Cbd oil for 85 years old alzheimer’s

Effects of THC-Free CBD Oil on Agitation in Patients With Alzheimer’s Disease

This is a randomized, double-blinded, placebo-controlled, crossover trial that aims to 1) determine the efficacy of THC-free cannabidiol (CBD oil) in reducing the severity of agitation among participants and 2) determine whether THC-free CBD oil can reduce the burden on caregivers and increase the participants’ quality of life.

Condition or disease Intervention/treatment Phase
Alzheimer Disease Dementia Major Neurocognitive Disorder With Aggressive Behavior Drug: THC-free CBD Oil Drug: Placebo Phase 2

Individuals with Alzheimer’s and other forms of dementia often go through a period of significant behavioral and psychological symptoms of dementia (BPSD). It is estimated that up to 90% of persons with dementia (PWD) experience behavior problems at some point. BPSDs can be challenging for both unpaid family caregivers as well as paid caregivers. Family caregivers provide the bulk of care for PWD and number over 15 million. One of the most common types of BPSDs is agitation with a prevalence of up to 87%, based on a recent systematic review. Agitation can lead to impaired daily functioning, prolongation of hospitalization, reduced time to institutionalization, and is associated with higher mortality. Additionally, agitated behavior is associated with increased injury to both patients and caregivers. Based on the 2018 Alzheimer’s disease drug development pipeline report almost 70% of clinical trials related to BPSD are dedicated to agitation behavior. Finding ways to address agitation is necessary to improve overall quality of life for PWD and their caregivers. Currently, there are no medications available specifically for the treatment of BPSDs. The use of benzodiazepines, antipsychotics and mood stabilizing agents are common, but the risks and side effects often outweigh any benefits.

Several small studies have investigated the use of cannabinoids in the treatment of pathology and symptomology of Alzheimer’s disease (AD), as well as treatment of the agitation component of BPSD. A handful of these studies showed that the symptoms of BPSD were decreased with the use of cannabinoids. However, due to small sample sizes, study design, and short trial duration of these studies, the efficacy of these agents on BPSD cannot be confirmed. In addition, cannabinoids have demonstrated anti-oxidant and anti-inflammatory effects, and both processes have been indicated as major contributors to the neurologic effects of AD. Some evidence exists that agitation is related to this neuroinflammatory process. This study will examine the effects of cannabinoids on the behavioral and psychological symptoms of individuals with a dementia diagnosis.

Can CBD Help Seniors with Alzheimer’s & Dementia?

CBD, or cannabi diol , has been suggested as a treatment to help seniors with dementia manage their symptoms. While there is currently no evidence to show that CBD can stop, reverse, or prevent dementia , there is research that sho ws that it could help manage symptoms. This could be great news for families and seniors who are struggling with the effects of dementia. In this post, we will explore what CBD is along with how CBD can be used to help seniors deal with Alzheimer’s or related dementias.

What Is CBD?

Let’s start with the basics of CBD. It comes from the hemp plant , which is related to the marijuana plant . The plant is dried and the resin is extracted. This compound contains 2 parts: tetrahydrocannabinol (THC) and cannabidiol (CBD).

  • THC is the recreational form of cannabis, which is associated with generating a “high.” In the US, products with more than 0.2% THC are considered illegal.
  • CBD is the medicinal form of cannabis that generally helps improve mood and reduce damage caused by inflammation. It does not CBD is legal in various forms in 47 US states. It also does not exhibit the potential for dependence or health-related problems.

This distinction is important because CBD does not have the intoxicating feeling associated with THC. Instead, it has been shown t o have anti-anxiety properties that can help manage behavior and promote calm. Additionally, CBD is the main ingredient in recent FDA-approved medication, Epidiolex, to treat epilepsy.

CBD can be administered in different forms, but the most common is as oil, which can be dropped onto the tongue , contained in gel capsule s, or applied to the skin directly. However, it is also available in pill forms or as an inhalant.

