Brigitte Grass-Kapanke, Arija Busmane, Andris Lasmanis, Robert Hoerr, Reiner Kaschel
.
DOI: 10.4236/nm.2011.21007   PDF    HTML     7,956 Downloads   18,523 Views   Citations

Abstract

Objective: To assess effects of EGb 761® on cognition and quality of life in subjects with very mild cognitive impair-ment. Methods: We randomized 300 subjects aged 45 to 65 with cognitive complaints and low functioning (more than one standard deviation below appropriate norm) in at least one cognitive test to double-blind treatment with once daily 240 mg EGb 761® or placebo for 12 weeks. Results: The exploratory intention-to-treat analysis showed significant im-provement (p < 0.025, one-sided) beyond practice effects for EGb 761® in a measure of attention (Vienna Test System - Work Performance Series) and trends in favour of EGb 761® in measures of memory (Wechsler Memory Scale III - Faces I, Appointments Test – delayed recall), and perceived physical health (SF36 - factor score Physical Health). Cognitive effects were more pronounced and more consistent (p < 0.025 in 4 of 5 tests) in subjects with lower memory function at baseline. Specifically, practice effects in the more demanding tests were attenuated or absent in these sub-jects. Conclusion: Ginkgo biloba extract EGb 761® improved cognitive functioning and aspects of quality of life in sub-jects with very mild cognitive impairment.

Keywords

Ginkgo Biloba, EGb 761®, Mild Cognitive Impairment, Memory, Concentration, Randomised Controlled Trial

Share and Cite:

