⌛ Gingko Biloba Research Paper
Gingko Biloba Research Paper, even Gingko Biloba Research Paper we Gingko Biloba Research Paper the two scales, Gingko Biloba Research Paper beneficial effect of Gb remained evident at least Gingko Biloba Research Paper the SKT. Our evidence-based analysis on ginkgo biloba features unique references Gingko Biloba Research Paper The History of Art papers. Xiongwei Zhu et al. Gen Pharmacol. Pros And Cons Of Interrogations Opin Pharmacother. The safety of Gb Gingko Biloba Research Paper appeared good. Author s :.
The Benefits of Gingko Biloba
This example Gingko Biloba Essay is published for educational and informational purposes only. If you need a custom essay or research paper on this topic please use our writing services. Essay Examples. Psychology Essay Examples. Special offer! Two researchers NB and SR independently reviewed all information about the articles provided by the databases. Any discrepancies were solved by consensus.
We assessed the quality of the study design, duration of the study, comparability of study groups, and clinical outcomes on different widely used rating scales. When it was possible, data were pooled by means of meta-analysis. A random-effects model DerSimonian-Laird was used to calculate a pooled effect estimate, because of heterogeneity. Heterogeneity of effect sizes was evaluated by the statistic. If meta-analyses were not possible, the results of individual studies are presented. Meta-analyses were performed using Meta-Analyst and RevMan 5 for all calculations [ 33 ].
Our literature search identified clinical publications. Summary of the final articles included is shown in Table 1. Overall, the methodology of the included studies was good Figure 2. Patients were randomly assigned to receive either Gb or placebo in adjunction to risperidone. The primary outcome was the ABC-C scale. There was no statistically significant difference between the two groups according to the aforementioned subscale. Thus, Gb seemed to be not an efficacious adjunctive therapy to risperidone. However, it appeared to be safe and well tolerated even in childhood. Salehi et al. The investigators reported that Gb had no comparable efficacy in comparison with methylphenidate.
Even if Gb determined significantly few side effects especially insomnia and loss of appetite , methylphenidate determined a dramatic improvement in a range of symptoms. Only one double-blind randomized controlled study had been conducted so far involving 44 DSM-IV cocaine-dependent men and women [ 36 ]. Each participant randomly received either piracetam, Gb, or placebo. The primary outcome was the relapse from abstinence measured as self-reported relapse, treatment dropout, or positive urine toxicology screening.
At the end of the study, no significant differences were observed between the three groups. Only one study investigating the effects of Gb on GAD fulfilled the review criteria [ 37 ]. The authors reported a significant improvement in psychopathological symptoms. Of note, there was a significant inverse dose-response relationship between the dose per Kg and the HAMA score. The safety of Gb extract appeared good. Recently, Zhang et al. All participants were on antipsychotic medication chlorpromazine equivalents were comparable between the two groups.
Tardive dyskinesia severity, which represented the primary outcome of the study, was assessed by means of the Abnormal Involuntary Movement Scale AIMS. Despite the significant effect of Gb on movement symptoms, no significant effect of group was observed for psychopathological symptoms representing a secondary outcome of the study , as both groups showed an improvement over time. Three randomized clinical trials evaluating Gb extract in patients with schizophrenia were included in the analysis [ 39 — 41 ]. Two studies were double-blind and placebo controlled. Randomization procedure and methodology were considered adequate in all cases. Gb was used as an adjunctive therapy to different antipsychotics: clozapine Doruk et al.
Mean chlorpromazine equivalent doses were comparable in the first two studies 8. All studies included only patients with chronic schizophrenia. Heterogeneity was substantial. To perform sensitivity analysis, we decided to remove the study from Atmaca et al. Removing this trial did not significantly change our findings. Heterogeneity remained substantial.
Ten studies fulfilled the inclusion criteria: meta-analysis was performed only on eight studies [ 42 — 49 ] which were comparable for clinical purposes. Eight studies were placebo controlled, while two studies were a head-to-head trial with donepezil as comparison group [ 50 ] or a triple-blind study with Gb, donepezil, and placebo [ 51 ]. The very different dosages of Gb and donepezil rendered meta-analytical examination unfeasible in the latter studies.