What Are the Benefits of CBD for Seniors with Dementia?

CBD is commonly used to help with anxiety, insomnia, poor sleep, and even pain relief. B ecause CBD has been shown to help reduce anxiety and agitation, it is believed that it can help reduce these symptoms in seniors with dementia.

Because of how dementia affects the brain, a senior may become agitated or anxious in everyday situations. Sometimes this agitation can even turn vio lent. But remember that these behavior changes are caused by the disease and are not your loved one’s fault. CBD may be able to help alleviate these symptoms .

Additionally, Dementia Care Central indicates that CBD may also help:

  • Reduce inflammation
  • Reduce oxygen buildup
  • Stimulate the brain & reduce the decline of memory and other brain functions

Let’s dive deeper into how CBD could help in each of these areas.

Inflammation

Inflammation is the body’s natural response to injury. You might be used to seeing inflammation around a cut or wound. However, neuroinflammation is also associated with various forms of dementia. For example, Alzheimer’s disease causes clumps of proteins to build up in the brain. This can make it harder for the brain to function over time. As a result, the body may respond with inflammation in the area, which could make it even harder for the brain to make connections. However, CBD may help reduce that inflammation and help with dementia.

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Oxygen Buildup

Oxygen buildup ties in with inflammation in the brain. As brain tissue expands, oxygen is released. So, the more inflammation, the more oxygen that builds up. As more oxygen is released into the brain, the brain loses functionality. This can result in memory loss or other brain deterioration. Oxygen is also released when the body is stressed, which happens often for seniors with dementia. CBD may help reduce stress and reduce the negative effects of oxygen on the brain.

Memory & Brain Function

As dementia progresses, brain tissue actually dies and function is lost for good. This process can take the time or it can happen very rapidly. In some trials, CBD showed promising results to help stop or even reverse the loss of brain function and memory loss in dementia patients. Additionally, CBD may help stimulate the brain to help keep connections within the brain and help seniors potentially delay the effects of dementia.

While this information gives us much hope in the fight against dementia, know that only small clinical trials have been conducted to determine the effects of CBD on dementia, making it difficult to come to a scientific conclusion. However, scientists are continuing to conduct rese arch to help further our ability to help those with dementia.

Are There Any Risks Associated with CBD?

The World Health Organization (WHO ) has stated that “no public health problems. have been associated with the use of pure CBD.” Additionally, it does not exhibit addictive properties and has not been shown to cause any health risks.

However, this applies to pure CBD. There are some retailers who produce CBD products with other ingredients or strains of CBD that have been tainted with other substances. Some companies also misrepresent their products and place different packaging labels on the products. This could pose a risk for your loved one, so i t’s important for you to obtain any CBD products through a company that has been approved by a third party , meaning the products have been tested independently for quality.

If you or your loved one is interested in using CBD to manage symptoms, make sure you talk to a doctor first to evaluate the risks and discuss the best options.

There is still much we do not know when it comes to CBD and its effectiveness in treating the symptoms of dementia. However, we are hopeful that new research and medications will be developed that will end dementia for good!

Medical Cannabis for Older Patients—Treatment Protocol and Initial Results

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Abstract

Older adults may benefit from cannabis treatment for various symptoms such as chronic pain, sleep difficulties, and others, that are not adequately controlled with evidence-based therapies. However, currently, there is a dearth of evidence about the efficacy and safety of cannabis treatment for these patients. This article aims to present a pragmatic treatment protocol for medical cannabis in older adults. We followed consecutive patients above 65 years of age prospectively who were treated with medical cannabis from April 2017 to October 2018. The outcomes included treatment adherence, global assessment of efficacy and adverse events after six months of treatment. During the study period, 184 patients began cannabis treatment, 63.6% were female, and the mean age was 81.2 ± 7.5 years (median age-82). After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition. Special caution is warranted in older adults due to polypharmacy, pharmacokinetic changes, nervous system impairment, and increased cardiovascular risk. Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.