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Kasper and H. Schubert, “Ginkgo Biloba Extract EGb 761? in the Treatment of Dementia: Evidence of Efficacy and Tolerability [Ginkgo-Spezialextrakt EGb 761? in der Behandlung der Demenz: Evidenz für Wirksamkeit und Vertr?glichkeit],” Fortschritte der Neurologie Psychiatrie, Vol. 77, No. 9, September 2009, pp. 494-506.
[2]	S. Weinmann, S. Roll, C. Schwarzbach, C. Vauth and S. N. Willich, “Effects of Ginkgo Biloba in Dementia: Systematic Review and Meta-Analysis,” BMC Geriatrics, Vol. 10, 2010, p.14. http://www.biomedcentral.com/1471-2318/10/14
[3]	B. S. Wang, H. Wang, Y. Y. Song, H. Qi, Z. X. Rong, L. Zhang and H. Z. Chen, “Effectiveness of Standardized Ginkgo Biloba Extract on Cognitive Symptoms of Dementia with a Six-Month Treatment: A Bivariate Random Effect Meta-Analysis,” Pharmacopsychiatry, Vol. 43, No. 3, May 2010, pp. 86-91.
[4]	T. Crook, R. T. Bartus, S. H. Ferris, P. Whitehouse, G. D. Cohen and S. G. Gershon, “Age-Associated Memory Impairment: Proposed Diagnostic Criteria and Measures of Clinical Change: Report of a National Institute of Mental Health Work Group,” Developmental Neuro -psychology, Vol. 2, No. 4, 1986, pp. 261-276.
[5]	R. C. Blackford and A. La Rue, “Criteria for Diagnosing Age-Associated Memory Impairment: Proposed Improvement from the Field,” Developmental Neuropsychology, Vol. 5, No. 4, 1989, pp. 295-306.
[6]	R. Levy and the Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization, “Report: Aging-Associated Cognitive Decline,” International Psychogeriatrics, Vol. 6, No. 1, Spring 1994, pp. 63-68.
[7]	E. M. Ebly, D. B. Hogan and I. M. Parhad, “Cognitive Impairment in the Nondemented Elderly; Results from the Canadian Study of Health and Aging,” Archives of Neurology, Vol. 52, No. 6, June 1995, pp. 612-619.
[8]	M. Zaudig, “A New Systematic Method of Measurement and Diagnosis of ‘Mild Cognitive Impairment’ and De-Mentia According to Icd-10 and DSM-III-R Criteria,” International Psychogeriatrics, Vol. 4, No. S2, 1992, pp. 203-219.
[9]	R. C. Petersen, G. E. Smith, S. C. Waring, R. J. Ivnik, E. F. Tangalos and E. Kokmen, “Mild Cognitive Impairment; Clinical Characterization and Outcome,” Archives of Neurology, Vol. 56, No. 3, March 1999, pp. 303-308.
[10]	R. C. Petersen, R. Doody, A. Kurz, R. C. Mohs, J. C. Morris, P. V. Rabins, K. Ritchie, M. Rossor, L. Thal and B. Winblad, “Current Concepts in Mild Cognitive Impairment,” Archives of Neurology, Vol. 58, No. 12, December 2001, pp. 1985-1992.
[11]	M. Zaudig, “Mild Cognitive Impairment in the Elderly,” Current Opinion in Psychiatry, Vol. 15, No. 4, 2002, pp. 387-393.
[12]	H. Wolf, M. Grunwald, G. M. Ecke, D. Zedlick, S. Bettin, C. Dannenberg, J. Dietrich, K. Eschrich, T. Arendt and H. J. Gertz, “The Prognosis of Mild Cognitive Impairment in the Elderly,” Journal of Neural Transmission Supplements, Vol. 54, 1998, pp. 31-50.
[13]	J. C. Morris, M. Storandt, P. Miller, D. W. McKeel, J. L. Price, E. H. Rubin and L. Berg, “Mild Cognitive Impairment Represents Early-Stage Alzheimer Disease,” Archives of Neurology, Vol. 58, No. 3, March 2001, pp. 397-405.
[14]	S. Larrieu, L. Letenneur, J. M. Orgogozo, C. Fabrig- oule, H. Amieva, N. Le Carret, P. Barberger-Gateau and J. F. Dartigues, “Incidence and Outcome of Mild Cognitive Impairment in a Population-Based Prospec -tive Cohort,” Neurology, Vol. 59, No. 10, November 2002, pp. 1594-1599.
[15]	G. Smith, “Is Mild Cognitive Impairment Bridging the Gap between Normal Aging and Alzheimer’s Disease?” Journal of Neural Transmission Supplements, Vol. 62, No. 2, 2002, pp. 97-104.
[16]	M. F. Elias, A. Beiser, P. A. Wolf, R. Au, R. F. White and R. B. D’Agostino, “The Preclinical Phase of Alzheimer Disease; A 22-Year Prospective Study of the Framingham Cohort,” Archives of Neurology, Vol. 57, No. 6, June 2000, pp. 808-813.
[17]	A. Collie, P. Maruff, R. Shafiq-Antonacci, M. Smith, M. Hallup, P. R. Schofield, C. L. Masters and J. Currie, “Memory Decline in Healthy Older People; Implications for Identifying Mild Cognitive Impairment,” Neurology, Vol. 56, No. 11, June 2001, pp. 1533-1538.
[18]	C. H. Kawas, M. M. Corrada, R. Brookmeyer, A. Morrison, S. M. Resnick, A. B. Zonderman and D. Arenberg, “Visual Memory Predicts Alzheimer’s Disease More than a Decade before Diagnosis,” Neuorology, Vol. 60, No. 7, April 2003, pp. 1089-1093.
