Ginkgo Biloba for Post-COVID Cognitive Impairment

Cognitive impairment affects a significant number of people living with post-COVID-19 syndrome (PCS), often described as ‘brain fog’. No treatments directly target the underlying causes, which are believed to involve neuroinflammation, poor brain blood flow, and disrupted cellular energy. A new clinical trial, the EGb COCOS study, is now testing whether a specific Ginkgo (Ginkgo biloba extract) biloba extract, EGb 761®, can offer a solution. The study, led by researchers Jordi A. Matias-Guiu, Katrin Arélin, and Paula Jiménez Serrano, will investigate this extract’s potential to treat cognitive impairment in PCS by addressing its suspected mechanisms (Matias-Guiu et al., 2026).

Why Target Ginkgo Biloba for Post-COVID Brain Fog?

Current management for cognitive impairment in PCS is limited to symptom relief. The EGb COCOS trial is unique because it tests a treatment based on the emerging biological understanding of the condition. The researchers note that key pathological factors include chronic neuroinflammation, dysfunction in the brain’s small blood vessels (neurovascular dysfunction), and a breakdown in how neurons produce energy (mitochondrial function).

EGb 761® is a dry extract from Ginkgo biloba leaves, standardized to contain specific active compounds. Preclinical and clinical research has shown it possesses three properties directly relevant to these proposed mechanisms: it reduces neuroinflammation, improves microcirculation (blood flow in small vessels), and supports mitochondrial function in neurons. Its clinical efficacy for age-related cognitive decline has been documented. “It is therefore reasonable to assume that the extract might be beneficial for use in cognitive impairment associated with PCS,” the authors state, citing prior case series where patients improved over six months of treatment.

The EGb COCOS Study Design: A Rigorous Test

To move beyond anecdotal reports, the team designed a prospective, multicenter, randomized, placebo-controlled, triple-blind trial. This is considered the gold standard for proving a treatment’s effectiveness. Neither the participants, the clinicians administering treatment, nor the scientists assessing outcomes will know who receives the active drug or the placebo.

The study plans to enroll 400 adults aged 18 or older who have a history of SARS-CoV-2 infection and a diagnosis of PCS. Key inclusion criteria are cognitive symptoms lasting at least two months, objectively measured cognitive impairment, and mild-to-moderate anxiety or depressive symptoms. Participants will be randomly assigned to take either 240 mg of EGb 761® or a matching placebo once daily for 12 weeks.

Because validated primary endpoints for PCS cognitive trials are not yet established, the analysis will be exploratory. Researchers will assess the effect of EGb 761® on a range of outcomes: cognitive performance, neuropsychiatric symptoms (anxiety/depression), neurosensory changes, and functional ability in daily life. The inclusion of neurosensory outcomes is particularly relevant for a hearing health audience, as it opens the door to measuring changes in co-occurring conditions like tinnitus or hyperacusis, which are common in PCS and share pathways of central nervous system dysfunction. Safety will be monitored by recording all adverse events.

Potential Implications for Hearing and Sensory Health

The outcome of this trial has implications beyond memory and concentration. The “brain fog” of PCS frequently exists alongside other neurological symptoms, including tinnitus, sound sensitivity (hyperacusis or misophonia), and dizziness. These are all thought to stem from dysregulation in the central auditory and sensory processing networks—a concept explored in our article on “Advances in Hearing Health: From Cochlea to Cortex”.

If EGb 761® proves effective by reducing central neuroinflammation and improving cerebral metabolism and blood flow, it could potentially benefit these auditory symptoms as well. This aligns with the holistic view of integrated auditory health, where treating the brain is as important as treating the ear. Furthermore, the cognitive and sleep disturbances common in PCS are deeply intertwined; improving cognitive function could positively affect sleep quality, and vice versa. Managing sleep is a critical component of overall neurological recovery, as discussed in resources like the “Evidence-Based Sleep Hygiene Guide” on SleepScience.space.

What to Expect Next

The EGb COCOS trial is registered and underway. Its results, expected after 2026, will provide the first high-quality evidence from a controlled trial on whether EGb 761® is an effective treatment for cognitive impairment in PCS. A positive result would offer a much-needed, mechanism-based treatment option for a debilitating aspect of Long COVID. It would also stimulate further research into anti-neuroinflammatory and neurovascular support strategies for other central sensory processing disorders.

For now, patients and clinicians should view EGb 761® as an unproven but scientifically plausible candidate. Its use should be guided by a healthcare professional, considering potential interactions with other medications. The trial by Matias-Guiu, Arélin, and Serrano represents a significant step toward moving post-COVID care from generalized symptom management to targeted, pathology-informed treatment.