Weiland, Lisa S, Ludeman, Emilie, Chi, Yuan, Feinberg, Termeh M, Chen, I-Hui, Chen, Kee-Hsin, Zhu, Yanan, Wolverson, Emma and Amri, Hakima (2026) Ginkgo biloba for cognitive impairment and dementia (Review). Cochrane Database of Systematic Reviews (2).

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Abstract

Background
Dementia is a neurocognitive disorder that interferes with cognition and independent functioning. Common dementia subtypes include Alzheimer's disease, vascular dementia, and mixed type. Mild cognitive impairment (MCI) is a risk factor for dementia, and subjective cognitive complaints may be the earliest manifestation. Although cholinesterase inhibitors may help reduce some cognitive and behavioral symptoms, there is no established treatment that cures or slows dementia progression. Ginkgo biloba (ginkgo) is a popular herbal preparation that is used to improve brain and circulatory health, and neuroprotective eJects are biologically plausible.

Objectives
To assess the benefits and harms of Ginkgo biloba for the treatment of people with cognitive impairment or dementia.

Search methods
We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and two trials registries on 8 December 2022. The search was updated in MEDLINE, Embase, CENTRAL, and the trials registers on 18 November 2024.

Selection criteria
We included randomized controlled trials (RCTs) comparing ginkgo with placebo, usual treatment, or other treatments for cognitive problems in people with cognitive complaints or diagnoses of MCI or dementia.

Data collection and analysis
Two review authors independently selected trials, extracted data, and assessed studies for risk of bias. Key outcomes were global clinical status, global cognitive function, activities of daily living (ADLs), adverse events (AEs), and serious adverse events (SAEs) at six months. When clinically appropriate, we pooled data using a random-eJects model and expressed treatment eJects as mean diJerences (MDs),standardized mean diJerences (SMDs), or risk ratios (RRs), each with its 95% confidence interval (CI). We used GRADE methods to assess the certainty of the evidence for each estimate.

Main results
We included 82 studies with 10,613 participants; 72 studies with 9783 participants provided extractable data. Four studies were at low risk of bias in all domains. Below we present data for the comparison of ginkgo versus placebo in people with diJerent clinical conditions.

Subjective cognitive impairment
Three studies (597 participants) compared ginkgo with placebo for people with subjective cognitive complaints. Based on one study that lasted six months, it is uncertain whether ginkgo has any eJect on global clinical status measured on a five point Likert scale (MD 0.00,95% CI −0.33 to 0.33; P = 1.00; 1 study, 197 participants; very low-certainty evidence). There were no data on cognition or ADLs. One study reported no diJerence in minor side eJects between treatment groups and did not mention SAEs. A larger study lasting three months found that the risk of AEs may be higher with ginkgo versus placebo. It provided very uncertain evidence on the risk of SAEs.

Multiple sclerosis and cognitive impairment
Two studies (164 participants) tested ginkgo versus placebo over three months in people with multiple sclerosis and cognitive problems. Ginkgo probably has little or no eJect on cognition measured on the Perceived Deficits Questionnaire (MD −0.09, 95% CI −0.41 to 0.22; P =0.55, IP = 0%; 2 studies, 152 participants; moderate-certainty evidence). There were no data on global clinical status or ADLs. The studies suggested no important diJerence in numbers of AEs between groups, and there was no indication of SAEs due to ginkgo.

Mild cognitive impairment
Twelve studies (1913 participants) tested ginkgo against placebo in people with MCI. At six months, moderate-certainty evidence suggests that ginkgo probably has little to no eJect on global clinical status measured on the Clinical Dementia Rating Scale (MD −0.03, 95% CI −0.06 to 0.01; 3 studies, 631 participants; IP = 0%), cognition measured on the Alzheimer's Disease Assessment Scale – cognition (MD −0.07, 95% CI −0.67 to 0.51; IP = 0%; 2 studies, 508 participants), and ADLs measured on the Instrumental ADL scale (MD −0.05, 95% CI −0.29 to 0.19; 1 study, 350 participants). There may be little or no diJerence between ginkgo and placebo at up to 12 months in the risk of AEs (RR 0.98, 95% CI 0.77 to 1.24; IP = 58%; 7 studies, 991 participants, 379 events; low-certainty evidence), and there is little or no diJerence in the risk of SAEs (RR 0.95, 95% CI 0.82 to 1.09; IP = 0%; 3 studies, 714 participants, 327 events; high-certainty evidence).

Dementia
Thirteen studies (3288 participants) compared ginkgo with placebo for dementia. At six months, low-certainty evidence suggests that people taking ginkgo may have better global clinical status on a six-point Likert scale (lower is better; MD −0.06, 95% CI −1.00 to −0.20; IP = 88%; 5 studies, 1359 participants), better cognition measured by decreases on a short cognitive performance test (Syndrom-Kurztest; MD−1.86, 95% CI −3.48 to −0.24; IP = 96%; 9 studies, 2801 participants), and slightly better ADLs measured on the ADL International Scale (MD −0.19, 95% CI −0.35 to −0.03; IP = 91%; 8 studies, 2571 participants). There is probably little or no diJerence between ginkgo and placebo in the risk of AEs at up to 12 months (RR 0.95, 95% CI 0.90 to 1.00; IP = 0%; 9 studies, 2746 participants, 1480 events; moderate-certainty evidence). There may be little or no diJerence in risk of SAEs at six months (RR 0.88, 95% CI 0.58 to 1.33; IP = 0%; 6 studies, 2463 participants, 89 events; low-certainty evidence).

Authors' conclusions
In people with cognitive complaints, we are unsure whether ginkgo improves global clinical status at six months, and it may be associated with an increased risk of AEs at three months. Ginkgo probably has no benefit at three months for cognition in multiple sclerosis; numeric data on AEs were unavailable, but studies did not suggest concerns. In people with MCI, ginkgo probably has little or no eJect at six months on global status, cognition, or ADLS. There may be little or no diJerence in AEs, and there is little or no diJerence in SAEs, at up to 12 months. In people with dementia, there may be small to moderate benefits at six months for global status, cognition, and ADLs. There is probably little or no diJerence in AEs at up to 12 months, and there may be no diJerence in SAEs.

Item Type:	Article
Identifier:	10.1002/14651858.CD013661.pub2
Subjects:	Medicine and health > Clinical medicine > Dementia
Date Deposited:	11 Feb 2026
URI:	https://repository.uwl.ac.uk/id/eprint/14540

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