A review of randomized controlled trials found little to no benefit of Ginkgo biloba for mild cognitive impairment or multiple sclerosis-related cognitive symptoms. Evidence suggests small symptomatic improvements in dementia, but findings are uncertain due to study variability and limited long-term data.
Study: Ginkgo biloba for cognitive impairment and dementia. Image Credit: Gondronx Studio / Shutterstock
In a recent systematic review published in the Cochrane Database of Systematic Reviews, researchers evaluated the clinical efficacy and safety of Ginkgo biloba (ginkgo) for individuals with cognitive impairment and dementia. The review analyzed data from 82 randomized controlled trials (RCTs) involving 10,613 participants, with 72 studies providing extractable outcome data; however, not all outcomes were suitable for quantitative pooling. The review aimed to elucidate ginkgo’s impact on memory, cognitive function, and daily routine task performance.
Review findings revealed that ginkgo offers little to no benefit for those with mild cognitive impairment (MCI) or multiple sclerosis-related cognitive impairment. While the authors noted small to moderate benefits for patients already diagnosed with dementia, the review highlights significant heterogeneity in study outcomes, emphasizing the need for standardized future protocols. Evidence for dementia benefits is of low certainty, and some analyses have shown very high statistical heterogeneity across trials.
Dementia Burden and Herbal Supplement Interest
Dementia is an umbrella term for a spectrum of progressive neurocognitive disorders characterized by significant declines in memory, thinking, behavior, and cognitive function that often hamper routine life.
The condition is increasingly recognized as a global health crisis, especially as advancements in modern medicine have led to projections of 1.4 billion people aged 60 and older by 2030. Despite decades of research, dementia and other forms of cognitive decline, such as Alzheimer’s disease (AD), have no scientifically validated cure or clearly established disease-modifying therapy.
Current interventions aim to prevent dementia onset through risk assessment and delay progression once clinically diagnosed. Consequently, many individuals seek alternative remedies in traditional folk medicine and media-popularized cures. Among the most popular is Ginkgo biloba, ginkgo, an extract from one of the oldest extant tree species.
Modern medicine typically uses a standardized extract known as EGb 761, which contains specific bioactive compounds, flavonoids, and terpene lactones. These compounds are believed to act as antioxidants, reduce brain inflammation, and protect neurons from damage, making the plant and its extracts biologically plausible candidates for treating cognitive disorders, although this Cochrane review evaluated clinical outcomes rather than mechanistic effects.
Despite widespread use as an over-the-counter supplement, scientific evidence for ginkgo’s effectiveness remains inconsistent, necessitating an updated synthesis of its potential cognitive benefits.
Systematic Review Design and Outcomes
This Cochrane systematic review synthesized trial evidence on ginkgo’s efficacy across a large, diverse pooled sample. Review data were obtained through searches of major medical databases, including MEDLINE and Embase, and were updated in November 2024 to include multiple trial registries and regional databases.
The review focused on RCTs investigating ginkgo supplementation in adults with subjective cognitive complaints, MCI, dementia, or multiple sclerosis-related cognitive problems rather than exclusively older adults.
The final analysis included 82 studies with 10,613 participants, including people with subjective memory complaints, multiple sclerosis, MCI, and diagnosed dementia, such as Alzheimer’s or vascular dementia.
The primary endpoints included global clinical status, an overall clinician-rated impression of change in health or functioning, global cognitive function assessed using standard tools such as the Mini-Mental State Examination (MMSE) or the Alzheimer’s Disease Assessment Scale-cognition (ADAS-Cog), activities of daily living (ADLs), and safety based on adverse events (AEs) and serious adverse events (SAEs).
Cognitive Effects in MCI and Dementia
Analyses suggested that baseline health status altered ginkgo’s apparent efficacy. For participants with multiple sclerosis-related cognitive impairment, ginkgo’s effects were not statistically distinguishable from placebo, with moderate-certainty evidence of little or no cognitive benefit.
Similarly, among 1,913 participants with MCI, ginkgo did not show a significant advantage over placebo at six months, with moderate-certainty evidence indicating little or no meaningful improvement in global clinical status, cognition, or daily functioning.
In contrast, participants with a formal dementia diagnosis showed improved global clinical status and cognitive function, and a slightly improved ability to perform daily tasks compared with the placebo group. However, evidence certainty was low, results varied widely between trials, longer-term data beyond about six months were limited, and current evidence does not demonstrate disease-modifying effects, only possible symptomatic benefit.
Safety assessments found no significant increase in adverse event risk compared with placebo in MCI and dementia populations. One short trial in people with subjective cognitive complaints suggested adverse events may occur more frequently with ginkgo, and evidence for serious adverse events remains uncertain.
Clinical Interpretation and Research Gaps
This review synthesizes randomized trial evidence and concludes that while ginkgo is not a preventive “magic pill” for cognitive decline in healthy or mildly impaired individuals, it may provide modest symptomatic improvement for people living with dementia based on low-certainty evidence and heterogeneous results.
The review highlights substantial heterogeneity across RCTs and emphasizes the need for standardized methodologies and longer-term trials to identify which patients, such as those with Alzheimer’s versus vascular dementia, are most likely to benefit from supplementation.
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