Cannabis and Alzheimer’s: A Promising Avenue for Managing Agitation

As a seasoned cannabis medical doctor, I’ve seen firsthand how cannabis has revolutionized the treatment of a wide range of conditions. From chronic pain to anxiety, it’s a versatile medicine with the potential to enhance the quality of life for many. One area that’s beginning to capture attention is the use of cannabis in managing Alzheimer’s disease, particularly the often distressing symptom of agitation.

Alzheimer’s disease (AD) is a neurodegenerative disorder that causes progressive cognitive decline, leading to memory loss, confusion, and changes in behavior. One of the most challenging aspects of caring for a person with Alzheimer’s is dealing with agitation. This symptom, which can include restlessness, irritability, and aggression, is distressing for the patient and their caregivers. While traditional treatments like antipsychotics are often prescribed, they come with significant side effects, especially for older adults. Fortunately, there’s emerging evidence that cannabis, specifically THC (the active ingredient in cannabis), may offer a safer and more effective alternative.

Dronabinol: THC’s Synthetically Produced Counterpart

One of the most compelling pieces of evidence in this area comes from recent clinical trials examining the use of dronabinol—a synthetic, FDA-approved form of THC—in patients with Alzheimer ’s-induced agitation. At the 2024 International Psychogeriatric Association conference, researchers from Johns Hopkins University and Tufts University presented data showing that dronabinol significantly reduced agitation in patients with Alzheimer’s.

In this study, 75 patients with severe agitation were either given a placebo or 5-milligram doses of dronabinol twice daily. The results were striking. Patients who received dronabinol showed a 30 percent reduction in agitation. This result was comparable to the efficacy of traditional antipsychotics but with a key difference: dronabinol exhibited a superior safety profile. This is an important distinction, as older patients with Alzheimer’s are particularly vulnerable to the side effects of traditional antipsychotics, which can include increased risk of stroke, falls, and death.

Cannabis in Alzheimer’s: Beyond Agitation

The promising results with dronabinol are part of a larger body of research suggesting that cannabis may have broader applications for Alzheimer’s disease. While managing agitation is a significant benefit, cannabis may also help alleviate other common symptoms of Alzheimer’s, including irritability, sleep disturbances, and anxiety.

Sleep Disturbances

Sleep disturbances are common in Alzheimer’s patients, and poor sleep can exacerbate cognitive decline. Several studies have found that cannabis, particularly its active ingredient THC, may help promote better sleep in patients with Alzheimer’s. Cannabis’s sedative properties can help calm the brain and promote restful sleep, which can, in turn, improve cognitive function and mood during the day.

Anxiety and Irritability

Patients with Alzheimer’s often experience anxiety and irritability, which can make caring for them even more challenging. Cannabis, particularly strains with a balanced ratio of THC and CBD (cannabidiol), may help to ease anxiety. CBD is non-intoxicating and has been shown to reduce anxiety in both clinical and preclinical studies, making it a promising compound for patients who may not tolerate the psychoactive effects of THC.

The Science Behind Cannabis and Alzheimer’s

One of the key questions I often get from patients and their families is: How does cannabis work in the brain of someone with Alzheimer’s? It’s a great question, and the answer lies in the interaction between cannabinoids (the active compounds in cannabis) and the body’s endocannabinoid system (ECS).

The Endocannabinoid System and Alzheimer’s

The ECS is a complex cell-signaling system that plays a role in regulating a wide range of physiological processes, including mood, appetite, and pain sensation. Cannabinoids like THC and CBD interact with the ECS to produce their effects.

In the context of Alzheimer’s, research has shown that both THC and synthetic THC agonists (like dronabinol) can modulate neuroinflammation and reduce the formation of amyloid plaques—the abnormal protein clumps that are believed to play a key role in Alzheimer’s progression.

Preclinical studies suggest that cannabinoids may protect neurons from damage and help reduce inflammation in the brain, which is one of the hallmarks of Alzheimer’s disease. By reducing inflammation and amyloid plaque buildup, cannabis could potentially slow the progression of the disease, though much more research is needed in this area.

The Historical Context of Cannabis and Alzheimer’s

Interestingly, the use of cannabis in patients with Alzheimer’s is not entirely new. Clinical trials dating back to the 1990s have shown positive results for the use of dronabinol in Alzheimer’s patients, particularly in managing behavioral symptoms like agitation. These early studies paved the way for more recent research, which has expanded beyond synthetic THC to include whole-plant cannabis extracts.

One of the advantages of whole-plant cannabis extracts is the presence of a wide range of cannabinoids and terpenes that may work together synergistically—a phenomenon known as the entourage effect. This means that using the entire plant, rather than just an isolated compound like THC, may provide dronabinol.

The Future of Cannabis in Alzheimer’s Treatment

While the current research is promising, it’s important to remember that we are still in the early stages of understanding the full potential of cannabis in treating Alzheimer’s. Most studies to date have been small, and larger, more comprehensive trials are needed to confirm the safety and efficacy of cannabis for Alzheimer’s patients.

However, the available data is encouraging, particularly in light of the limited options available for managing symptoms like agitation. The superior safety profile of dronabinol, compared to traditional antipsychotics, is a key selling point. For patients and their families, finding a treatment that offers relief from agitation without the risk of severe side effects is a significant victory.

As more states and countries continue to legalize cannabis for medical use, I expect we’ll see an increase in both clinical trials and real-world applications of cannabis for Alzheimer’s patients. In my own practice, I’ve already seen a growing number of patients and caregivers who are interested in exploring cannabis as an option for managing Alzheimer’s symptoms. While I always emphasize that cannabis is not a cure for Alzheimer’s, it can be an invaluable tool in the overall management of the disease.

Practical Considerations for Patients and Caregivers

If you’re considering cannabis as a treatment option for Alzheimer’s symptoms, there are a few important things to keep in mind:

Consult with a Medical Professional: It’s essential to speak with a healthcare provider who is knowledgeable about cannabis, especially if the patient is taking other medications. Cannabis can interact with certain drugs, so it’s important to ensure that it’s used safely.

Start Low and Go Slow: For patients with Alzheimer’s, it’s crucial to start with a low dose of cannabis and gradually increase it as needed. Older adults can be more sensitive to the effects of THC, so a cautious approach is key.

Consider Different Forms of Cannabis: While dronabinol is taken in capsule form, other forms of cannabis, such as tinctures or oils, may be more suitable for some patients. These forms allow for easier dosing and quicker onset of effects.

Monitor the Patient’s Response: Caregivers should keep a close eye on how the patient responds to cannabis. Finding the right dose and strain may take some trial and error, and it’s important to adjust the treatment plan based on the patient’s needs.

Conclusion: A Hopeful Path Forward

Alzheimer’s disease is a devastating condition that affects not only the patient but also their family and caregivers. The emergence of cannabis as a potential treatment for symptoms like agitation offers hope for improving the quality of life for those living with Alzheimer’s.

While there is still much to learn about how cannabis affects the brain, the growing body of research—particularly on dronabinol and its impact on agitation—suggests that it may be a valuable addition to the Alzheimer’s treatment toolbox. For patients who are struggling with agitation, irritability, and other behavioral symptoms, cannabis may provide a safer, more effective alternative to traditional medications. As the research evolves, I look forward to continuing to explore how cannabis can improve the lives of Alzheimer’s patients and their families.

As we all, sooner or later, shall face the challenges of enhancing the closing chapters on a life well-lived, we should keep an open mind about the benefits of medical cannabis. Quality over quantity has been our life-long mantra. When quantity is no longer an option, quality becomes the focus.