Treatment of dementia and mild cognitive impairment with or without cerebrovascular disease: Expert consensus on the use of Ginkgo biloba extract, EGb 761 ^®

Abstract

© 2018 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd 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.