Cannabinoids for Patients with Alzheimer’s Disease

In honor of  World Alzheimer’s Month, KannAInsight features new research that suggests cannabinoids could help manage behavioral symptoms associated with Alzheimer’s Disease (AD). 

According to the World Health Organization, there are approximately 50 million individuals worldwide suffering from dementia (including AD) and this number is increasing, with roughly 10 million new cases diagnosed each year. Many patients develop behavioral and psychiatric symptoms during the course of the disease, including agitation, delusions, hallucinations, and depression. Currently, there are no drugs specifically approved by the U.S. Food and Drug Administration (FDA) to treat behavioral and psychiatric dementia symptoms, although anxiolytic, antidepressant, and antipsychotic medications are often prescribed “off-label”.  

In addition to prescription medication, many patients and caregivers try complimentary or alternative therapies to help treat the disease’s symptoms. In fact, AD is a qualifying condition for medical marijuana in several states. However, there is little scientific evidence to support the use of cannabinoids in dementia patients. 

Now, a promising new study suggests that the synthetic cannabinoid Nabilone may improve agitation in patients with moderate-to-severe AD. Over the course of 14-weeks, the effects of Nabilone were compared to placebo in patients with treatment-resistant agitation. Outcomes included agitation, caregiver distress/behavior, cognition, clinical impression, and adverse events. All patients were maintained on their currently prescribed medications. 

Results indicated that Nabilone treatment was associated with a significant reduction in agitation over 6 weeks. Nabilone was also associated with significantly greater improvements on overall neuropsychiatric symptoms, caregiver burden, and nutritional status. However, results regarding measures of cognition were mixed- a small, significant improvement was noted on the Mini-Mental State Exam (MMSE), but the converse was seen on the Severe Impairment Battery (SIB). Notably, there were no significant differences in adverse events between treatment groups, although sedation was frequently reported. 

These findings suggest that Nabilone may be an effective treatment for agitation, with potential benefits for other behavioral and psychiatric symptoms as well. However, side effects, such as sedation, and possible cognitive decline need to be investigated further. Additional trials are needed to determine long-term safety and tolerability of cannabinoids in AD patients. 

Citation: Herrmann N, Ruthirakuhan M, Gallagher D, Verhoeff NPLG, Kiss A, Black SE, Lanctôt KL. Randomized placebo-controlled trial of Nabilone for agitation in Alzheimer’s Disease. Am J Geriatr Psychiatry. 2019 May 8. pii: S1064-7481(19)30355-0. 

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