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Abstract
Objectives. To review current evidence of efficacy of Ginkgo biloba extract EGb 761® in dementia with behavioural and psychological symptoms (BPSD). Methods. Randomized, placebo-controlled trials assessing the effects of EGb 761® in dementia patients with BPSD were included if the diagnosis was made in accordance with internationally accepted criteria, the treatment period was at least 22 weeks, outcome measures covered BPSD and at least two of the following domains of assessment, i.e. cognition, activities of daily living and clinical global assessment, and methodological quality was adequate. An analysis of covariance (ANCOVA) model was used to calculate the pooled effect estimates and to compare effects of EGb 761® and placebo; furthermore, combined risk differences of response rates were calculated. Results. Four published trials were identified, involving altogether 1,628 outpatients with mild to moderate dementia. Least-square mean differences for change from baseline in cognition, BPSD (including caregiver distress rating), activities of daily living, clinical global impression, and quality of life favoured EGb 761® (P < 0.001 for all comparisons). Conclusions. The pooled analyses provide evidence of efficacy of EGb 761® at a daily dose of 240 mg in the treatment of out-patients suffering from Alzheimer's, vascular or mixed dementia with BPSD.
Highlights
Population aging and the resulting increased prevalence of both Alzheimer’s disease (AD) and vascular dementia (VaD) has significant implications worldwide
Behavioural and psychological symptoms of dementia (BPSD), referred to as neuropsychiatric symptoms, have been found in 80% to nearly 100% of patients with dementia (Steinberg et al 2008; van der Mussele et al 2013), patients with such symptoms have been excluded from many anti-dementia drug trials, which limits the generalizability of the trial results to the actual patient population (Schneider et al 1997a)
Powlishta et al (2004) have demonstrated that cognitive impairment even in very mild AD is driven by the underlying disease and its severity is independent of concomitant depression
Summary
Population aging and the resulting increased prevalence of both Alzheimer’s disease (AD) and vascular dementia (VaD) has significant implications worldwide. It is estimated that the number of people living with dementia worldwide (35.6 million in 2010) will increase to 65.7 million by 2030 and 115.4 million by 2050 (Alzheimer’s Disease International 2010). Behavioural and psychological symptoms of dementia (BPSD), referred to as neuropsychiatric symptoms, have been found in 80% to nearly 100% of patients with dementia (Steinberg et al 2008; van der Mussele et al 2013), patients with such symptoms have been excluded from many anti-dementia drug trials, which limits the generalizability of the trial results to the actual patient population (Schneider et al 1997a). Powlishta et al (2004) have demonstrated that cognitive impairment even in very mild AD is driven by the underlying disease and its severity is independent of concomitant depression
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