1. Introduction

The recent interest and use of medical cannabis (MC) are growing substantially in many countries. The regulations on its use vary among countries, affecting medical practice and experience [1]. Current public opinion is that cannabis has the therapeutic potential to treat and cure a long list of diseases, but there is a large gap between that opinion and the current evidence in the medical literature [2]. Another common opinion is that MC is mainly used by young adults. However, the use of MC by older adults is increasing [3], and studies show variable prevalence, ranging from approximately 7% to more than one-third, depending on the country [4,5]. Recreational use of cannabis by older adults is also increasing substantially, especially in the United States [6].

Relief of suffering and promotion of functional status and quality of life are major goals of geriatric medicine. Chronic pain, Parkinson’s disease, depression, sleeping disorders, and malnutrition are all common among older adults [7,8,9,10,11,12]. Current medical treatments of these syndromes can have serious adverse events, frequently endangering patients’ health. For example, some non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal bleeding, renal impairment, and cardiovascular adverse events [13]. Sedative hypnotics can cause psychomotor impairment, dizziness, confusion, increased risk of falls, next-day somnolence, impairment of driving skills, orthostatic hypotension, and blood electrolyte impairment [14]. Opioid treatment causes constipation, nausea, vomiting, drowsiness, delirium, sedation, anticholinergic effects, falls, and respiratory depression, which is the most serious potential adverse effect [13]. Beyond individual factors, current concerns about opioid-related deaths have greatly influenced our thinking about pain management and medication treatment [15].

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1.1. Efficacy and Indications for Medical Cannabis in Older Adults

The geriatric population may benefit from cannabis treatment for a variety of symptoms, such as chronic pain, sleep difficulties, tremor, spasticity, agitation, nausea, vomiting, and reduced appetite. Cannabis may also be useful in palliative care. However, currently, there is a dearth of evidence about the efficacy of cannabis in older adults for any of these symptoms. This has been emphasized in several reviews [16,17,18] and in large reports such as the report of the National Academies of Sciences in the United States [19] and the Information for Health Care Professionals in Canada [20].

1.2. Chronic Pain

Chronic pain is one of the most common indications for prescribing MC. The report by the National Academies of Sciences concludes that cannabis is effective for the treatment of chronic pain in adults [19]. Despite this conclusion and a large number of studies, including randomized controlled trials, the efficacy for cannabis as a chronic pain medication remains in dispute [21]. Pain relief is very often cited as a reason for MC use among older individuals. For example, 89.7% of the older patients in the Colorado MC registry listed pain as their primary or secondary condition [4]. All the large studies that evaluated cannabis for pain have included older adults in the inclusion criteria, but their number was small, or they were not analyzed separately for safety and efficacy [21,22].

1.3. Parkinson’s Disease

Parkinson’s disease (PD) is a common neurodegenerative disease found mostly among older adults, which is caused by dopaminergic neuron loss. It is mainly characterized by motor symptoms that include bradykinesia in combination with resting tremor or rigidity [23]. PD also has a distinct prodromal stage identified by non-motor symptoms, such as olfactory dysfunction, constipation, urinary dysfunction, depression, anxiety, and pain [24]. Two small-scaled randomized controlled trials failed to demonstrate the efficacy of cannabis in treating the motor symptoms of PD [25,26]. However, cannabis might improve quality of life in PD and relieve other non-motor symptoms [27].

1.4. Sleep Difficulties

Approximately 50% of people above age 65 complain about sleeping difficulties, and there is an increase in sleep disturbances in old age [28]. Care must be taken not to mistake geriatric sleep complaints for physiological aging, as these complaints are mainly attributable to medical, psychiatric and health-related burdens [29]. It should be noted that sleep disturbances are among the most frequent complaints of cannabis withdrawal, and are a major cause for continued use after attempts to quit [30]. Both pharmacological and non-pharmacological treatments are used to address sleep disorders among older individuals [31]. A meta-analysis evaluating the therapeutic effect of cannabis on sleeping disturbances has not reached a decisive conclusion. The effects of cannabis on the sleep–wake cycle are also unclear [32], though some research suggests that cannabis might aid in sleep disorders due to its anxiolytic effect [30].

