Does Ginkgo biloba really work for dementia?

February 21, 2025

Healthcaretoday, Ginkgo biloba, Dementia, Cognitive health, Alzheimers, Memory care, Brain health, Healthy aging, Dementia awareness, Caregiver support, Cognitive decline,

While some studies suggest potential benefits, the overall evidence of the efficacy of Ginkgo biloba remains inconclusive.

The use of Traditional and Complementary Medicine (TCM) in treating dementia has sparked considerable debate, particularly regarding the efficacy of Ginkgo biloba. While some studies suggest potential benefits, the overall evidence remains inconclusive.

A meta-analysis examining the effects of Ginkgo biloba extract (EGb761) at a dosage of 240mg/day reported improvements in cognitive function, activities of daily living (ADL), global assessment of change, and behavioral symptoms among individuals with dementia. However, significant heterogeneity among the primary studies raises questions about the reliability of these findings. Additionally, no significant differences in adverse events were noted between the Ginkgo biloba group and placebo, suggesting a similar safety profile.

Despite these observations, another meta-analysis did not find a higher bleeding risk associated with standardized Ginkgo biloba extract compared to placebo. Yet, it is important to note that the study populations were not exclusively composed of individuals with dementia, and many primary studies exhibited moderate to high risk of bias.

According to the Clinical Practice Guidelines (2021) for the Management of Dementia by the Ministry of Health, Malaysia, there is insufficient evidence to support the use of TCM, including Ginkgo biloba, in treating dementia. The guidelines state, “A Cochrane review could not conclude on the effectiveness and safety of traditional Chinese herbal medicine for vascular dementia due to poor reporting and trial methodology of the primary papers.”

In a systematic review and meta-analysis published in GMC Geriatrics in 2010 by Stefan Weinmann et al., Ginkgo biloba extract EGb 761 was highlighted as one of the most commonly used herbal remedies for dementia. However, most efficacy studies are small, suffer from methodological limitations, and are subject to considerable controversy.

Two major trials have recently reignited discussions about Ginkgo biloba’s efficacy. The study by McCarney et al. (2008) found no evidence supporting the effectiveness of 120mg Ginkgo biloba in patients with mild to moderate dementia. Similarly, the Ginkgo Evaluation of Memory (GEM) study published in JAMA in 2008 demonstrated that 240mg EGb 761 did not prevent dementia onset in older adults with mild cognitive impairment.

The GEM trial, being sufficiently large, provided robust evidence against the efficacy of Ginkgo biloba in preventing dementia as well as in reducing overall mortality in individuals without dementia. Critics have pointed out methodological flaws in the McCarney study, including an insufficient sample size.

Previous reviews have consistently shown inconsistent results regarding Ginkgo biloba's benefits for individuals diagnosed with dementia. A Cochrane review published in 2009 concluded that there was not enough evidence to support Ginkgo biloba as beneficial for cognitive impairment and dementia. The limitations of the available reviews, including a lack of subgroup analyses and inconsistent definitions of cognitive impairment, further complicate the understanding of Ginkgo biloba’s efficacy.

Moreover, the German Health Technology Assessment Institute (IQWiG) released a favorable report on Ginkgo biloba’s effectiveness, but this was limited to Alzheimer's disease and contradicted findings from the Cochrane review. Given the overlap between various types of dementia and the limited significance of dementia subtyping in the routine use of anti-dementia drugs, no substantial differences in the effectiveness of these treatments have been established.

As the debate continues, individuals must weigh the available evidence when considering treatments for dementia, including Ginkgo biloba.

References
Clinical Practice Guidelines (2021) Management of Dementia Third Edition, Ministry of Health, Malaysia.

Weinmann, S., et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. GMC Geriatrics.

McCarney, R., et al. (2008). Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial. Int J Geriatr Psychiatry, 23, 1222–1230.

DeKosky, S.T., et al. (2008). Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA, 300, 2253–2262.

Birks, J. (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev, 21(1): CD003120.