Ginkgo Biloba May Improve Early Cognitive Recovery After Stroke

The preliminary study treated adults who experienced an ischemic (clot-caused) stroke with 14 days of intravenous injections of ginkgo diterpene lactone meglumine (GDLM), which is a combination of biologically active component of ginkgo biloba. Findings showed that the patients who were treated within the first two weeks after the stroke had better cognitive recovery at 14 and 90 days. 

In 2023 the same researchers published results from a multicenter trial in China showing that those who experienced an ischemic stroke had better recovery from overall stroke symptoms if they were treated with daily injections of GDLM.  The current study also analyzed the cognitive recovery of participants of this previous study. 

“If our positive results are confirmed in other trials, GDLM injections may someday be used to improve cognitive function for patients after ischemic stroke,” said Anxin Wang, Ph.D., an associate professor of clinical epidemiology at the Beijing Tiantan Hospital of the Capital Medical University in Beijing.

For this study, the cognitive recovery of 3,163 stroke survivors with an average age of 63 years old who were treated for mild to moderate ischemic stroke was analyzed.  Within 48 hours of the stroke, close to half of the survivors were randomly selected to receive daily intravenous 25 mg injections of GDLM for 14 days, and the other half received placebo injections. Patient cognitive performance was assessed before treatment, at 14 days, and again at 90 days using the Montreal Cognitive Assessment Scale (MoCA). 

Within 48 hours of the stroke and before beginning treatment at baseline, most of the patients were experiencing moderate cognitive impairment with an average score of 17 out of 30. At 14 days, those who received the GDLM injection had improved scores by an average of 3.93 points compared to the placebo group's average improvement of 3.62 points higher. By day 90, those in the GDLM treatment group had an average of 5.51 points improvement compared to an average improvement of 5.04 in the placebo group. 

“The proportion of patients who reached a clinically significant level of improvement was 20% higher in the GDLM group, indicating that GDLM injections may improve cognitive function in patients with acute ischemic stroke,” Wang said. “Since the follow-up time in this study was only 90 days, the longer-term effect of GDLM injections requires longer-term research.”

“GDLM has shown a neuroprotective effect through multiple mechanisms, such as expanding brain blood vessels and improving brain cells tolerance to hypoxia (inadequate oxygen) and increasing cerebral blood flow. GDLM also has neuroprotective antioxidation, anti-inflammation and anti-apoptosis (cell death) properties,” Wang said. “Additionally, laboratory studies have previously indicated that GDLM may promote secretion of chemicals associated with avoiding neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease.”

A 2022 AHA Scientific Statement noted that there may be some benefits as well as risks to complementary and alternative medicines.“While this American Heart Association statement focused on the use of supplements in patients with heart failure, the same approach and caution should be used when treating all cardiovascular diseases including stroke,” said Chair of the scientific statement writing committee Sheryl L. Chow, Pharm.D., FAHA, an associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, California, and an associate clinical professor of medicine at the University of California, Irvine. “Stroke patients should not take gingko biloba or other herbs or supplements without discussing it with their doctor and pharmacist. If this new research proves to be effective in future clinical trials it may be a valuable tool for after-stroke care; however, efficacy and safety would need to be demonstrated to meet the same standards as all prescription medications and secure FDA approval.” Dr. Chow was not involved in this study.