Strategies for the use of Ginkgo biloba extract, EGb 761(R), in the treatment and management of mild cognitive impairment in Asia: Expert consensus

Abstract

Background Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761 (R), is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. Aims To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761 (R) in MCI. Materials & Methods The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761 (R) as a treatment option. Results EGb 761 (R) has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761 (R) may help delay progression from MCI to dementia in some individuals. Discussion EGb 761 (R) is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761 (R) may benefit MCI patients with underlying CVD. Conclusion As an expert group, we suggest it is clinically appropriate to incorporate EGb 761 (R) as part of the multidomain intervention for MCI.