does cbd help with dementia patientsDecember 15, 2021
Studies have reported changes in the endocannabinoid system in the brain of patients with Alzheimer’s disease (AD), playing a role in the pathophysiology of AD. Cannabinoids have been shown to have neuroprotective properties, reduce neuroinflammation, and enhance neurogenesis. Evidence suggests that the utilization of marijuana products containing both tetrahydrocannabinol (THC) and cannabidiol (CBD) or CBD alone have been effective and safe for use in older people with agitation associated with dementia. A review in 2017 summarized positive findings for therapeutic benefits of cannabinoids in agitation of AD and dementia, but there was no definitive conclusion because of varying cannabinoid products. Cannabinoids were shown to be well tolerated, with few short-term side effects. This differs from first-line medications utilized for dementia behaviors, which can have unwanted side effects. Further research regarding the safety, efficacy, and variability of these products in older people is needed.
Individuals with Alzheimer’s and other forms of dementia often go through a period of significant behavioral and psychological symptoms of dementia (BPSD). It is estimated that up to 90% of persons with dementia (PWD) experience behavior problems at some point. BPSDs can be challenging for both unpaid family caregivers as well as paid caregivers. Family caregivers provide the bulk of care for PWD and number over 15 million. One of the most common types of BPSDs is agitation with a prevalence of up to 87%, based on a recent systematic review. Agitation can lead to impaired daily functioning, prolongation of hospitalization, reduced time to institutionalization, and is associated with higher mortality. Additionally, agitated behavior is associated with increased injury to both patients and caregivers. Based on the 2018 Alzheimer’s disease drug development pipeline report almost 70% of clinical trials related to BPSD are dedicated to agitation behavior. Finding ways to address agitation is necessary to improve overall quality of life for PWD and their caregivers. Currently, there are no medications available specifically for the treatment of BPSDs. The use of benzodiazepines, antipsychotics and mood stabilizing agents are common, but the risks and side effects often outweigh any benefits.
Several small studies have investigated the use of cannabinoids in the treatment of pathology and symptomology of Alzheimer’s disease (AD), as well as treatment of the agitation component of BPSD. A handful of these studies showed that the symptoms of BPSD were decreased with the use of cannabinoids. However, due to small sample sizes, study design, and short trial duration of these studies, the efficacy of these agents on BPSD cannot be confirmed. In addition, cannabinoids have demonstrated anti-oxidant and anti-inflammatory effects, and both processes have been indicated as major contributors to the neurologic effects of AD. Some evidence exists that agitation is related to this neuroinflammatory process. This study will examine the effects of cannabinoids on the behavioral and psychological symptoms of individuals with a dementia diagnosis.
Dr. Collins points out that all medications come with the risk of potential side effects.
“I don’t want everybody to get on the cannabis bandwagon because we have a few scattered reports which is why this study is so important,” she said.
William Scholey says “the problem” with sedatives for his brother was that they made it more difficult for David to communicate simple things like which movies he wants to watch.
Aggression and other disruptive behaviours linked to Alzheimer’s disease are notoriously difficult to treat, sometimes leading to patients being restrained or medically sedated, but some doctors are now investigating the potential for success with a new strategy: CBD oil.
“I was so worn out from looking after her. It is hard enough looking after seniors but an Alzheimer’s patient is literally a 24/7 job. I was sleeping two hours a day. I was exhausted dealing with my own health issues,” he said.
“One of the things I like to caution people about is that there is no miracle cure,” she added.
A nurse administers CBD oil to David Scholey, who has dementia, in Fenelon Falls, Ont.
“He’s a movie buff and he is constantly looking for new titles. He likes the old war and cowboy movies and stuff and David has a great memory in that regard,” Scholey said.
“Anecdotally, I’ve heard several reports of cannabis being effective for managing a wide variety of symptoms including these behaviours of dementia including these psychological symptoms,” she said. “However, there are not enough of them currently to say yes we need to run with this.”
Family members of patients with dementia say CBD oil, short for Cannabidiol and derived from the cannabis plant, can make a world of difference.
Dr. Rhonda Collins, the Chief Medical Officer of Revera, is part of what’s called an open label study at more than 20 Ontario long term care facilities, conducted in partnership with Canopy Growth. Some 500 seniors some with dementia will be assessed before and after starting medically prescribed CBD oil for pain, anxiety, insomnia and the often-disruptive behaviours of dementia. Preliminary data could be available in about six months.
David Scholey’s yelling used to echo through the hallways of his Ontario long term care facility in Fenelon Falls, Ont. Ever since he tried CBD oil two months ago, the 76-year-old’s dementia-related disruptions have declined.
“Within a couple of days you could tell it was working because of the fact that he was a lot quieter, he was a lot calmer,” said Catherine Mantle, a registered nurse and care director at Fenelon Court.
Dr. Collins says there is little research so far on whether CBD oil is a safe and effective treatment for elderly patients, and it’s unclear how it could react with medications. But she there is a definite need for “new tools” to handle things disruptive behaviours.
‘No miracle cures’
Scholey joked that his brother is now a “pothead,” but also said that the therapy doesn’t appear be making David “high.” That’s likely because CBD is not the chemical in cannabis that makes people feel euphoric. The “high” comes mainly from Tetrahydrocannabinol (THC).
Betty Wigle’s family has also turned to CBD oil. Her son, James Tripp, says the drug shifted his 92-year-old mother’s mood from anxious and depressed to cheerful.
“And what works for me might not necessarily work for you because we are all different,” she added. “We all have different chemistries. We have different genetics.”
“When we got her on the (CBD) therapy it solved so many of the volatility issues,” Tripp added.
As her caregiver, Tripp says the CBD therapy has been a godsend.
‘Godsend for caregivers’
David’s brother, William Scholey also noticed a major improvement. “I think it is wonderful for not only David but for people and family just to see that he is not. as anxious and frustrated,” he said.
Betty Wigle’s mood shifted from anxious and depressed to cheerful thanks to CBD oil, according to her son.