In a situation where the clinical significance of the effects of anti-dementia drugs is increasingly questioned, and neither empirical data nor a consensus on minimally clinically important differences in outcome parameters is available [43], it is difficult to assess if the moderate effects of ginkgo on cognition and ADLs make a difference for the patients in the long run. The validity and reliability of clinical endpoints remain unclear with some early trials using outcomes that would not be accepted for modern studies. Furthermore, there was only one study with a 52-week-follow-up which showed a small but statistically significant advantage in cognition and daily activities. The effects did not differ in magnitude from the 26-week results. On the other hand, even a short follow-up time of 12 weeks was sufficient to separate ginkgo from placebo in one study [31]. This indicates that the duration of the study and the setting as well as methodological factors may be stronger outcome modifiers than the effects of the medication itself.