Condition
    Moderate Evidence
    Effectiveness 3/5

    Ginkgo Biloba for Cognitive Decline

    Standardised ginkgo (EGb 761) at 240 mg/day produces small symptomatic gains in diagnosed dementia, but it does not prevent cognitive decline in healthy older adults.

    Overview

    Standardised ginkgo (EGb 761) at 240 mg/day produces small symptomatic gains in diagnosed dementia, but it does not prevent cognitive decline in healthy older adults.

    Verdict

    Mixed evidence

    How It Works

    Ginkgo flavonoids and terpene lactones improve cerebral microcirculation, inhibit platelet-activating factor and scavenge free radicals in neural tissue.

    Dosing & Protocol

    Typical dose

    Recommended dose
    120-240mg standardized extract daily in divided doses
    Expected timeframe
    Trials reporting benefit measured change at 22-26 weeks. Nothing meaningful should be expected before 3 months.

    Protocol

    form
    EGb 761 or an equivalent extract standardised to 24% flavone glycosides and 6% terpene lactones
    duration
    22-26 weeks before judging; large prevention trials ran 4-6 years and were negative
    co factor
    Take with meals. Layer on the interventions with better evidence — blood pressure control, hearing correction, exercise and sleep treatment
    titration
    Increase to 240 mg daily in two divided doses after two weeks; 240 mg is the dose used in the trials reporting benefit
    starting dose
    120 mg standardised extract daily with food

    Evidence

    What the studies say

    The GEM and GuidAge prevention trials, together enrolling over 6,000 older adults, found no reduction in dementia incidence. Cochrane analyses of treatment trials in existing dementia show modest cognition and activities-of-daily-living benefits at 240 mg/day.

    Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial

    Score: 9/10
    2009
    rct
    n=3069

    Snitz BE, O'Meara ES, Carlson MC +3 more

    Compared with placebo, the use of G. biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment.

    View source

    Safety

    Caveats

    Evidence is mixed: some symptomatic trials in existing dementia show small gains, while large prevention trials found no reduction in progression. Ginkgo inhibits platelet-activating factor and can raise bleeding risk with warfarin, DOACs, aspirin and NSAIDs; stop at least 2 weeks before surgery. Avoid with seizure disorders and in pregnancy.

    Less likely to help if

    People with cognitively healthy ageing, and those hoping to prevent dementia, are the groups where trials were clearly negative. Decline driven by depression, thyroid disease, B12 deficiency or medication side effects needs the underlying cause treated.

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    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.