Treatment of dementia and mild cognitive impairment with or without cerebrovascular disease: Expert consensus on the use of Ginkgo biloba extract, EGb 761®

CNS Neurosci Ther. 2019 Feb;25(2):288-298. doi: 10.1111/cns.13095.


Background: The Ginkgo biloba special extract, EGb 761® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer's disease (AD).

Methods: To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence-based consensus recommendations regarding the use of EGb 761® in neurocognitive disorders with/without cerebrovascular disease.

Results: Key randomized trials and robust meta-analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761® versus placebo in patients with mild-to-moderate dementia. In those with mild cognitive impairment (MCI), EGb 761® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761® with the same strength of evidence as acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761® to have a positive risk-benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta-analyses have not supported this association.

Conclusions: The Expert Group foresee an important role for EGb 761® , used alone or as an add-on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761® should be used in alignment with local clinical practice guidelines.

Keywords: Ginkgo biloba; Alzheimer disease; EGb 761®; cerebrovascular disease; dementia.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / psychology*
  • Cognitive Dysfunction / complications
  • Cognitive Dysfunction / drug therapy*
  • Cognitive Dysfunction / psychology*
  • Consensus
  • Dementia / complications
  • Dementia / drug therapy*
  • Dementia / psychology*
  • Ginkgo biloba
  • Humans
  • Plant Extracts / therapeutic use*
  • Randomized Controlled Trials as Topic


  • Plant Extracts
  • Ginkgo biloba extract