Primary Care Blog
Short of taking Egrifta at $46/d for 20 weeks in just over 150 participants, no other medication or dietary supplement has been shown to slow the development of dementia, much less reverse it. While cocoa,Mediterranean diet & exercise may decrease the rate of cognitive decline, most of us are looking for any easier way out, usually in the form of a pill. Our hopes have been pinned on ginkgo biloba for some time, although multiple studies over the years have demonstrated no benefit.
For instance, a May 2008 randomized controlled study of 118 participants w/normal cognitive function followed for 42 months demonstrated no benefit (although there was a hint of benefit when taking into account adherence). A November 2008 RCTof 3,069 participants, most w/normal cognitive function, followed for 6+yrs also demonstrated no benefit. A December 2009 analysis of this same group demonstrated no benefit from ginkgo biloba.
"Insanity is doing the same thing over and over again but expecting different results."
So perhaps it should come as no surprise that arandomized controlled trial published September 6 in Lancet Neurology found no delay in progression to dementia when comparing ginkgo biloba 120mg twice daily to placebo over 5yrs in 2,854 participants. Of note, this study was sponsored by the supplement manufacturer who had much to gain if benefit was found. Not surprisingly, the lead author opined that "it may be that people need to take it for longer."
On the other hand, I am in Dr. Lon Schneider's camp: If something doesn't do what you want it to do, why continue taking it? I suppose one could hold out hope and keep taking this supplement since it's "relatively benign" but at what cost? I think we'd have better luck focusing, as noted above, on nutrition & exercise, possibly cocoa. And if one had a lot of loose change and felt like acting as a guinea pig, perhaps taking off-label Egrifta, if larger, longer duration studies pan out.
Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
