Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo‐controlled double‐blind study

Abstract

The Ginkgo biloba special extract EGb 761 seems to produce neuroprotective effects in neurodegenerative diseases of multifactorial origin. There is still debate about the efficacy of Ginkgo biloba special extract EGb 761 compared with second-generation cholinesterase inhibitors in the treatment of mild to moderate Alzheimer's dementia. Our aim is to assess the efficacy of the Ginkgo biloba special extract E.S. in patients with dementia of the Alzheimer type in slowing down the disease's degenerative progression and the patients' cognitive impairment compared with donepezil and placebo. The trial was designed as a 24-week randomized, placebo-controlled, double-blind study. Patients aged 50-80 years, suffering from mild to moderate dementia, were allocated into one of the three treatments: Ginkgo biloba (160 mg daily dose), donepezil (5 mg daily dose), or placebo group. The degree of severity of dementia was assessed by the Syndrom Kurz test and the Mini-Mental State Examination. Clinical Global Impression score was recorded to assess the change in the patients' conditions and the therapeutic efficacy of tested medications. Our results confirm the clinical efficacy of Ginkgo biloba E.S. (Flavogin) in the dementia of the Alzheimer type, comparable with donepezil clinical efficacy. There are few published trials that have directly compared a cholinesterase inhibitor with Ginkgo for dementia. This study directly compares a cholinesterase inhibitor with Ginkgo biloba for dementia of the Alzheimer type and could be a valid contribution in this debate. Our study suggests that there is no evidence of relevant differences in the efficacy of EGb 761 and donepezil in the treatment of mild to moderate Alzheimer's dementia, so the use of both substances can be justified. In addition, this study contributes to establish the efficacy and tolerability of the Ginkgo biloba special extract E.S. in the dementia of the Alzheimer type with special respect to moderately severe stages.

Amyloid-β-Induced Pathological Behaviors Are Suppressed byGinkgo bilobaExtract EGb 761 and Ginkgolides in TransgenicCaenorhabditis elegans

“…7 A, B), suggesting that protective effects of EGb 761 against A␤ toxicity is mediated primarily by inhibition of A␤ oligomerization. If a similar mechanism is shared with other species, it may represent a rationale for the beneficial effects of EGb 761 in humans with AD-related dementia (Le Bars et al, 2000;Mazza et al, 2006) and for the enhanced . Age-synchronized groups of transgenic C. elegans strain CL4176 and the control strain CL1175 maintained at 16°C for 38 h were temperature upshifted to 23°C for 38 h followed by the DCF assay for H 2 O 2 described in Materials and Methods.…”

“…Several clinical trials have provided evidence of efficacy (Le Bars et al, 1997;Birks et al, 2002;Mix and Crews, 2002;Le Bars, 2003), comparable with Donepezil (Mazza et al, 2006), as a symptomatic treatment of mild to moderate AD, and suggestive for AD prevention (Andrieu et al, 2003). Currently, a National Institutes of Health-supported GEM (Ginkgo Evaluation of Memory) study in the United States and a GuidAge study in Europe are underway to evaluate EGb 761 as a preventive drug (DeKosky et al, 2006).…”

Protection against β-amyloid induced abnormal synaptic function and cell death by Ginkgolide J

“…As a consequence ginkgo and EGb-761 have been relegated to the realm of phytomedicines possessing dubious beneficial effects on health and looked upon with skepticism by the much of the medical community. Recent well-designed animal [47,55] and human studies [2,32,34] have shown that EGb-761, a complex mixture, can improve the cognitive performance of AD transgenic mice as well as the cognitive performance of people with early AD. In the studies reported here, we have attempted to analyze the effect of individual terpene trilactones (ginkgolides and bilobalide) in a system that is known to be affected by Aβ and is probably connected to early synaptic and cognitive changes following amyloid elevation -hippocampal LTP.…”

“…Two large studies performed in the United States and in Europe respectively are currently evaluating the efficacy of the Gingko derivative EGB-761 against AD [10,51]. In spite of this long experience, the number of well-controlled studies on the efficacy of these extract is limited and its effect in neurodegenerative disorders characterized by dementia, such as AD needs to be confirmed [2,11,20,24,31,32,34,38,40,46,54].…”

Repair and regeneration properties of Ginkgo biloba after ischemic brain injury

“…The standardized extract of this herb, EGb 761, is prescribed as a dietary supplement and is touted to have neuroprotective and neurorestorative properties that have been consistently reproduced in many animal models of CNS disorders (Kehr et al, 2012; Diamond and Bailey, 2013; Tulsulkar and Shah, 2013; Wang et al, 2013a). Its use as a symptomatic treatment for dementia has been established in many preclinical studies (Tchantchou et al, 2007; Wang et al, 2013b) and clinical trials (Oken et al, 1998; Schneider et al, 2005; Mazza et al, 2006; Weinmann et al, 2010). A number of clinical studies conducted in Europe and the US have demonstrated the potential therapeutic effects of G. biloba in multi-infarct dementia, early or mild cognitive decline, and severe types of senile dementias (Weinmann et al, 2010; Amieva et al, 2013).…”