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Ginkgo biloba

Lauren Gollehon, Andy Cox, Hannah Borges, Emily


Smith, Lindsay Kalanta
Outline

Introduction

Alzheimers Introduction

Signs of Alzheimers

Patient Case Study

Relevant Medicinal Research Studies

Patient Teaching

Memory Activity
Introduction
Two components of ginkgo are believed to act as
medicine: flavonoids and terpenoids.

Flavonoids are thought to protect the nerves, heart


muscle, blood vessels, and retina from damage.
Terpenoids improve blood flow by dilating blood
vessels and reducing the stickiness of platelets.

Ginkgo is thought to help people with Alzheimer


disease:
Improve thinking, learning, and memory
Have an easier time performing daily activities

Improve social behavior

Have fewer feelings of depression


What is Alzheimers?
Alzheimers is the most common form of
dementia

Dementia is a general term that refers to any


decline in mental ability to interfere with daily
life

Alzheimers causes problems with memory,


thinking and behavior

Alzheimers is a progressive disease that becomes


more severe with time

There is no cure for Alzheimers at this time. The


http://www.alz.org/what-is-dementia.as

goal of treatment is to manage symptoms and


10 Signs of Alzheimers
1.Memory loss that disrupts daily life

2.Challenges in planning or solving


problems

3.Difficulty completing familiar tasks

4.Confusion with time or place

5.Trouble understanding visual images and


spatial relationships

6.New problems with words or speaking

7.Misplacing things and losing the ability


to retrace steps http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.as
Case Study
Buddy is an 82-year old man who has a history of hypertension,
diabetes and testicular cancer and has been experiencing memory loss
and is having trouble solving problems. His spouse, Mary, is concerned
that Buddy may be displaying early signs of Alzheimers. Mary has
brought Buddy to consult with a nurse practitioner.
Effects of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric
features: review of recently completed randomised, controlled trials.

Purpose of Study: To investigate the efficacy of Ginkgo biloba extract EGb 761()
in elderly patients with Alzheimer or vascular dementia with neuropsychiatric features.

Study Design: Review of 4 RCTs.


Trial A: Compared 120 mg twice a day to placebo
Trial B and C: 240 mg/day EGb 761() to placebo
Trial D: 240mg/day EGb 761 () compared to donepezil.
Duration: treatment was 22 or 24 weeks.

Tools to Validate Study: P values less than 0.05 for the primary outcome measures were considered
statistically significant. SKT total score improvement by at least 3 points and NPI score improvement by at least
4 points were considered clinically relevant effects.

Sample: 4 RCTs. 1,294 patients analyzed. Patients with a total score of 9-23 in the Syndrom-Kurz test (SKT)
and with a composite score 6 and greater in the Neuropsychiatric Inventory (NPI) were included.

Results: Supports the findings of the RCTs. Safe and well-tolerated. Showed improvements of cognitive
performance and behavioural symptoms, advances in ADLs and a reduced burden to caregivers. In each
placebo-controlled trial, EGb 761() was significantly superior (p < 0.01). In the actively controlled trial, EGb
761() and donezepil had similar effects.
A Systematic Review on Natural Medicines for the Prevention and Treatment
of Alzheimers Disease with Meta-Analyses of Intervention Effect of Ginkgo
Purpose of Study: To investigate the effects of ginkgo biloba on the prevention
and treatment of Alzheimers disease
Study Design: Systematic review

Tools to Validate Study: Two meta-analyses were performed for evaluating the treatment efficacy
of Ginkgo vs. the placebo. One meta-analysis was performed for assessing the preventative effect of
Ginkgo against AD. The dichotomous data of AD incidence was analyzed with random-effects and
Mantel-Haenszel methods. The second meta-analysis looked that the cognitive effects of Ginkgo on
patients AD. Standard mean difference was used to compare between studies.

Sample: 21 studies were included in this review. Eight studies were included in quantitative
synthesis for the comparison between Ginkgo and placebo, of which 6 studies looked at the effect of
treatments and 2 studies looked at the preventative effect of Ginkgo for AD.

Findings: Ginkgo may help established AD patients with cognitive symptoms but cannot prevent the
neurodegenerative progression of the disease.
Yang, M., Xu, D., Zhang, Y., Liu, X., Hoeven, R., Cho, W. (2014). A systematic review on natural medicines for the prevention and treatment of Alzheimers disease with meta-analysis of
intervention effect of ginkgo. American Journal of Chinese Medicine, 42(3), 505-521.
Nursing Considerations
Side effects of Ginkgo biloba include upset stomach, headache, skin
irritation, GI bleeding, and dizziness

Alzheimers patients usually receive between 120-240 mg daily in


divided doses

Ginkgo can potentially interact with blood thinners, anti-seizure


medications and medications broken down in the liver

Ginkgos vasodilative properties lower blood pressure. Use cautiously


if taking blood pressure medications concurrently

Ginkgo can raise or lower insulin levels. Use cautiously with diabetic
patients
Memory Activity!!!
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