inventory score, the informants' global impression of change, and both Trail-Making Test scores. There were statistical trends favoring EGb 761 in the Geriatric Depression Scale and the patients' global impression of change. Adverse events (all non-serious) were reported by 37 patients taking EGb 761 and 36 patients receiving placebo. Conclusions: EGb 761 improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.

Apart from a few, encouraging, single-case studies, evidence of imagery-based mnemonics for the rehabilitation of memory in brain-damaged individuals is sparse. The literature suggests that if imagery is of any use, then it should be applied to mildly memory impaired patients, the learning process should be tailored and a direct transfer training to individual memory problems should be implemented into the training. We compared the outcome of such a programme (nine memory impaired patients) with other approaches to the rehabilitation of memory used in participating centres (12 memory impaired patients). After 4 weeks of baseline and a repeated test battery patients received 30 single sessions of therapy in 10 weeks. Results suggest that imagery training significantly improves delayed recall of everyday relevant verbal materials (stories, appointments). Frequency of memory problems observed by relatives is reduced and each of these effects is stable at 3-month follow-up. This study suggests that a simple imagery technique can improve relevant aspects of everyday verbal memory performance.

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Sleep deprivation is an unpleasant burden of young hospital doctors during their medical training. It may disrupt the balance between coping strategies available to them and the professional demands encountered. Impaired medical care offered by sleep-deprived juniors may be a consequence. Valid research work on this subject is rare and surprisingly contradictory. Therefore, we evaluated the task-specific cognitive status and emotional condition of 40 young hospital doctors (27 men and 13 women, 29.9 +/- 2.9 years of age) at the University of Tuebingen, all of whom were in the beginning of their academic career. Subjects were tested twice acting as their own control, once at 8.00 am after a night off duty (OD) (at least 6 hours of uninterrupted sleep), and once at a similar time after a night on call (OC) being in the hospital for 24 hours. Standardized and reliable psychometric tests thought to represent daily routine medical function were performed. On-call activities were recorded by means of a sleep diary, whereas a questionnaire interrogated aspects of private and professional life. Neuropsychological function deteriorated significantly: number connection test (per cent of norms +/- SD, 103.2 +/- 9.8 OC vs 107.8 +/- 10.5 OD, F = 27.7, P < 0.001), things-to-do list (correct items +/- SD, 6.7 +/- 1.2 OC vs 7.4 +/- 1.5 OD, F = 12.7, P < 0.01), Vienna reaction timer (per cent of norms +/- SD, 95.6 +/- 9.0 OC vs 97.7 +/- 10.4 OD, F = 4.8, P < 0.05), Stroop test (T-values +/- SD, 59.7 +/- 6.3 OC vs 64.6 +/- 7.1 OD, F = 37.1, P < 0.001), ECG test (correct responses +/- SD, 38.3 +/- 7.3 OC vs 43.4 +/- 6.5 OD, F = 45.2, P < 0.001) and status of mood (T-value +/- SD, 60.3 +/- 9.0 OC vs 54.0 +/- 6.6 OD, F = 19.6, P < 0.001). Cognitive function and mood status of young hospital doctors after a night on call decrease considerably. In view of the special vulnerability of medical trainees to occupational stress all efforts are warranted to reduce sleep deprivation in the medical profession.

Objective: To assess effects of EGb 761 ® on cognition and quality of life in subjects with very mild cognitive impairment. Methods: We randomized 300 subjects aged 45 to 65 with cognitive complaints and low functioning (more than one standard deviation below appropriate norm) in at least one cognitive test to double-blind treatment with once daily 240 mg EGb 761 ® or placebo for 12 weeks. Results: The exploratory intention-to-treat analysis showed significant improvement (p < 0.025, one-sided) beyond practice effects for EGb 761 ® in a measure of attention (Vienna Test System-Work Performance Series) and trends in favour of EGb 761 ® in measures of memory (Wechsler Memory Scale III-Faces I, Appointments Test-delayed recall), and perceived physical health (SF36-factor score Physical Health). Cognitive effects were more pronounced and more consistent (p < 0.025 in 4 of 5 tests) in subjects with lower memory function at baseline. Specifically, practice effects in the more demanding tests were attenuated or absent in these subjects. Conclusion: Ginkgo biloba extract EGb 761 ® improved cognitive functioning and aspects of quality of life in subjects with very mild cognitive impairment.

AD is associated with a functional vasoregulative deficit possibly due to decreased levels of the endothelial nitric oxide synthase. Augmenting levels with AChEI normalized flow regulation possibly leading to a better blood supply to active neurons.