Older adults who used the herbal supplement Ginkgo biloba for several years did not have a slower rate of cognitive decline compared to adults who received placebo, according to a recent study [JAMA, 302(24): 2663-2670].

"Ginkgo biloba is marketed widely and used with the hope of improving, preventing, or delaying cognitive impairment associated with aging and neurodegenerative disorders such as Alzheimer disease," the authors write. "Indeed, in the United States and particularly in Europe, G biloba is perhaps the most widely used herbal treatment consumed specifically to prevent age-related cognitive decline." However, evidence from large clinical trials regarding its effect on long-term cognitive functioning is lacking.

Beth E. Snitz, PhD, of the University of Pittsburgh, and colleagues analyzed outcomes from the Ginkgo Evaluation of Memory (GEM) study to determine if G biloba slowed the rate of cognitive decline in older adults who had normal cognition or mild cognitive impairment (MCI) at the beginning of the study.

The GEM study previously found that G biloba was not effective in reducing the incidence of Alzheimer dementia or dementia overall. The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.

In this study, the largest randomized controlled trial of G biloba to report on outcomes to date, the researchers found no evidence for an effect of G biloba on global cognitive change and no evidence of effect on specific cognitive domains of memory, language, attention, visuospatial abilities and executive functions. They also found no evidence for differences in treatment effects by age, sex, race, education or baseline cognitive status (MCI vs. normal cognition).

"In sum, we find no evidence that G biloba slows the rate of cognitive decline in older adults," the authors concluded. "These findings are consistent with previous smaller studies examining prevention of decline and facilitation of cognitive performance and with the 2009 Cochrane review of G biloba for dementia and cognitive impairment."