Ginkgo biloba for Prevention of Dementia A Randomized Controlled Trial

University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2008; 300(19):2253-62. DOI: 10.1001/jama.2008.683
Source: PubMed


Ginkgo biloba is widely used for its potential effects on memory and cognition. To date, adequately powered clinical trials testing the effect of G. biloba on dementia incidence are lacking.
To determine effectiveness of G. biloba vs placebo in reducing the incidence of all-cause dementia and Alzheimer disease (AD) in elderly individuals with normal cognition and those with mild cognitive impairment (MCI).
Randomized, double-blind, placebo-controlled clinical trial conducted in 5 academic medical centers in the United States between 2000 and 2008 with a median follow-up of 6.1 years. Three thousand sixty-nine community volunteers aged 75 years or older with normal cognition (n = 2587) or MCI (n = 482) at study entry were assessed every 6 months for incident dementia.
Twice-daily dose of 120-mg extract of G. biloba (n = 1545) or placebo (n = 1524).
Incident dementia and AD determined by expert panel consensus.
Five hundred twenty-three individuals developed dementia (246 receiving placebo and 277 receiving G. biloba) with 92% of the dementia cases classified as possible or probable AD, or AD with evidence of vascular disease of the brain. Rates of dropout and loss to follow-up were low (6.3%), and the adverse effect profiles were similar for both groups. The overall dementia rate was 3.3 per 100 person-years in participants assigned to G. biloba and 2.9 per 100 person-years in the placebo group. The hazard ratio (HR) for G. biloba compared with placebo for all-cause dementia was 1.12 (95% confidence interval [CI], 0.94-1.33; P = .21) and for AD, 1.16 (95% CI, 0.97-1.39; P = .11). G. biloba also had no effect on the rate of progression to dementia in participants with MCI (HR, 1.13; 95% CI, 0.85-1.50; P = .39).
In this study, G. biloba at 120 mg twice a day was not effective in reducing either the overall incidence rate of dementia or AD incidence in elderly individuals with normal cognition or those with MCI. Trial Registration Identifier: NCT00010803.

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    • "identifier: NCT01955161). Additionally, even drugs with uncertain mechanism were reported to be effective in symptomatic improvement and protection against neurotoxicity by Aβ, including ethanolic extract of Angelica gigas (INB-176) and Ginkgo biloba (EGb761) respectively, however, none of which showed successful effectiveness in their preclinical and clinical trials (29, 30, 31). "
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    • "Two large RCTs on the use of Gb extracts (the GEM and the GuidAge study) did not show less cognitive decline over time in older adults with normal cognition or MCI taking Gb than those assuming placebo (Snitz et al., 2009; Vellas et al., 2012). Also, Gb showed no effects in reducing either the overall incidence rate of dementia or AD in old age individuals with normal cognition or MCI (De Kosky et al., 2008). The latest published Cochrane review including 36 RCTs could not report a significant evidence for a predictable clinical benefit of Gb for people with dementia or cognitive impairment (Birks and Grimley Evans, 2009). "
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