Biomarker-confirmed trials finally offer a cleaner signal.
STUDY: Yang YS et al, Brain Sci 2026;16:430
STUDY TYPE: Review
FUNDING: Korea Health Industry Development Institute; Soonchunhyang University Research Fund
Background
Twenty years of ginkgo biloba trials in Alzheimer’s have produced the same frustrating conclusion: possible benefit, but inconsistent and never convincing. This review argues the problem wasn’t the drug — it was the trial design. Older trials mixed Alzheimer’s with vascular and “mixed” dementia, used variable doses, and relied on short follow-ups. Lumping biologically different patients together dilutes any true signal.
The Study
This narrative review synthesizes symptomatic trials, prevention trials, and meta-analyses of ginkgo biloba across the Alzheimer’s disease spectrum, then zeroes in on a newer generation of biomarker-confirmed studies. More recent trials confirmed Alzheimer’s at the biological level, enrolling amyloid PET-positive patients. In those studies, ginkgo monotherapy (240 mg/day for 12 months) was associated with preserved cognition (on MMSE) and improved daily function, alongside reductions in a plasma marker of amyloid oligomerization (MDS-OAβ), while the comparison group worsened on both. Another study using amyloid-PET criteria found similar results by augmenting donepezil with ginkgo.
These biomarker-confirmed studies are small, retrospective, and mostly from one research group; in need of replication.
The prevention data are unclear. Large community trials found no reduction in dementia incidence. Meta-analyses of symptomatic trials suggest possible benefit on cognition and daily function, but heterogeneity is substantial and clinical meaningfulness is debated.
Practice Implications
- The biomarker-confirmed data hint that past trials may have buried a real, if modest, signal in Alzheimer’s.
- The branded standardized extract is difficult to find and expensive (Egb-761 (Tebonin)). Other brands whose integrity was confirmed by independent labs include Life Extension, GNC Herbal Plus, Nature Made, Nature’s Way, Nutrilite Memory Builder, Pure Encapsulations, Memory Pro, Vitamin Shoppe.
- Anticoagulant interactions in older patients are a concern; ginkgo has some antiplatelet activity.
Ginkgo also has positive trials in depression, mild cognitive impairment, and post-stroke cognitive impairment… suggesting someone should study it in vascular depression.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
