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A study on the duration of Ginkgo biloba extract effective in improving cognitive function in the elderly: A systematic review and meta-analysis

  • Cui, Fengjiao (Department of Food and Nutrition, Hanyang University) ;
  • Nawaz, Hadia (Department of Food and Nutrition, Hanyang University) ;
  • Kim, Hyun Kyung (Department of Food and Nutrition, Hanyang University) ;
  • Go, Gwang-woong (Department of Food and Nutrition, Hanyang University)
  • Received : 2022.07.13
  • Accepted : 2022.08.16
  • Published : 2022.08.31

Abstract

Evidence regarding the efficacy of Ginkgo biloba extract on cognitive function has been contentious. This study evaluated the effective period of G. biloba intake to improve cognition in the elderly. PubMed, EMBASE, Cochrane, Web of Science, and PsycArticles databases were searched for short-listing relevant studies. Twenty-five studies fulfilled the inclusion criteria. Cognitive efficacy was assessed based on the duration of intervention. G. biloba intake for 3-6 months statistically significantly affected cognitive function (SMD= -0.21; 95% CI -0.39, -0.03; p=0.02). However, the improvement in activities of daily living (ADLs) was not statistically significant. Thus, G. biloba intake for more than three months improves cognition in the elderly people with cognitive impairment and AD dementia without any safety risk. Intake for up to six months does not improve ADLs significantly in mild to moderate dementia patients.

