An Observational, Longitudinal Study of Cognition in Medical Cannabis Patients over the Course of 12 Months of Treatment: Preliminary Results

Abstract

Objective:Cannabis use has increased dramatically across the country; however, few studies have assessed the long-term impact of medical cannabis (MC) use on cognition. Studies examining recreational cannabis users generally report cognitive decrements, particularly in those with adolescent onset. As MC patients differ from recreational consumers in motives for use, product selection, and age of onset, we assessed cognitive and clinical measures in well-characterized MC patients over 1 year. Based on previous findings, we hypothesized MC patients would not show decrements and might instead demonstrate improvements in executive function over time.Method:As part of an ongoing study, MC patients completed a baseline visit prior to initiating MC and evaluations following 3, 6, and 12 months of treatment. At each visit, patients completed a neurocognitive battery assessing executive function, verbal learning/memory, and clinical scales assessing mood, anxiety, and sleep. Exposure to delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) was also quantified.Results:Relative to baseline, MC patients demonstrated significant improvements on measures of executive function and clinical state over the course of 12 months; verbal learning/memory performance generally remained stable. Improved cognitive performance was not correlated with MC use; however, clinical improvement was associated with higher CBD use. Analyses suggest cognitive improvements were associated with clinical improvement.Conclusions:Study results extend previous pilot findings, indicating that MC patients may exhibit enhanced rather than impaired executive function over time. Future studies should examine distinctions between recreational and MC use to identify potential mechanisms related to cognitive changes and the role of clinical improvement.

A survey of medical cannabis use during perimenopause and postmenopause

“…Although the current study assessed modes of use, future research should query additional cannabis use characteristics, including cannabinoid profiles of individual products used as well as frequency and magnitude of use. Future research should also examine the impact of MC use on menopause-related cognitive impairment as observational studies in humans 18 , 19 , 21 and preclinical research on ovariectomized mice 58 indicate that cannabinoid-based therapies may be associated with improved cognitive outcomes after treatment. Lastly, expectancy of MC treatment effects was not assessed in the current study.…”

“…Given expanding legalization of MC, increasing numbers of individuals are exploring MC to alleviate symptoms for a variety of conditions; estimates indicate more than 5.5 million MC patients are registered in the United States. 17 Several observational studies have demonstrated that MC use is associated with various clinical benefits, including improvements on measures of anxiety, mood, sleep, and pain, [18][19][20][21][22][23][24] as well as cognitive improvement after treatment. 18,19,21 In addition, historical texts suggest that cannabinoid-based therapies have been utilized as safe and efficacious treatments for menopause-related symptoms throughout history.…”

“…17 Several observational studies have demonstrated that MC use is associated with various clinical benefits, including improvements on measures of anxiety, mood, sleep, and pain, [18][19][20][21][22][23][24] as well as cognitive improvement after treatment. 18,19,21 In addition, historical texts suggest that cannabinoid-based therapies have been utilized as safe and efficacious treatments for menopause-related symptoms throughout history. 25 However, although some recent work has focused on MC treatment for gynecological diseases, such as endometriosis, 26,27 few studies have examined the prevalence and efficacy of MC to alleviate menopause-related symptoms.…”

Quality of Life and a Surveillant Endocannabinoid System

“…Finally, an important discussion is necessary when long-term effects on cognition of medical cannabis (MC) use is compared to recreational cannabis, especially in those with adolescent onset. Comparison of MC patients from recreational consumers considers diverse factors as motives for use, product selection, and age of onset, and a recent study evaluated cognitive and clinical measures in well-characterized MC patients over 1 year (Sagar et al, 2021). MC patients finalized a baseline visit prior to initiating MC and evaluations following 3, 6, and 12 months of treatment, performing a neurocognitive battery assessing executive function, verbal learning/memory, and clinical scales assessing mood, anxiety, and sleep.…”

“…Authors reported that MC patients exhibited significant enhancements on measures of executive function and clinical state over the course of 12 months; clinical improvement was associated with higher CBD use. Therefore, MC patients may show improvements rather than impaired executive function over time (Sagar et al, 2021). As Cannabis research remains in its infancy (Zolotov and Gruber, 2021), further studies are necessary to evaluate differences between recreational and MC use to identify potential mechanisms related to cognitive changes and the role of clinical improvement.…”