According to the World Health Organization, there were around 50 million persons worldwide suffering from dementia and this number is increasing with the global aging of the population in most countries.
Currently, the options for treating BPSD (Behavioral and Psychological Symptoms of Dementia) include pharmacological and nonpharmacological therapies. Psychotropic medications are often used to reduce the frequency and severity of BPSD, but in the majority of patients, they provide only modest symptom control and important side effects.
The interest of cannabinoids in Alzheimer disease and other forms of dementia has increased first as neuroprotective drugs in animal studies. Indeed, some studies suggest a potential beneficial effect of CB1 and CB2 receptor agonists on reducing harmful β-amyloid peptide action and tau phosphorylation seen in Alzheimer disease as well as increasing intrinsic brain repair mechanisms.
The Study...
The aim of this pilot study was to demonstrate the feasibility of the administration of a THC/CBD-based medication in patients with severe dementia and BPSD and/or rigidity living in one nursing home in Geneva.
Other studies used pure, often synthetic, THC medications but researchers hypothesize that a natural cannabis extract might be better tolerated and/or that CBD adds to the overall positive effects on behavior.THC/CBD “natural cannabis”-based oral medication in severely demented patients, suggesting excellent tolerance, acceptability, and benefit for the patients, notably on BPSD.
Cannabis oil has to be given with some oil-rich food after having tried out different food options, the nurses found that putting the drops on a small piece of chocolate cake was the best administration option.
-nabiximol (oromucosal spray with THC/CBD in equal amounts),
-dronabinol solution (pure THC),
-cannabis tincture (11 mg THC/22 mg CBD),
-cannabis oil (11 mg THC/24 mg CBD).
At the start of the study they decided to use the cannabis tincture, since the nurses had the experience of difficulties in administering the oromucosal nabiximol spray.
The Results...
Researcers included 10 severely demented patients, all females, with an average age of 79.5 years. Inclusion was gradual and follow-up varied from 2 to 5 months.
After a few weeks, they discovered that 3 patients seemed to have pain when swallowing, even worse with the (alcoholic) tincture, and had mouths ulcers. When cannabis tincture was changed to cannabis oil, the ulcers disappeared.
The average daily dosage was:
-7.6 mg THC/13.2 mg CBD daily after 2 weeks,
-8.8 mg THC/17.6 mg CBD after 1 month,
-9.0 mg THC/18.0 mg CBD after 2 months, and then remained stable.
-The lowest daily dosage was 7 mg THC/14 mg CBD, the highest 13 mg THC/26 mg CBD.
One patient died after 1 month for reasons unrelated to the cannabinoid medication. No patient stopped the cannabinoids for reasons of side effects. Systolic blood pressure decreased from 135.4 to 120 mm Hg, other vital parameters (diastolic blood pressure, heart rate, weight) remained stable over time.
-The average NPI score decreased from 71.1 to 38.3 after 2 months.
-The CMAI score from 74.5 to 47.5. The rigidity score (UPDRS) decreased from 3.4 to 1.7.
-Scores for daily activities both decreased, but this was due to a decrease (less good functioning) in 2 patients, whereas 7 patients improved.
-The VAS score for the most invalidating behavior problem (screaming, aggressive behavior, tearing clothes) decreased from 9 to 5.
-The effects persisted after 2 months for the 4 persons for whom longer follow-up was available.
-The nurses, several of whom were quite reluctant to the study in the beginning, observed in almost all patients less overall rigidity, with more relaxed faces, necks, shoulders, and limbs, making daily washing and transfers easier and more comfortable.
-They described the patients as calmer, more relaxed, less irritable, and smiling more. Two women with persistent screaming almost stopped doing so, which was a major relief for other patients and the staff.
-One patient stopped frequent vomiting.
-Two patients could stop all morphine within 3 months and 1 patient decreased by two-thirds in 2 months. These 3 patients had no more constipation, which was noted as an important time gain for the staff, beyond the benefit for the patients.
-One patient decreased benzodiazepine use by three-fourths after 3 months
-One patient stopped two antipsychotic medications after 1 month.
-Also the feedback from the families was astonishingly positive overall. They were in general thankful that the director and the doctor were trying to improve the situation for their relatives, and all accepted to participate in the study. Most were satisfied with the improvement, while a few were disappointed by the limited change, probably due to high expectations.
Conclusion...
This pilot study suggests that naturall THC/CBD oral medication in severely demented patients with behavior problems is acceptable, well tolerated, and improves rigidity and behavior overall. It allowed the decrease or stop of other psychotropic medications in half of the patients. The staff appreciated the decrease in rigidity, making daily care and transfers easier, the improved direct contact with the patients, and the improvement in behavior. There was no withholding of the medication for reasons of side effects, and the effects persisted after 2 months.
Source:https://www.karger.com
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