Keywords

References

  1. Amieva H, Meillon C, Helmer C, Barberger-Gateau P, Dartigues JF. Ginkgo biloba extract and long-term cognitive decline: a 20-year follow-up population-based study. PLoS One. 8: e52755 (2013) https://doi.org/10.1371/journal.pone.0052755
  2. Bajenaru O, Prada G, Antochi F, Jianu C, Tudose C, Cuciureanu A, Docu AA, Perrot V, Avram M, Tiu C. Effectiveness and Safety Profile of Ginkgo biloba Standardized Extract (EGb761®) in Patients with Amnestic Mild Cognitive Impairment. CNS Neurol. Disord. Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders). 20: 378-384 (2021)
  3. Birks J, Evans JG. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst. Rev. (2009)
  4. Brautigam MRH, Blommaert FA, Verleye G, Castermans J, Steur EJ, Kleijnen J. Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double-blind placebo-controlled study. Phytomedicine. 5: 425-434 (1998) https://doi.org/10.1016/S0944-7113(98)80038-X
  5. Cockle SM, Kimber S, Hindmarch I. The effects of Ginkgo biloba extract (LI 1370) supplementation on activities of daily living in free-living older volunteers: a questionnaire survey. Hum. Psychopharmacol. 15: 227-235 (2000) https://doi.org/10.1002/1099-1077(200006)15:4<227::AID-HUP208>3.0.CO;2-M
  6. Deeks JJ, Higgins JPT, Altman DG. Chapter 10: Analysing data and undertaking meta-analyses. Available from www.training.cochrane.org/handbook. Accessed August 24, 2022
  7. eMedicineHealth. Alzheimer's Disease Medications. Available from: https://www.emedicinehealth.com/understanding_alzheimer_disease_medications/article_em.htm#what_is_alzheimers_disease. Accessed August 24, 2022
  8. Gauthier S, Schlaefke S. Efficacy and tolerability of Ginkgo biloba extract EGb 761® in dementia: a systematic review and meta-analysis of randomized placebo-controlled trials. Clin. Interv. Aging 9: 2065-2077 (2014) https://doi.org/10.2147/CIA.S72728
  9. Gavrilova SI, Preuss UW, Wong JWM, Hoerr R, Kaschel R, Bachinskaya N, GIMCIPlus study group. Efficacy and safety of Ginkgo biloba extract EGb 761® in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo-controlled, double-blind, multi-center trial. Int. J. Geriatr. Psychiatry 29: 1087-1095 (2014) https://doi.org/10.1002/gps.4103
  10. Gschwind YJ, Bridenbaugh SA, Reinhard S, Granacher U, Monsch AU, Kressig RW. Ginkgo biloba special extract LI 1370 improves dual-task walking in patients with MCI: a randomised, double-blind, placebo-controlled exploratory study. Aging Clin. Exp. Res. 29: 609-619 (2017) https://doi.org/10.1007/s40520-016-0699-y
  11. Kang EY, Cui F, Kim HK, Go GW. Bioactive compounds in food for age-associated cognitive decline: A systematic review. Korean J. Food Sci. Technol. 53: 278-289 (2021)
  12. Kanowski S, Herrmann WM, Stephan K, Wierich W, Horr R. Proof of efficacy of the Ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry. 29: 47-56 (1996) https://doi.org/10.1055/s-2007-979544
  13. Kleijnen J, Knipschild P. Ginkgo biloba. The Lancet. 340: 1136-1139 (1992) https://doi.org/10.1016/0140-6736(92)93158-J
  14. Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA 278: 1327-1332 (1997) https://doi.org/10.1001/jama.1997.03550160047037
  15. Le Bars PL. Response patterns of EGb 761® in Alzheimer's disease: influence of neuropsychological profiles. Pharmacopsychiatry. 36: 50-55 (2003) https://doi.org/10.1055/s-2003-40456
  16. Le Bars PL, Velasco FM, Ferguson JM, Dessain E C, Kieser M, Hoerr R. Influence of the severity of cognitive impairment on the effect of the Ginkgo biloba extract EGb 761® in Alzheimer's disease. Neuropsychobiology. 45: 19-26 (2002) https://doi.org/10.1159/000048668
  17. Liao Z, Cheng L, Li X, Zhang M, Wang S, Huo R. Meta-analysis of Ginkgo biloba preparation for the treatment of Alzheimer's disease. Clin. Neuropharmacol. 43: 93-99 (2020) https://doi.org/10.1097/WNF.0000000000000394
  18. Maurer K, Ihl R, Dierks T, Frolich L. Clinical efficacy of Ginkgo biloba special extract EGb 761 in dementia of the Alzheimer type. J. Psychiatr. Res. 31: 645-655 (1997) https://doi.org/10.1016/S0022-3956(97)00022-8
  19. Mazza M, Capuano A, Bria P, Mazza S. Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo-controlled double-blind study. Eur. J. Neurol. 13: 981-985 (2006) https://doi.org/10.1111/j.1468-1331.2006.01409.x
  20. McCarney R, Fisher P, Iliffe S, van Haselen R, Griffin M, van der Meulen J, Warner J. Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial. Int. J. Geriatr. Psychiatry 23: 1222-1230 (2008) https://doi.org/10.1002/gps.2055
  21. Mix JA, Crews Jr. WD. A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761® in a sample of cognitively intact older adults: neuropsychological findings. Hum. Psychopharmacol. 17: 267-277 (2002) https://doi.org/10.1002/hup.412
  22. Mix JA, Crews Jr. WD. An examination of the efficacy of Ginkgo biloba extracts EGb 761 on the neuropsychologic functioning of cognitively intact older adults. J. Altern. Complement. Med. 6: 219-229 (2000) https://doi.org/10.1089/acm.2000.6.219
  23. Napryeyenko O, Sonnik G, Tartakovsky I. Efficacy and tolerability of Ginkgo biloba extract EGb 761® by type of dementia: Analyses of a randomised controlled trial. J. Neurol. Sci. 283: 224-229 (2009) https://doi.org/10.1016/j.jns.2009.02.353
  24. Nasab NM, Bahrammi MA, Nikpour MR, Rahim F, Naghibis SN. Efficacy of rivastigmine in comparison to ginkgo for treating Alzheimer's dementia. Age (Years). 65: 65-72 (2012)
  25. NIH National Institute on Aging. How Is Alzheimer's Disease Treated? Available from: https://www.nia.nih.gov/health/how-alzheimers-disease-treated. Accessed August 24, 2022
  26. Persson J, Bringlov E, Nilsson L-G, Nyberg L. The memory-enhancing effects of Ginseng and Ginkgo biloba in healthy volunteers. Psychopharmacology. 172: 430-434 (2004) https://doi.org/10.1007/s00213-003-1675-8
  27. Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo-controlled study of Ginkgo biloba extract ('tanakan') in elderly outpatients with mild to moderate memory impairment. Curr. Med. Res. Opin. 12: 350-355 (1991) https://doi.org/10.1185/03007999109111504
  28. Rapp M, Burkart M, Kohlmann T, Bohlken J. Similar treatment outcomes with Ginkgo biloba extract EGb 761 and donepezil in Alzheimer's dementia in very old age: a retrospective observational study. Int. J. Clin. Pharmacol. 56: 130 (2018)
  29. Schunemann H, Brozek J, Guyatt G, Oxman A. GRADE Handbook for grading quality of evidence and strength of recommendations. GRADE Working Group. (2013)
  30. Snitz BE, O'Meara ES, Carlson MC, Arnold AM, Ives DG, Rapp SR, Saxton J, Lopez OL, Dunn LO, Sink KM, DeKosky ST. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA 302: 2663-2670 (2009) https://doi.org/10.1001/jama.2009.1913
  31. Solomon PR, Adams F, Silver A, Zimmer J, DeVeaux R. Ginkgo for memory enhancement: a randomized controlled trial. JAMA 288: 835-840 (2002) https://doi.org/10.1001/jama.288.7.835
  32. Tan MS, Yu JT, Tan CC, Wang HF, Meng XF, Wang C, Jiang T, Zhu XC, Tan L. Efficacy and adverse effects of Ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis. J. Alzheimers. Dis. 43: 589-603 (2015)
  33. Weinmann S, Roll S, Schwarzbach C, Vauth C, Willich SN. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr. 10: 1-12 (2010) https://doi.org/10.1186/1471-2318-10-1
  34. Winther KAJ, Randlov C, Rein E, Mehlsen J. Effects of Ginkgo biloba extract on cognitive function and blood pressure in elderly subjects. Curr. Ther. Res. Clin. Exp. 59: 881-888 (1998) https://doi.org/10.1016/S0011-393X(98)85053-4
  35. World Health Organization. Dementia. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia. Accessed August 24, 2022
  36. Yancheva S, Ihl R, Nikolova G, Panayotov P, Schlaefke S, Hoerr R, GINDON Study Group. Ginkgo biloba extract EGb 761®, donepezil or both combined in treating Alzheimer's disease with neuropsychiatric features: A randomised, double-blind, exploratory trial. Aging Ment. Health 13: 83-190 (2009)
  37. Yin B, Xu Y, Wei R, Luo B. Ginkgo biloba on focal cerebral ischemia: a systematic review and meta-analysis. Am. J. Chin. Med. 42: 769-783 (2014) https://doi.org/10.1142/S0192415X14500499
  38. Zheng Y, Xie Y, Qi M, Zhang L, Wang W, Zhang W, Sha L, Wu J, Li W, Wu T. Ginkgo biloba extract is comparable with donepezil in improving functional recovery in alzheimer's disease: results from a multilevel characterized study based on clinical features and resting-state functional magnetic resonance imaging. Front. pharmacol. 12. (2021)