Asian experts issue consensus statement on use of Ginkgo biloba in mild cognitive impairment

The Asian Clinical Expert Group on Neurocognitive Disorders (ASCEND) has issued a consensus statement, suggesting it is clinically appropriate to incorporate Ginkgo biloba extract as part of the multidomain intervention for mild cognitive impairment (MCI). [CNS Neurosci Ther 2021;27:149-162]

MCI is a clinically defined neurocognitive state between normal cognitive ageing and dementia, with evidence of neuropsychological changes but without sufficient functional decline to warrant a diagnosis of dementia. [Neurology 2019;93:705-713]

“Individuals with MCI are at increased risk for progression to dementia, but only a small proportion of them are likely to present for diagnosis and treatment. Hence, there is a need to raise awareness of this syndrome and its management,” wrote the authors of the consensus statement. [Neurology 2018;90:126-135; Neurology 2013;80:2112-2120]

Ginkgo biloba extract appears to have profound effects on neuronal function, neuroplasticity, neuroregeneration and neuroinflammation, and positively influences synaptic plasticity and brain functions that require high amounts of cellular energy. [World J Biol Psychiatry 2019;20:173-189] Additionally, evidence suggests that Ginkgo biloba extract increases cerebral blood flow and brain perfusion by decreasing cerebral blood viscosity, and protects cerebral blood vessels against processes involved in atherosclerosis. [Atherosclerosis 2007;192:438-444] “Thus, the known mechanisms of action of Ginkgo biloba extract provide strong rationale for its use in age‐related cognitive disorders,” wrote the experts. [CNS Neurosci Ther 2019;25:288-298]

Four key trials have reported the benefit of Ginkgo biloba extract in patients with MCI.

The double‐blind GIMCIPlus trial enrolled 160 outpatients aged ≥55 years with amnestic MCI and randomized them to receive Ginkgo biloba extract 240 mg/day or placebo. Results showed that Ginkgo biloba extract significantly improved Neuropsychiatric Inventory composite scores vs placebo (mean, -7.0 vs -5.5; p=0.001), including a significant improvement in anxiety and a trend toward improved depression. [Int J Geriatr Psychiatry 2014;29:1087-1095]

In a trial of 300 patients aged 45–65 years with very mild MCI, those receiving Ginkgo biloba extract 240 mg/day showed significant improvement in both visual and prospective verbal memory, free recall, and recognition, with cognitive benefits being more pronounced among those with poorer baseline memory function. [Neuroscience Med 2011;2:48-56]

In a multicentre trial that included 120 patients aged 60–85 years with MCI including episodic memory complaints, the clinical memory scale and logical memory tests significantly improved from baseline with Ginkgo biloba extract (p<0.01 and p<0.05, respectively) at 6 months, while healthcare alone showed no significant improvement in these endpoints. [Zhong Xi Yi Jie He Xue Bao 2012;10:628-634]

Finally, in a placebo‐controlled study conducted in 61 elderly individuals with subjective memory impairment, participants receiving Ginkgo biloba extract 240 mg/day had improved cognitive flexibility without brain activation changes vs placebo at 8 weeks, suggesting improved processing efficiency potentially resulting from mild enhancement of prefrontal dopaminergic function. [Hum Psychopharmacol 2016;31:227-242]

“Based on clinical trial data and pathomechanistic reasoning, we concluded that Gingkgo biloba extract may be considered for use in patients with MCI, including those with evidence of cardiovascular disease [class of recommendation, IIB; level of evidence, A],” summarized the researchers.