,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,實證醫學個案討論,急診內科,何英豪醫師,95-10-18,1,實證醫學個案討論急診內科1,Q:,一位76歲的男性患有輕度阿茲海默症，但未服用任何藥物。他的兒子帶他來門診就診，想要了解銀杏治療失智症的療效。,2,Q:一位76歲的男性患有輕度阿茲海默症，但未服用任何藥物。,PICO,P:Alzheimers disease,I:Gingko biloba,C:,O:Effect,3,PICOP:Alzheimers disease3,Search terms&Strategy,Keyword:Gingko,Alzheimers disease,Database:PubMed,Search strategy:,Gingko:1414,A.D.:50043,Gingko and A.D.:134,+English,Chinese,Human,Abstract:67,+Clinical Trial,Meta-analysis,RCT:15,4,Search terms&StrategyKeyword,Oxford Centre for EBM Levels of Evidence(2001-5),1a,:SR(with homogeneity)of RCTs.,1b,:Individual RCT(with narrow confidence interval).,2a,:SR(with homogeneity)of cohort studies,2b,:Individual cohort study(low quality RCT;80%follow-up),3a,:SR(with homogeneity)of case-control studies.,3b,:Individual case-control study.,4,:Case-series(poor quality cohort and case-control studies).,5,:Expert opinion without explicit critical appraisal,or based on physiology,bench research or“first principles”,5,Oxford Centre for EBM Levels o,Ginkgo biloba and donepezil:a comparison in the treatment of Alzheimers dementia in a randomized placebo-controlled double-blind study,Eur J Neurol 2006 Level:Ib,24-week randomized,placebo-controlled,double-blind study.,Aged 50-80years,mild to moderate dementia,Ginkgo biloba(160 mg daily dose),donepezil(5 mg daily dose),or placebo group.,No evidence of relevant differences in the efficacy of EGb 761 and donepezil in the treatment of mild to moderate Alzheimers dementia,so the use of both substances can be justified.,6,Ginkgo biloba and donepezil:a,A randomized,double-blind,placebo-controlled trial of two doses of Ginkgo biloba extract in dementia of the Alzheimers type.,Curr Alzheimers Res.2005 Level:Ib,Randomized,placebo-controlled,double-blind,parallel-group,multicenter trial,513 outpatients with uncomplicated dementia of the Alzheimers type scoring 10 to 24 on MMSE and less than 4 on the modified Hachinski Ischemic Score.,26-week treatment with GbE at daily doses of 120 mg or 240 mg or placebo,The trial did not show efficacy of GbE,however,the lack of decline of the placebo patients may have compromised the sensitivity of the trial to detect a treatment effect.,Thus,the study remains inconclusive with respect to the efficacy of GbE.,7,A randomized,double-blind,pl,The situation of patients with dementia may be rectified by Ginkgo biloba.Results of a health services research study concerning the ability of patients with dementia,quality of life of the nursing family members and total treatment costs MMV Fortschr Med 2005 Level:IIb(?),Non-randomised,two-armed cohort study with an open design,683 slightly or moderately demented patients,etween 65 and 80 years.,Quality-of-life of care-taking relatives(p 0.001)in the Ginkgo-cohort.,Barthel-Index in the Ginkgo-cohort(p or=0,001).,3.614,75 euro in the standard-cohort,3.031,78 euro in the Ginkgo-cohort(p=0.067).,Ginkgo treatment has a valid place in caretaking structure of health services.,Gingko attributes to a higher quality of life for both care-takers and patients,the progression of disease is slowed down and treatment costs are lower.,8,The situation of patients with,Ginkgo biloba compared with cholinesterase inhibitors in the treatment of dementia:a review based on meta-analyses by the Cochrane collaboration.,Dement Geriat Cogn Disord 2004 Level:Ia,Cochrane Collaboration meta-analyses of ginkgo,donepezil,rivastigmine and galantamine in patients with dementia.,6 months of treatment,Trial data for cholinesterase inhibitors were more consistent than those for ginkgo,particularly regarding patient populations and outcome measures.,Significant benefits on cognition vs.placebo were seen with donepezil,5 and 10 mg,rivastigmine,6-12 mg,and galantamine,16 and 24 mg.,Significant benefit vs.placebo with ginkgo was seen only when all doses were pooled.Similar proportions of patients discontinued treatment with ginkgo and placebo.,Cholinesterase inhibitors were also well tolerated,although a significantly greater proportion of patients receiving active treatment discontinued vs.placebo with some doses.,9,Ginkgo biloba compared with ch,Ginkgo biloba extract EGb 761 in dementia:intent-to-treat analyses of a24-week,multi-center,double-blind,placebo-controlled,randomized trial.,Pharmacopsychiatry 2003 Level:Ib,Ginkgo biloba special extract EGb 761(240 mg/day)in outpatients with pre-senile and senile primary degenerative dementia of the Alzheimer type(DAT)and multi-infarct dementia(MID)of mild to moderate severity.,Double-blind,placebo-controlled,randomized,multi-center study,The results of this ITT analysis substantiate the outcomes previously obtained with a responder analysis of the per-protocol population and confirm that EGb 761 improves cognitive function in a clinically relevant manner in patients suffering from dementia.,10,Ginkgo biloba extract EGb 761,Response patterns of EGb 761 in Alzheimers disease:influence of neuropsychological profiles.,Pharmacopsychiatry 200