Nagaendran Kandiah1,2,3, Yee Fai Chan4, Christopher Chen5, Darwin Dasig6, Jacqueline Dominguez7, Seol-Heui Han8, Jianping Jia9, SangYun Kim10, Panita Limpawattana11, Li-Ling Ng12, Dinh Toan Nguyen13, Paulus Anam Ong14, Encarnita Raya-Ampil15, Nor'izzati Saedon16, Vorapun Senanarong17, Siti Setiati18, Harjot Singh19, Chuthamanee Suthisisang20, Tong Mai Trang21, Yuda Turana22, Narayanaswamy Venketasubramanian23, Fee Mann Yong24, Yong Chul Youn25, Ralf Ihl26. 1. National Neuroscience Institute, Singapore, Singapore. 2. Duke-NUS, Singapore, Singapore. 3. Lee Kong Chian-Imperial College, Singapore, Singapore. 4. Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. 5. Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, Memory Aging and Cognition Centre, National University of Singapore, Singapore, Singapore. 6. Makati Medical Center, Manila, Philippines. 7. St Luke's Medical Center, Manila, Philippines. 8. Konkuk University Medical Center, Seoul, Korea. 9. Xuanwu Hospital, Capital Medical University, Beijing, China. 10. Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Korea. 11. Srinakarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 12. Changi General Hospital, Singapore, Singapore. 13. Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam. 14. Hasan Sadikin General Hospital, Jawa Barat, Indonesia. 15. University of Santo Tomas, Metro Manila, Philippines. 16. Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 17. Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 18. Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 19. Dr Harjot Singh's Neuropsychiatry Centre and Hospital, Amritsar, India. 20. Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. 21. Department of Neurology, University Medical Center, Ho Chi Minh City, Vietnam. 22. School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia. 23. Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore. 24. Subang Jaya Medical Centre, Selangor, Malaysia. 25. Chung-Ang University Medical Center, Seoul, Korea. 26. Alexian Hospital, Krefeld, Germany.
Abstract
BACKGROUND: Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761® , is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. AIMS: To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761® in MCI. MATERIALS & METHODS: The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761® as a treatment option. RESULTS: EGb 761® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761® may help delay progression from MCI to dementia in some individuals. DISCUSSION: EGb 761® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761® may benefit MCI patients with underlying CVD. CONCLUSION: As an expert group, we suggest it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI.
BACKGROUND: Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761® , is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. AIMS: To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761® in MCI. MATERIALS & METHODS: The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761® as a treatment option. RESULTS: EGb 761® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761® may help delay progression from MCI to dementia in some individuals. DISCUSSION: EGb 761® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761® may benefit MCI patients with underlying CVD. CONCLUSION: As an expert group, we suggest it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI.
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