Natural and Synthetic Cannabinoids for Agitation and Aggression in Alzheimer’s Disease

Ruthirakuhan, Myuri; Lanctôt, Krista L.; Vieira, Danielle Soares Rocha; Herrmann, Nathan

doi:10.4088/jcp.18r12617

Cited by 29 publications

(31 citation statements)

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“…Both reviews found significant heterogeneity across studies and neither review found differences in the occurrence of adverse events or dropouts due to an adverse event between treatment groups. However, the key differences were that the present review-based on nine studies [36][37][38][39][40][41][42]74,75 -found a significant effect of cannabinoids on NPS, while the review of Ruthirakuhan and colleagues 58 -which was based on six 37,39,40,42,74,75 articles-did not. Of note, all six studies identified by Ruthirakuhan and colleagues were included in the present review; hence, there were differences in our conclusions despite overlaps in the studies considered.…”

Section: Comparison With Previous Reviewscontrasting

confidence: 71%

“…Three trials used THC preparations, [39][40][41] five used dronabinol, [36][37][38]42,75 and one 74 used nabilone. Outcome measures reported by studies included the NPI, 36,[38][39][40][41][42]58,75 the CMAI, [36][37][38][39][40][41][42]74 nocturnal motor activity (as measured by actigraphy), 36,38,41,42,75 the MMSE, 39,41,74 and the Clinical Global Impression (CGI). 38,40,41 Efficacy of Cannabinoids for NPS All trials (n ¼ 208 participants) provided data to inform the pooled efficacy of cannabinoids for NPS using one or more outcome measures.…”

Section: Resultsmentioning

confidence: 99%

“…Our findings are consistent with the conclusions of several previously published reviews, 15,29,30,[43][44][45][46]50,51,57,[76][77][78][79][80] but these contrast the conclusions of a recent meta-analysis that declared a lack of efficacy for agitation and aggression. 58…”

Section: Discussionmentioning

confidence: 99%

“…A more recently published meta-analysis of six clinical trials declared that there was no effect of cannabinoids on agitation symptoms or NPS overall. 58 However, several potential limitations were noted by the authors-such as the small number of studies, the small sample size, the lack of adequate controls, the short trial duration, and the low quality of extant trials-may have diminished their study's statistical power to detect a significant signal to noise ratio. The authors concluded that their findings were inconclusive due to substantial heterogeneity-which justified the need for additional, rigorous studies.…”

Section: Introductionmentioning

confidence: 99%

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Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis

2019

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Background: In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990—mainly due to increases in aging and population growth. Up to 90% of individuals with dementia experience neuropsychiatric symptoms (NPS). However, the limitations of current treatments for NPS have drivent he search for safer pharmacotherapies—including cannabinoids. Aim: To assess the efficacy and acceptability of cannabinoids for the treatment of NPS in individuals with dementia. Design: Systematic review and meta-analysis of clinical trials. Setting and participants: Of 6,902 papers, 9 were eligible ( n = 205, 44% female, 78 ± 7 years, 85% Alzheimer disease). Trials were in North America and Europe and explored tetrahydrocannabinol ( n = 3), dronabinol ( n = 5), or nabilone ( n = 1). Measurement: Titles/abstracts were independently screened by one reviewer and reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on the standardized mean difference (SMD) for several NPS instruments, trial completion, and adverse events. Data were pooled using random-effects models. Findings: Cannabinoids led to significant improvements across NPS instruments, including the Cohen Mansfield Agitation Inventory (SMD = −0.80; 95% confidence interval [CI], −1.45 to −0.16), the Neuropsychiatric Inventory (SMD = −0.61; CI, −1.07 to −0.15), and nocturnal actigraphy (SMD = −1.05; CI, −1.56 to −0.54h). Cannabinoids were well-tolerated, with an overall trial completion rate of 93% (193/205) and no serious treatment-related adverse events. Treatment efficacy was associated with baseline dementia severity and dose, but not dementia subtype, age, or sex. The overall study quality was rated as low. Conclusions: There is preliminary evidence for the efficacy and tolerability of cannabinoids as treatments for NPS. Population-based studies are needed to characterize their real-world effectiveness and acceptability.

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Section: Comparison With Previous Reviewscontrasting

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis

2019

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“…Although no data were identified suggesting that medical cannabis can modify, slow, or cure Alzheimer disease (AD), some published clinical data show that medical cannabis may improve dementia-related neuropsychiatric symptoms secondary to AD (eg, agitation, anorexia-associated weight loss, nighttime disturbances). 16-27 A single observational study investigated the efficacy of cannabis oil (plant extract containing 1.65% THC) for managing behavioral and psychological symptoms of dementia in 11 hospitalized AD patients and found significantly decreased Neuropsychiatric Inventory scores from baseline to week 4 (44.4 to 12.8; P < 0.01) but no significant change in weight or Mini-Mental Status Examination scores. 16 A recent meta-analysis included 6 randomized, placebo-controlled trials in AD patients who received oral THC, dronabinol, or nabilone for the management of dementia-related aggression and agitation.…”

Section: Clinical Evidence Summary For Cannabis In Select Disease Statesmentioning

confidence: 99%

Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

et al. 2020

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Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.

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Cannabinoids for the treatment of dementia

Kuharić¹,

Marković

Brković

et al. 2021

Cochrane Database of Systematic Reviews

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Natural and Synthetic Cannabinoids for Agitation and Aggression in Alzheimer’s Disease

Cited by 29 publications

References 0 publications

Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis

Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis

Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

Cannabinoids for the treatment of dementia

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