Source: AMA Morning Rounds 12/30/09; JAMA. 2009; 302:2663-2670
Gingko biloba not effective in preventing cognitive decline, improving memory.
The CBS Evening News (12/29, story 9, 0:20, Smith) reported, "Americans spend a quarter billion dollars a year on" gingko biloba supplements, "hoping to improve their memory and slow cognitive decline."
NBC Nightly News (12/29, story 5, 2:00, Williams) reported that "now, a major study shows" that gingko biloba, "one of the most popular supplements, flat out does not work."
USA Today (12/30, Weise) reports that, according to a study published in the Dec. 23-30 issue of the Journal of the American Medical Association, "the popular botanical...does not improve memory, nor does it prevent cognitive decline in older people." After analyzing data "from the Ginkgo Evaluation of Memory study" on "more than 3,000 people between ages 72 and 96 for seven years," researchers from the University of Virginia Medical School "found that a twice-daily dose of 120 milligrams of ginkgo biloba extract was not effective in reducing the incidence of Alzheimer's dementia or dementia overall."
According to the Los Angeles Times (12/29, Kaplan) "Booster Shots" blog, the National Center for Complementary and Alternative Medicine, "a branch of the National Institutes of Health, has been researching ginkgo for 10 years to see whether the type of clinical trials required for FDA-regulated pharmaceuticals would reveal any benefit. The new findings are in line with several other studies, including a Cochrane review published this year that found 'no convincing evidence' that the herb preserves mental function in any way."
The investigators "found no evidence that ginkgo delayed or prevented normal declines in memory, language, attention, visuospatial abilities, or executive functions, such as anticipating outcomes and adapting to changing situations and thinking abstractly," HealthDay (12/29, Reinberg) reported. Moreover, "these results remained the same regardless of sex, age, race or education," the investigators found. However, the supplement was found to be safe, "and no serious side effects were noted," study author Steven T. DeKosky, MD, said.
WebMD (12/29, DeNoon) reported that "in a written statement," Douglas MacKay, ND, of the Council for Responsible Nutrition, "a group representing the supplement industry," said that "the DeKosky study 'should not be viewed as the final work' on ginkgo." He stated that "as a former practicing licensed naturopathic doctor," he "would continue to recommend ginkgo biloba to older adults as a safe, effective option for supporting cognitive health."
Ginkgo biloba for Preventing Cognitive Decline in Older Adults
A Randomized Trial
Beth E. Snitz, PhD ; Ellen S. O’Meara, PhD ; Michelle C. Carlson, PhD ; Alice M. Arnold, PhD ; Diane G. Ives, MPH ; Stephen R. Rapp, PhD ; Judith Saxton, PhD ; Oscar L. Lopez, MD ; Leslie O. Dunn, MPH ; Kaycee M. Sink, MD ; Steven T. DeKosky, MD ; for the Ginkgo Evaluation of Memory (GEM) Study Investigators
JAMA. 2009;302(24):2663-2670.
Context The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning.
Objective To determine whether G biloba slows the rates of global or domain-specific cognitive decline in older adults.
Design, Setting, and Participants The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years.
Intervention Twice-daily dose of 120-mg extract of G biloba (n = 1545) or identical-appearing placebo (n = 1524).
Main Outcome Measures Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests.
Results Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05).
Conclusion 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.
Trial Registration clinicaltrials.gov Identifier: NCT00010803
Author Affiliations: Departments of Neurology (Drs Snitz, Saxton, Lopez, and DeKosky and Ms Dunn) and Epidemiology (Ms Ives), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Washington, Seattle (Drs O’Meara and Arnold); Department of Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland (Dr Carlson); Departments of Psychiatry and Behavioral Medicine (Dr Rapp) and Internal Medicine (Geriatrics/Gerontology), School of Medicine (Dr Sink), Wake Forest University, Winston-Salem, North Carolina; and School of Medicine, University of Virginia, Charlottesville (Dr DeKosky).
Ginkgo biloba for Preventing Cognitive Decline in Older Adults
A Randomized Trial
JAMA. 2009;302(24):2663-2670.
Context The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning.
Objective To determine whether G biloba slows the rates of global or domain-specific cognitive decline in older adults.
Design, Setting, and Participants The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years.
Intervention Twice-daily dose of 120-mg extract of G biloba (n = 1545) or identical-appearing placebo (n = 1524).
Main Outcome Measures Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests.
Results Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05).
Conclusion 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.
Trial Registration clinicaltrials.gov Identifier: NCT00010803
Author Affiliations: Departments of Neurology (Drs Snitz, Saxton, Lopez, and DeKosky and Ms Dunn) and Epidemiology (Ms Ives), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Washington, Seattle (Drs O’Meara and Arnold); Department of Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland (Dr Carlson); Departments of Psychiatry and Behavioral Medicine (Dr Rapp) and Internal Medicine (Geriatrics/Gerontology), School of Medicine (Dr Sink), Wake Forest University, Winston-Salem, North Carolina; and School of Medicine, University of Virginia, Charlottesville (Dr DeKosky).
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