Somewhat disheartening results from the PAQUID Cohort
The piracetam group was small (a pathetic 4% of study participants) and mostly men. They were more depressed, had more memory issues and were on more psychotropic medicated than the ginkgo group, overall a terrible comparison, but I still would have expected better results from the piracetam group. Was/is considered a fairly decent anti-aging supplement with its prevention of lipofuscin accumulation, preservation of mitochondrial function, membrane fluidity etc.
Ginkgo Biloba Extract and Long-Term Cognitive Decline: A 20-Year Follow-Up Population-Based Study
BACKGROUND: Numerous studies have looked at the potential benefits of various nootropic drugs such as Ginkgo biloba extract (EGb761®; Tanakan®) and piracetam (Nootropyl®) on age-related cognitive decline often leading to inconclusive results due to small sample sizes or insufficient follow-up duration. The present study assesses the association between intake of EGb761® and cognitive function of elderly adults over a 20-year period.
METHODS AND FINDINGS: The data were gathered from the prospective community-based cohort study 'Paquid'. Within the study sample of 3612 non-demented participants aged 65 and over at baseline, three groups were compared: 589 subjects reporting use of EGb761® at at least one of the ten assessment visits, 149 subjects reporting use of piracetam at one of the assessment visits and 2874 subjects not reporting use of either EGb761® or piracetam. Decline on MMSE, verbal fluency and visual memory over the 20-year follow-up was analysed with a multivariate mixed linear effects model. A significant difference in MMSE decline over the 20-year follow-up was observed in the EGb761® and piracetam treatment groups compared to the 'neither treatment' group. These effects were in opposite directions: the EGb761® group declined less rapidly than the 'neither treatment' group, whereas the piracetam group declined more rapidly (β= -0.6). Regarding verbal fluency and visual memory, no difference was observed between the EGb761® group and the 'neither treatment' group (respectively, β=0.21 and β=-0.03), whereas the piracetam group declined more rapidly (respectively, β= -1.40 and β= -0.44). When comparing the EGb761® and piracetam groups directly, a different decline was observed for the three tests (respectively β= -1.07, β= -1.61 and β= -0.41).
CONCLUSION: Cognitive decline in a non-demented elderly population was lower in subjects who reported using EGb761® than in those who did not. This effect may be a specific medication effect of EGb761®, since it was not observed for another nootropic medication, piracetam.
from the full text
...The study population consisted of 3612 subjects (95.6% of the total cohort). Of these, 589 (16.3%) reported use of EGb761® at any time of follow-up and 149 (4.1%) reported use of piracetam, whereas 2874 (79.6%) did not report use of either... The three treatment groups did not differ in terms of age or number of medications, but significant differences were observed for all other variables. Subjects taking neither EGb761® nor piracetam tended to be more frequently men, less-educated, and to have less memory complaints than subjects taking either EGb761® or piracetam. Compared to subjects taking piracetam, subjects reporting EGb761® use were more frequently women and less frequently reported depressive symptoms or memory complaints. Baseline MMSE scores were slightly higher in the EGb761® group. At the end of follow-up, 73.3% of subjects in the EGb761® group, 86.6% in the piracetam group and 81.3% in the control group had died
...The Table 2 shows the means and standard deviations for the three cognitive scores at each time point. The analysis of decline in cognitive scores using the linear mixed effects model with repeated measures is displayed in Table 3. As can be seen, the MMSE score declined in the ‘neither treatment’ group by around 0.3 points between each study visit. A significant difference in the rate of change of MMSE score over the twenty-year follow-up period was observed in the EGb761® and piracetam treatment groups compared to the ‘neither treatment’ group. However, the direction of the treatment effect differed between the two treatments, subjects reporting use of EGb761® declining less rapidly than the ‘neither treatment’ group (p<0.0001), with a mean difference of 0.5 points on the MMSE per follow-up visit (around five points over the entire follow-up period). In contrast, the piracetam group declined more rapidly. With respect to the IST and the BVRT, no significant difference was observed between the EGb761® group compared to the ‘neither treatment’ group, whereas the piracetam group declined to a greater extent.
...The predicted MMSE score at the end of the follow-up period remained above the threshold of 24 (roughly normal cognitive function) in the group using EGb761®, which is also of clinical relevance. This effect appears to be a specific medication effect of EGb761®, since it was not observed for another nootropic medication, piracetam, prescribed for the same condition as EGb761®, whose users performed less well all along the follow-up period in the three tests studied.
...An alternative explanation for the present findings showing lesser long-term cognitive decline in subjects reporting using EGb761® than in those reporting use of piracetam or neither drug could be related to differences in psychotropic use observed between the study groups. Indeed, our results showed that use of EGb761® was associated with significantly lower consumption of psychotropic drugs including antidepressants, benzodiazepines and antipsychotics. Given the well-characterised adverse effects of chronic psychotropic drug use on cognitive function [54]–[55], it was possible that the beneficial effect observed of EGb761® on cognitive decline was indirectly due to less psychotropic drugs consumption. However, when psychotropic drug use was taken into account as a possible confounding factor in the statistical model, the differences in the rate of cognitive decline between groups persisted, suggesting that the slower decline of MMSE scores in the EGb761® group cannot be explained by differences in psychotropic drug consumption.
Regarding, the finding of stronger decline in the group using piracetam, due to the small number of participants in this group, it is difficult to draw conclusions. The study of the relationship between cognitive decline and piracetam consumption was not the principal objective of our study, and was included in this study to have a point of comparison with a group of participants using a nootropic drug prescribed for the same condition as EGb761®. However, this result is somewhat intriguing and it would be important to replicate this result in another prospective study to draw reliable conclusions.
In conclusion, even though some points remain unclear, in particular the reason for the stronger decline observed in the piracetam group, or the question of a possible dose-effect of EGb761® that could not be presently tested, this study reports a beneficial effect of EGb761® on long-term cognitive decline as assessed by the MMSE in non-demented elderly people. This effect may be a specific medication effect of EGb761®, since it was not observed for another nootropic medication, piracetam, which was associated with more rapid decline in cognitive function, and cannot be accounted for by differences in psychotropic drug use.
Edited by Bateau, 13 January 2014 - 08:47 PM.
