Does Ginkgo Biloba Aid in Treating Forgetfulness Associated with Dementia?

Extracts from Ginkgo biloba are a commonly used herbal medicine for the treatment of forgetfulness. Various prior studies have yielded inconsistent results regarding the benefits of Ginkgo biloba extracts. In the present review, data from these studies was reanalyzed to identify the patient-relevant advantage of the use of Ginkgo biloba. While Ginkgo biloba seems to be more effective than placebo, the clinical significance of this finding is difficult to establish.

Forgetfulness commonly occurs because of Alzheimer’s disease or dementia. Other causes for dementia include old age and decrease in blood supply to the brain. Drugs belonging to the group of anticholinergic drugs are frequently prescribed for patients of Alzheimer’s disease who have moderate to severe symptoms. Ginkgo biloba extract, a herbal product, is thought to help in reducing the symptoms of all types of dementia and in retarding the progression of the disease. However, the studies conducted to assess the effectiveness of this drug have failed to establish firm conclusions. The present review analyzed the results of various clinical trials to investigate the effect of Ginkgo biloba in decreasing cognitive impairment, in increasing the ability to perform day-to-day activities, in reducing neuropsychiatric symptoms, and in improving the quality of life. The reviewers also looked at the side effects of the herbal product, which caused some participants to leave the clinical trials.

Studies regarding the utility of Ginkgo biloba extracts for the treatment of dementia were retrieved from various databases such as MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Only those studies, which were done for a minimum period of 12 weeks and with at least 10 participants in each group, were included in the review. Thus, out of 754 publications, nine trials could be included in the review. In these nine studies, 2,372 participants were included. Data regarding the type of study and the patients included in the study were collected. Patient outcomes and the side effects associated with Ginkgo biloba treatment and placebo groups were noted. In eight studies, the effects of Ginkgo biloba were compared with effects of placebo, while in one study this comparison was done with donepezil. All studies included patients suffering from Alzheimer’s disease. In six studies, patients with other types of dementia were also included. In all the studies, patients suffering from mild or moderate grade of dementia were included.

Results/Key findings
* All studies were double-blind randomized control trials.
* Improvement in cognitive function was significantly higher in the Ginkgo biloba treatment group compared to the placebo group. “Regarding activities of daily living, there was no significant difference for the whole dementia group. However, in the subgroup of patients with Alzheimer’s disease, the advantage of Ginkgo biloba compared to placebo was statistically significant.”
* In two trials, the effect on neuropsychiatric symptoms was analyzed. Both showed beneficial effects of Ginkgo biloba. There was significant improvement in the quality of life in the treatment group shown in three studies.
* The incidence of side effects resulting in the discontinuation of treatment varied from 0 to 8 percent in the placebo groups, while it was 1 to 6 percent in the treatment groups.

Shortcomings/Next steps
Different studies have shown differing or no benefits with the use of Ginkgo biloba in dementia patients. The criteria for diagnosis of dementia and the grading of various symptoms of Alzheimer’s disease are different in all these studies. This indicates a need to carry out a larger multicenter study, in which the assessment of symptoms is standardized, so that definitive results are available.

“We found a statistically significant advantage of Ginkgo biloba compared to placebo in improving cognition for the whole group of patients with Alzheimer’s disease, vascular or mixed dementia.” Ginkgo biloba causes stabilization of mitochondria within cells and improves the energy utilization of brain cells. It has few side effects. In recent years, the clinical significance of treatment of Alzheimer’s disease with anticholinergic drugs has been seriously debated. Ginkgo biloba can be an effective alternative, at least for those who have disease of mild to moderate severity. Further studies to compare the efficacy of anticholinergics with that of Ginkgo biloba are warranted.

For More Information:
Effects of Ginkgo Biloba in Dementia: Systematic Review and Meta-analysis
Publication Journal: BMC Geriatrics, March 2010
By Stefan Weinmann; Stephanie Roll; Charité University Medicine, Berlin, Germany

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