Treatment of dementia and mild cognitive impairment with or without cerebrovascular disease: Expert consensus on the use of Ginkgo biloba extract, EGb 761®. (15th January 2019)

• Record Type: Journal Article
• Authors: Kandiah, Nagaendran; Ong, Paulus Anam; Yuda, Turana; Ng, Li‐Ling; Mamun, Kaysar; Merchant, Reshma Aziz; Chen, Christopher; Dominguez, Jacqueline; Marasigan, Simeon; Ampil, Encarnita; Nguyen, Van Thong; Yusoff, Suraya; Chan, Yee Fai; Yong, Fee Mann; Krairit, Orapitchaya; Suthisisang, Chuthamanee; Senanarong, Vorapun; Ji, Yong; Thukral, Ramesh; Ihl, Ralf
• Is Part Of: CNS neuroscience & therapeutics. Volume 25:Number 2(2019)
• Page Start: 288
• Page End: 298
• Publication Date: 2019-01-15
• Subjects: Alzheimer disease -- cerebrovascular disease -- dementia -- EGb 761® -- Ginkgo biloba; Neuropharmacology -- Periodicals; Central nervous system -- Diseases -- Effect of drugs on -- Periodicals; 612.8
• DOI: 10.1111/cns.13095
• Languages: English
• ISSNs: 1755-5930

Abstract

Abstract: Background: The Ginkgo biloba special extract, EGb 761 ® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer's disease (AD). Methods: To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence‐based consensus recommendations regarding the use of EGb 761 ® in neurocognitive disorders with/without cerebrovascular disease. Results: Key randomized trials and robust meta‐analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761 ® versus placebo in patients with mild‐to‐moderate dementia. In those with mild cognitive impairment (MCI), EGb 761 ® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761 ® with the same strength of evidence as acetylcholinesterase inhibitors and N‐methyl‐D‐aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761 ® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761 ® to have a positive risk‐benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta‐analyses have not supported this association. Conclusions: The Expert Group foresee an important role for EGb 761 ®, used alone or as an add‐on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761 ® should be used in alignment with local clinical practice guidelines.