Effects of Ginkgo biloba in dementia: systematic review and meta-analysis.
BACKGROUND
The benefit of Ginkgo biloba has been discussed controversially. The aim of this review was to assess the effects of Ginkgo biloba in Alzheimer's disease as well as vascular and mixed dementia covering a variety of outcome domains.


METHODS
We searched MEDLINE, EMBASE, the Cochrane databases, CINAHL and PsycINFO for controlled trials of ginkgo for Alzheimer's, vascular or mixed dementia. Studies had to be of a minimum of 12 weeks duration with at least ten participants per group. Clinical characteristics and outcomes were extracted. Meta-analysis results were expressed as risk ratios or standardized mean differences (SMD) in scores.


RESULTS
Nine trials using the standardized extract EGb761(R) met our inclusion criteria. Trials were of 12 to 52 weeks duration and included 2372 patients in total. In the meta-analysis, the SMDs in change scores for cognition were in favor of ginkgo compared to placebo (-0.58, 95% confidence interval [CI] -1.14; -0.01, p = 0.04), but did not show a statistically significant difference from placebo for activities in daily living (ADLs) (SMD = -0.32, 95% CI -0.66; 0.03, p = 0.08). Heterogeneity among studies was high. For the Alzheimer subgroup, the SMDs for ADLs and cognition outcomes were larger than for the whole group of dementias with statistical superiority for ginkgo also for ADL outcomes (SMD = -0.44, 95% CI -0.77; -0.12, p = 0.008). Drop-out rates and side effects did not differ between ginkgo and placebo. No consistent results were available for quality of life and neuropsychiatric symptoms, possibly due to the heterogeneity of the study populations.


CONCLUSIONS
Ginkgo biloba appears more effective than placebo. Effect sizes were moderate, while clinical relevance is, similar to other dementia drugs, difficult to determine.
Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine, Luisenstrasse 57, Berlin, Germany. Stefan.Weinmann@charite.de
Stefan
S
Weinmann
Stephanie
S
Roll
Christoph
C
Schwarzbach
Christoph
C
Vauth
Stefan N
SN
Willich
D000544:Alzheimer Disease / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D020441:Ginkgo biloba; D006801:Humans; D010936:Plant Extracts / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D000096983:Ginkgo Extract
D010936:Plant Extracts; C063170:Ginkgo biloba extract; D000096983:Ginkgo Extract