[19]	T. Dwolatzky, V. Whitehead, G. M. Doniger, E. S. Simon, A. Schweiger, D. Jaffe and H. Chertkow, “Validity of a Novel Computerized Cognitive Battery for Mild Cognitive Impairment,” BMC Geriatrics, Vol. 3, No. 1, November 2003, p. 4. http://www.biomedcentral.com/1471-2318/3/4
[20]	B. Schmand, C. Jonker, M. I. Geerlings and J. Linde -boom, “Subjective Memory Complaints in the Elderly: Depressive Symptoms and Future Dementia,” British Journal of Psychiatry, Vol. 171, October 1997, pp. 373-376.
[21]	P. W. Schofield, K. Marder, G. Dooneief, D. Jacobs, M. Sano and Y. Stern, “Association of Subjective Memory Complaints with Subsequent Cognitive Decline in Community-Dwelling Elderly Individuals with Baseline Cognitive Impairment,” American Journal of Psychiatry, Vol. 154, No. 5, May 1997, pp. 609-615.
[22]	P. W. Schofield, D. Jacobs, K. Marder, M. Sano and Y. Stern, “The Validity of New Memory Complaints in the Elderly,” Archives of Neurology, Vol. 54, No. 6, June 1997, pp. 756-759.
[23]	M. I. Geerlings, C. Jonker, L. M. Bouter, H. J. Adèr and B. Schmand, “Association between Memory Com- Plaints and Incident Alzheimer’s Disease in Elderly People with Normal Baseline Cognition,” American Journal of Psychiatry, Vol. 156, No. 4, April 1999, pp. 531-537. http://ajp.psychiatryonline.org/cgi/content/full/156/4/531
[24]	A. K. Berger, L. Fratiglioni, Y. Forsell, B. Winblad and L. B?ckman, “The Occurrence of Depressive Symptoms in the Preclinical Phase of AD; A Population-Based Study,” Neurology, Vol. 53, No. 9, December 1999, pp. 1998-2002.
[25]	N. Rasgon and L. Jarvik, “Insulin Resistance May Link Affective Disorders and Alzheimer’s Disease: A Missing Link Hypothesis,” International Psychogeriatrics, Vol. 15, No. S2, August 2003, p. 153 (Abstract S071- 005).
[26]	C. G. Lyketsos, O. Lopez, B. Jones, A. L. Fitzpatrick, J. Breitner and S. T. DeKosky, “Prevalence of Neuro- Psychiatric Symptoms in Dementia and Mild Cognitive Impairment; Results from the Cardiovascular Health Study,” Journal of the American Medical Association, Vol. 288, No. 12, September 2002, pp. 1475-1483. http://jama.ama-assn.org/cgi/content/full/288/12/1475
[27]	D. C. Chan, J. D. Kasper, B. S. Black and P. V. Rabins, “Prevalence and Correlates of Behavioral and Psychiat -ric Symptoms in Community-Dwelling Elders with De-Mentia or Mild Cognitive Impairment: The Memory and Medical Care Study,” International Journal of Geriatric Psychiatry, Vol. 18, No. 2, February 2003, pp. 174-182.
[28]	Y. Forsell, K. Palmer and L. Fratiglioni, “Psychiatric Symptoms/Syndromes in Elderly Persons with Mild Cognitive Impairment; Data from a Cross-Sectional Study,” Acta Neurologica Scandinavica, Vol. 107, No. S179, 2003, pp. 25-28.
[29]	D. Wechsler, “WMS-III Administration and Scoring Manual,” The Psychological Corporation, San Antonio, 1997.
[30]	W. Neuwirth and M. Benesch, “Arbeitsleistungsserie Version 25.00; Handanweisung,” Schuhfried, M?dling, 2004.
[31]	W. Neuwirth and M. Benesch, “Wiener Determina -tionstest Version 31.00; Handanweisung,” Schuhfried, M?dling, 2005.
[32]	D. von Zerssen, “Clinical Self-Rating Scales (CSRS) of the Munich Psychiatric Information System (PSYCHIS München),” In: N. Sartorius and T. A. Ban, Eds., Assessment of Depression, Springer, Berlin, 1986, pp. 270-303.
[33]	J. E. Ware, K. K. Snow, M. Kosinski and B. Gandek, “SF-36 Health Survey Manual and Interpretation Guide.” New England Medical Center, the Health Institute, Boston, 1993.
[34]	A. E. Zehnder, S. Bl?si, M. Berres, R. Spiegel and A. U. Monsch, “Lack of Practice Effects on Neuropsychological Tests as Early Cognitive Markers of Alzheimer Disease?” American Journal of Alzheimer’s Disease & Other Dementias, Vol. 22, No. 5, October-November 2007, pp. 416-426.
[35]	H. Schubert and P. Halama, “Depressive Episode Primarily Unresponsive to Therapy in Elderly Patients: Efficacy of Ginkgo Biloba Extract EGb 761? in Combination with Antidepressants [Prim?r therapieresistente depressive Verstimmung ?lterer Patienten mit Hirnleistungsst?rungen: Wirksamkeit der Kombination von Ginkgo-biloba-Extrakt EGb 761? mit Antidepres- siva],” Geriatrie Forschung, Vol. 3, No. 1, 1993, pp. 45-53.
[36]	U. Stocksmeier and M. Eberlein, “Depression Associated with Impairment of Cerebral Function; Effects of a Ginkgo Biloba Extract Investigated in Double-Blind Trial [Depressive Verstimmung bei Hirnleistungsst?rungen; Wirkung eines Ginkgo-biloba-Extraktes in Doppelblind-Studieüberprüft],” TW Neurologie Psychiatrie, Vol. 6, January-February 1992, pp. 74-76.