Mer’s disease, which is known to progress over decades, expecting a positive effect of G. biloba on the incidence of dementia over a period of 3 to 6 years would imply that G. biloba has a direct effect on the neurodegenerative process itself, which is probably an overoptimistic hypothesis. Another alternative interpretation of these negative results might be that G. biloba is no longer effective once the neurodegenerative process of dementia is too advanced. In this case, dementia outcome over a relatively short follow-up would not be the most relevant outcome to assess the efficacy of G. biloba on cognitive aging. Therefore, determining whether G. biloba is associated with long-term cognitive decline may be of interest in order to understand more clearly the usefulness of such treatment in the elderly. This paper reports the effect of G. biloba on long-term cognitive decline within the PAQUID study. The PAQUID study is a large population-based study conducted in France, which has now 20 years of completed follow-up. As such, it is one of the largest and longest-running prospective studies of the natural history of cognitive decline and the incidence of dementia to have been performed. In this study, the rate of cognitive decline of elderly Biotin-NHS web people reporting use of EGb761H was compared to that of participants reporting use of piracetam, another nootropic agent prescribed for memory impairment in subjects without dementia. Both groups were compared to those participants reporting use of neither of these drugs. The rate of cognitive decline was assessed over a period of 20 years during which cognition has been repeatedly assessed in a standardized manner with three common neuropsychological tests. Due to possible confounding effects of psychotropic drugs on cognitive decline, the association between EGb761H and consumption of psychotropic drugs, including antidepressants, benzodiazepines or antipsychotics, and its possible contribution to the results observed was also considered.Methods General study designThis was an exploratory retrospective analysis of longitudinal data collected prospectively over the twenty years of follow-up of the PAQUID cohort. The study population and methodology of the PAQUID cohort have been described in detail elsewhere [35]. Briefly, the study initially get Licochalcone-A included a community based cohort of 3,777 elderly people, aged 65 and older, representative of Gironde and Dordogne, two areas in the southwest of France. The PAQUID Study was approved by the Ethics Committee of the Bordeaux University Hospital. Data were collected by means of a questionnaire administered at home by trained psychologists at the time of inclusion and after 1, 3, 5, 8, 10, 13, 15, 17 and 20 years. Physical health was evaluated by self-reported diseases or symptoms (treated diabetes, a history of heart disease, stroke, or hypertension, and dyspnoea) and scales assessing functional status. Medication consumption was documented by self-report by participants at each visit. The questionnaire also included items about sociodemographic characteristics, objective and subjective physical health, functional assessment, depressive symptomatology, as well as the MMSE as an evaluation of global mental status [36]. In addition to the MMSE, two specific neuropsychological tests were proposed systematically at each visit. The multiple choice recognition form of the Benton Visual Retention Test (BVRT) was used to measure visual memory (scores range from 0 to 1.Mer’s disease, which is known to progress over decades, expecting a positive effect of G. biloba on the incidence of dementia over a period of 3 to 6 years would imply that G. biloba has a direct effect on the neurodegenerative process itself, which is probably an overoptimistic hypothesis. Another alternative interpretation of these negative results might be that G. biloba is no longer effective once the neurodegenerative process of dementia is too advanced. In this case, dementia outcome over a relatively short follow-up would not be the most relevant outcome to assess the efficacy of G. biloba on cognitive aging. Therefore, determining whether G. biloba is associated with long-term cognitive decline may be of interest in order to understand more clearly the usefulness of such treatment in the elderly. This paper reports the effect of G. biloba on long-term cognitive decline within the PAQUID study. The PAQUID study is a large population-based study conducted in France, which has now 20 years of completed follow-up. As such, it is one of the largest and longest-running prospective studies of the natural history of cognitive decline and the incidence of dementia to have been performed. In this study, the rate of cognitive decline of elderly people reporting use of EGb761H was compared to that of participants reporting use of piracetam, another nootropic agent prescribed for memory impairment in subjects without dementia. Both groups were compared to those participants reporting use of neither of these drugs. The rate of cognitive decline was assessed over a period of 20 years during which cognition has been repeatedly assessed in a standardized manner with three common neuropsychological tests. Due to possible confounding effects of psychotropic drugs on cognitive decline, the association between EGb761H and consumption of psychotropic drugs, including antidepressants, benzodiazepines or antipsychotics, and its possible contribution to the results observed was also considered.Methods General study designThis was an exploratory retrospective analysis of longitudinal data collected prospectively over the twenty years of follow-up of the PAQUID cohort. The study population and methodology of the PAQUID cohort have been described in detail elsewhere [35]. Briefly, the study initially included a community based cohort of 3,777 elderly people, aged 65 and older, representative of Gironde and Dordogne, two areas in the southwest of France. The PAQUID Study was approved by the Ethics Committee of the Bordeaux University Hospital. Data were collected by means of a questionnaire administered at home by trained psychologists at the time of inclusion and after 1, 3, 5, 8, 10, 13, 15, 17 and 20 years. Physical health was evaluated by self-reported diseases or symptoms (treated diabetes, a history of heart disease, stroke, or hypertension, and dyspnoea) and scales assessing functional status. Medication consumption was documented by self-report by participants at each visit. The questionnaire also included items about sociodemographic characteristics, objective and subjective physical health, functional assessment, depressive symptomatology, as well as the MMSE as an evaluation of global mental status [36]. In addition to the MMSE, two specific neuropsychological tests were proposed systematically at each visit. The multiple choice recognition form of the Benton Visual Retention Test (BVRT) was used to measure visual memory (scores range from 0 to 1.