1.5. Nausea and Vomiting

A Cochrane review concluded that “Cannabis-based medications may be useful for treating refractory chemotherapy-induced nausea and vomiting” [33]. A more recent review states that there is low-quality evidence that cannabinoids prevent nausea and vomiting as compared to other agents or a placebo [34]. The only study that addressed this issue in older adults was in 1982, and it found no difference between tetrahydrocannabinol (THC) and prochlorperazine in reducing nausea and vomiting [35].

1.6. Post-Traumatic Stress Disorder (PTSD)

The efficacy of cannabis treatment for PTSD in older individuals was not evaluated thus far in any study. Several studies evaluated the efficacy of cannabis treatment for PTSD in younger adults, but these studies also failed to demonstrate a clear effect of MC treatment for these patients [21].

1.7. Dementia

Dementia is a prevalent condition in older adults causing cognitive decline [36]. Small studies that used Dronabinol, oral synthetic Δ 9 -THC, or an extract of THC from plants, showed it improved neuropsychiatric symptoms, agitation, nocturnal motor activity, sleep duration, and meals consumption in dementia patients, while only a few serious adverse events were observed [37,38,39].

However, a study conducted with Namisol, an oral tablet containing ≥98% natural ∆ 9 -THC, showed it did not reduce neuropsychiatric symptoms, agitation, activities of daily living, or improved quality of life in dementia patients [40].

1.8. Palliative Treatment

A recent systematic review and meta-analysis were unable to make any recommendation about the use of cannabis in palliative care after evaluating studies that included mainly younger adults and a small number of older adults [41].

2. Special Considerations and Precautions

2.1. Pharmacokinetics, Pharmacodynamics, and Drug Interactions

It is well known that aging is associated with substantial changes in pharmacokinetics and pharmacodynamics. For instance, hepatic drug clearance, as well as renal elimination, are both decreased in older adults. Furthermore, aging is associated with increased body fat and decreased lean body mass [42], which increases the volume of distribution for lipophilic drugs, such as cannabis. Two small studies evaluated the pharmacokinetics and pharmacodynamics of older adults who received an oral drug containing pure THC. These phase I and phase II trials included 12 healthy older adults and 10 older adults with dementia, respectively, and found smaller pharmacodynamic effects of THC in both groups, although the pharmacokinetic data showed substantial inter-individual variation [43,44]. Interaction between cannabis products and other drugs is also largely unknown, as the current evidence from human studies is sparse [45]. Concomitant administration of cannabis with other drugs that influence the hepatic CYP family enzymes may greatly alter the metabolism of the cannabinoids [46]. This issue is especially important in the geriatric population, where polypharmacy is common [47].

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2.2. Nervous System Impairment

The common adverse effects experienced by patients due to cannabis use include dizziness, euphoria, drowsiness, confusion, and disorientation [16]. These effects are particularly important in the geriatric population, which may have conditions such as dementia, frequent falls, mobility problems, hearing, or vision impairments [48]. The long-term effect of adult cannabis use on cognition is unclear. Two systematic reviews showed evidence that long-term use of cannabis is associated with negative effects on some cognitive functions, but evidence of enduring negative effects was weak [49,50].

2.3. Cardiovascular Risks

The effects of cannabis on cardiovascular diseases are not yet well established. In recent years, however, there has been an increasing number of case series and reports concerning young, healthy recreational cannabis users who suffer from arrhythmias, myocardial infarction, and even sudden cardiac death [51]. Direct causality has not been proven, but the implication is that care must be taken concerning older adults since they have more cardiovascular comorbidities and risk factors.

