Changes and therapeutic effects of Ginkgo biloba extract,Donepezil and combination therapy on gray matter volume and cortical morphology in patients with cognitive dysfunction
10.3969/j.issn.1004-1648.2025.04.010
- VernacularTitle:银杏酮酯分散片、多奈哌齐及联合治疗对认知功能障碍患者的大脑灰质体积、皮质形态学的改变及疗效
- Author:
Xinyu DU
1
;
Lihui DUAN
1
;
Peng YAN
1
Author Information
1. 210029 南京医科大学第一附属医院神经内科
- Publication Type:Journal Article
- Keywords:
cognitive impairment;
Ginkgo biloba extract;
Donepezil;
voxel-based morphometry;
surface-based morphometry
- From:
Journal of Clinical Neurology
2025;38(4):268-275
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the changes and therapeutic effects of Ginkgo biloba extract(GBE),Donepezil and combination therapy on gray matter volume and cortical morphology in patients with cognitive dysfunction.Methods According to different treatment methods,59 patients with mild cognitive impairment and Alzheimer's disease were divided into GBE group(n=20),Donepezil group(n=20)and combined treatment group(n=19).Before and after treatment,the patients were evaluated by MMSE,Alzheimer's disease assessment scale-cognitive subscale(ADAS-cog),instrumental activities of daily living scale(IADL),geriatric depression scale(GDS),neuropsychiatric inventory(NPI),and quality of life-Alzheimer's disease scale(QOL-AD).Before and after treatment,T1-weighted structural sequence images were acquired using cranial MRI,and voxel-based morphometry(VBM)and cortical morphological analyses were performed.Results There was no significant difference in the scores of MMSE,ADAS-cog,GDS,NPI,IADL and QOL-AD among the GBE group,Donepezil group and combined treatment group before and after treatment(all P>0.05).Compared with those before treatment,there were significant differences in MMSE and ADAS-cog scores in the GBE group,MMSE,ADAS-cog,IADL and NPI scores in Donepezil group,and MMSE,ADAS-cog and IADL scores in combined treatment group after treatment(P＜0.05-0.01).The volume of gray matter in the cerebellar region of GBE group was significantly increased(voxel P＜0.005,cluster P＜0.05,GRF corrected,one-tailed test).In the left putamen region,the difference of gray matter volume in the combined treatment group was significantly higher than that in the GBE group and Donepezil group(all P＜0.01).In the right putamen area,there was no significant difference among the three groups(all P>0.05).In the right hippocampus,the difference in gray matter volume between combined treatment group and GBE group was significantly higher than that in Donepezil group(all P＜0.05).In the left hippocampus,the difference in gray matter volume between GBE group and combined treatment group was significantly higher than that in Donepezil group(all P＜0.001).Correlation analysis showed that the volume of left and right hippocampal gray matter was positively correlated with MMSE before treatment(r=0.352,P=0.008;r=0.424,P=0.001),and negatively correlated with ADAS-cog(r=-0.336,P=0.012;r=-0.362,P=0.007)and IADL scores(r=-0.345,P=0.01;r=-0.312,P=0.02);after treatment,the gray matter volume of the left and right hippocampus was strong positively correlated with MMSE(r=0.582,P＜0.001;r=0.560,P＜0.001),strong negatively correlated with ADAS-cog(r=-0.512,P＜0.001;r=-0.567,P＜0.001)and IADL(r=-0.454,P＜0.001;r=-0.435,P＜0.001).The difference of gray matter volume in the right hippocampus before and after treatment was only weakly negatively correlated with GDS score(r=-0.269,P=0.047),the gray matter volume of right hippocampus was positively correlated with GDS score before treatment(r=0.451,P＜0.001),and this correlation disappeared after intervention(r=0.131,P=0.340).There was no correlation between the difference of gray matter volume before and after treatment in the left hippocampus and the neuropsychological test scores(all P>0.05).The cortex of the superior parietal lobule and inferior parietal lobe in the combined treatment group was significantly thickened(all P＜0.05,FWE corrected).Conclusions GBE,Donepezil and the combined therapy have significant effects on the reduction of cognitive function,and the changes of brain gray matter and cortical morphology are different.GBE improve the volume of the posterior superior cerebellum and other regions,and the combined therapy improve the cortical thickness of the superior parietal lobule and the inferior parietal lobule.
