In a retrospective study, 12 months of treatment with a Ginkgo biloba special extract as monotherapy or in combination with cholinesterase inhibitors resulted in a reduction in cognitive and neuropsychiatric symptoms in patients with vascular dementia. This is a relevant finding for clinical research and practice.
Vascular dementia is the second most common form of dementia after Alzheimer’s disease and is caused by vascular-related damage to the brain (e.g., cerebral infarcts, microangiopathy, and microbleeds) [1]. The risk of vascular dementia increases with each stroke. Hypertension, diabetes mellitus, atherosclerosis, atrial fibrillation, dyslipidemia, smoking, and physical inactivity are significant vascular risk factors. Similar to other dementing diseases, cognitive impairments such as impaired memory and slowed thinking functions occur in the context of vascular dementia. Symptoms depend on which areas of the brain have been damaged.
Symptom relief as a therapeutic goal
There is no set treatment regimen for vascular dementia. In addition to treatment of relevant vascular risk factors and underlying diseases, medications are sometimes used for symptomatic therapy of dementia-related symptoms. In addition to cholinesterase inhibitors (AChE-i) approved for AD in off-label use, drugs containing ginkgo are also frequently used [2]. The efficacy of the special ginkgo extract EGb 761® in alleviating vascular cognitive impairment has been documented, among others, in a Systematic Review published in 2021, which included data from 23 RCTs involving a total of more than 2000 patients with vascular dementia [3]. The results of a retrospective study published this year by a Spanish research team support the benefit of the special ginkgo extract EGb 761® as monotherapy or in combination with AChE-i in this patient population [2].
EGb 761® proved effective alone or combined with AChE-i
García-Alberca et al. included 77 patients who had visited the Alzheimer Disease Center and Memory Clinic of the Instituto Andaluz de Neurociencia in Málaga (Spain), between January 2018 and December 2020 [2]. All were diagnosed with vascular dementia according to VICCCS (The Vascular Impairment of Cognition Classification Consensus Study) classification criteria: Post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia [4]. The included patients had been treated with any of the following drugs [2]:
- Ginkgo biloba extract EGb 761® (240 mg daily)
- Donepezil (10 mg daily)
- Galantamine (16 or 24 mg daily)
- Rivastigmine patches (9.5 or 13.3 mg daily).
Significant improvements in various domains
The following three treatment groups were formed: EGb 761® alone (n=25), AChE-i alone (n=26), EGb 761® plus AChE-i (n=26). The test procedures used can be seen in overview 1 [2]. A statistically significant improvement was observed in the EGb 761® group compared to the AChE-i group at the 12-month follow-up with respect to CFT (+1.74, p<0.001), TMT-A (-17.91, p=0.031), and NPI (-5.89, p<0.001). With regard to combined use, participants treated with EGb 761® plus AChE-i showed statistically significant improvement in MMST (Fig. 1) compared with AChE-i treatment alone at 12-month follow-up, as well as in scores on the following tests: RAVLT, CFT, TMT-A, TMT-B, and NPI.
In summary, the results of the present study provide further evidence that patients with vascular dementia may benefit from treatment with EGb 761®. Symptom relief was achieved both when used alone and in combination with cholinesterase inhibitors. The additional performance enhancement produced by combination therapy can probably be explained by synergistic effects of the two drugs. Important mechanisms of action of the ginkgo special extract are the circulation-promoting properties and an improvement of the blood’s flow properties. EGb 761® tablets (120-240 mg per day) can be taken independently of meals.
Literature:
- Khan A, et al: Update on vascular dementia. J Geriatr Psychiatry Neurol 2016; 29: 281-301.
- García-Alberca JM, Mendoza S, Gris E: Benefits of Treatment with Ginkgo Biloba Extract EGb 761 Alone or Combined with Acetylcholinesterase Inhibitors in Vascular Dementia. Clin Drug Investig 2022, https://doi.org/10.1007/s40261-022-01136-8
- Zhan M, et al: EGb in the treatment for patients with VCI: a systematic review and meta-analysis. Oxid Med Cell Longev. 2021. https://doi.org/10.1155/2021/8787684.
- Skrobot OA, et al: The vascular impairment of cognition classification consensus study. Alzheimers Dement 2017; 13: 624-633.
HAUSARZT PRAXIS 2022; 17(6): 34
InFo PAIN & GERIATrIa 2022; 4(1-2): 28.