The acute cardiovascular effects of cannabis, based on studies performed on younger individuals, include an increase in sympathetic activity that causes an increase in heart rate, cardiac output, and myocardial oxygen demand. Tolerance of the effects of cannabis on heart rate develops rather quickly in young people [52].

This article aims to present a novel medical cannabis treatment protocol in older adults and the initial results from its use. The protocol will be presented in the Discussion segment of the manuscript.

3. Methods

3.1. Patients and Methods

Israeli medical cannabis regulations include a number of indications and recommendations for its use [1]. We have adopted the general recommendations to suit the physiological and pathophysiological needs of the elderly. In 2017, NiaMedic established a specialized geriatric clinic to provide MC therapy within a comprehensive geriatric platform. We have followed 184 consecutive patients above 65 years of age prospectively who were treated with MC from April 2017 to October 2018. The patients were followed for at least six months since treatment initiation. The inclusion criteria were age of 65 years and above and any of the following indications for cannabis treatment: chronic cancer pain and non-cancer pain, Parkinson’s disease, sleep disorders, anorexia, post-traumatic stress disorder, spasticity, and palliative treatment. The exclusion criteria were severe cardiovascular diseases, such as heart failure or a recent major myocardial infarction, liver failure, psychotic comorbidities, and those with a history of addictions. The follow-up evaluation includes detailed questioning regarding adverse events, adherence to treatment, and its efficacy.

3.2. The Treatment Protocol

As previously mentioned, the regulations of cannabis and its products vary by country, which affects the clinical experience of physicians. In Israel, cannabis can be prescribed for the following conditions: nausea and vomiting due to chemotherapy treatment, cancer-associated pain; Crohn’s disease, ulcerative colitis; neuropathic pain; AIDS patients with Cachexia; multiple sclerosis, Parkinson’s disease, Tourette syndrome, epilepsy (both adult and pediatric population); palliative treatment; post-traumatic stress disorder [1]. The initially approved dosing is 20 grams of cannabis compound per month (0.6 grams per day), with a cannabis product that contains the lowest concentration of active ingredients, but without limitation to the ratio of the different cannabinoids. The only cannabinoid-based medicine that is approved at the time of this manuscript preparation is Nabiximols, and its use is infrequent. Thus, we provide here our approach that is based on the available literature, data analysis, and our clinical experience with treating older adults with herbal cannabis, which includes the cohort above and previously published data [53]. We offer many recommendations consistent with Minerbi et al. and MacCallum et al. [17,54].

3.3. Ethics

Our study collected all the relevant clinical data as a part of the routine medical practice. Thus, Soroka University Medical Center institutional review board (IRB) Committee approved the protocol and waived the request for informed consent (confirmation number 0036-18-SOR). All clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.

4. Results

We present here initial data from a cohort of patients who initiated MC therapy between April 2017 and October 2018. Most of our patients, 83.2% (n = 153) were 75 years of age or older, and 63.6% (n = 117) were females. The demographic characteristics, the comorbidities of the patients, and the indications for cannabis treatment are detailed in Table 1 . When we evaluated the patients after six months of MC treatment, we found that 58.1% were still using cannabis, 8.1% discontinued the treatment, 10.9% were lost to follow-up, and 17.9% did not complete six months of treatment by the time of the analysis. Of the 122 patients eligible to respond, 91.8% (n = 112) globally assessed the effect of cannabis on their general condition, with 84.8% of them reporting some degree of improvement ( Figure 1 ). Of the patients who were still treated with cannabis, 33.6% reported adverse events, the most common of which were dizziness (12.1%), sleepiness and fatigue (11.2%), dry mouth (5.6%), and psychoactive sensation (5.6%). Since well-established and evaluated protocols for treatment of older adults with cannabis do not exist, we have developed our own approach based on close follow-up of effects, adverse events, and slow titration.