All studies were randomized, double-blind trials. Overall, the methodological quality of the included studies was judged as adequate, with most studies using an intent-to-treat analysis. In all included trials a standardized extract EGb was used. For meta-analysis, we focused on the effect of Gb on cognition and ADL. Of note, heterogeneity was substantial. To perform sensitivity analysis, we tried to remove the older trials in which the quality of methodological design was not as high as in most recent studies. ADLs were measured with different scales. Of note, we found substantial heterogeneity. The two trials performing a comparison between Gb and donepezil reported no statistically significant differences between the cholinesterase inhibitor and Gb in treating mild to moderate dementia.
Both studies showed comparable treatment time, but the study of Ihl et al. The effect of Ginkgo biloba has been studied in a variety of neuropsychiatric conditions. However, the general lack of evidence prevents drawing conclusions regarding Gb effectiveness in many neuropsychiatric conditions, such as autism, ADHD, addiction, GAD, and tardive dyskinesia. Of all the psychiatric disorders reviewed, dementia has been the most extensively studied. Our meta-analysis of eight studies in dementia showed that Gb differed significantly from placebo, providing beneficial effects both in cognition and activities of daily living.
Our results are consistent with a recent meta-analysis [ 13 ] on the effect of Gb on cognition. On the other hand, we found a significant difference between Gb and placebo for activities of daily living in patients with dementia which were not significant in the aforementioned report [ 13 ]. This difference may be at least in part due to the inclusion of a very recent study, yielding significant positive results in this area of functioning. We decided to pool together studies using different scales evaluating the same domain i.
Additionally, even if we separated the two scales, the beneficial effect of Gb remained evident at least for the SKT. Of note, we did not observe a significant improvement in heterogeneity. Considering the activities of daily living domain, there is a lack of studies using the same outcome scale; thus, we pooled together different questionnaires measuring the same area in order to improve power.
However, if we considered only trials using the same outcome scale, we still observed a beneficial effect of Gb in the ADL-IS. Although there is clear heterogeneity, we were unable to explain it. Sensitivity analysis excluding trial with poorer methodological quality did not explain the heterogeneity. Under these circumstances, we dealt with the existence of heterogeneity using a random-effect model. Notwithstanding the shortage of specific studies, available evidence also supports the use of Gb in chronic schizophrenia. In particular, Gb seems to exert a beneficial effect on positive psychotic symptoms.
No significant effect on negative symptoms has been observed. In particular, we performed sensitivity analysis excluding one study with different chlorpromazine equivalents. In fact, the study from Atmaca et al. However, heterogeneity was not modified. The beneficial effect of Gb in both dementia and chronic schizophrenia is however modest. Particularly, the mean effect observed in cognition is sometimes lower than what is considered clinically meaningful [ 52 ].
However, Gb was equal to donepezil in two recent clinical trials, thus potentially providing an evidence for its use in dementia, which to date could be treated with few pharmacological agents. Of note, Gb is generally used as an adjunctive therapy in schizophrenia, not as a first-line intervention, and, thus, even a small additional improvement could be valuable. Notably, all trials demonstrated an excellent safety profile for Gb. Limitations should caution against overinterpretation of the findings. The included studies showed high heterogeneity, which could possibly have biased our results.
Additionally, whether longer trials would yield more significant results in dementia and schizophrenia remains to be seen. Another potential limitation is that even though our search was systematic and rigorous, we could have missed eligible studies inadvertently. Despite the heterogeneity of the clinical trials, available evidence is sufficient to support the use of Gb in patients with dementia and as an adjunctive therapy in schizophrenic patients.
Despite the promising results, broad recommendations for the use of Gb in other neuropsychiatric conditions, such as ADHD, autism, and AD are still premature. It should be considered to run major multicenter studies in order to shed more light on the effectiveness of Gb in dementia subgroups and schizophrenia. Hopefully, the design of the study should use currently available level of treatment and care, in order to provide a broader generalizability of the results.
This research received no specific grant from any funding agency in the public, commercial, or noprofit sectors. All the other authors have no conflicts of interests. The authors would like to acknowledge Dr. Robert Hoerr for the precious advice on the analysis of data. They would like to thank Dr. Shien Guo, Dr. Andy Suter, and Professor Ralf Ihl for their help in collecting manuscripts. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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