Prescription of a THC/CBD-Based Medication to Patients with Dementia : A Pilot Study in Geneva
Barbara Broers, Zacharie Patà, Aline Mina, James Wampfler, Christian de Saussure, Sophie Pautex
Medical Cannabis & Cannabinoids, 2019, 2, 56–59
Doi : 10.1159/000498924
Background : Dementia is increasing worldwide. No effective medication is currently available for the treatment of the underlying disease and accompanying behavioral symptoms. Cannabinoids might have a beneficial effect, but clinical studies with (low-dose) synthetic THC have not been conclusive.
Objective : To test the acceptability, practical aspects, and clinical outcomes of the introduction of a THC/ CBD-based oral medication in severely demented patients in a specialized nursing home in Geneva.
Methods : This was a prospective observational study.
Results : Ten female demented patients with severe behavior problems received oral medication with on average 7.6 mg THC/13.2 mg CBD daily after 2 weeks, 8.8 mg THC/17.6 mg CBD after 1 month, and 9.0 mg THC/18.0 mg CBD after 2 months. The THC/CBDbased oil was preferred. Neuropsychiatric Inventory, Cohen- Mansfield Agitation Inventory score, and a behavior problem visual analog scale decreased by 40% after 2 months, rigidity score by 50%. Half of the patients decreased or stopped other psychotropic medications. The staff appreciated the decrease in rigidity, making daily care and transfers easier, the improved direct contact with the patients, the improvement in behavior, and the decrease in constipation with less opioids. There was no withholding of the medication for reasons of side effects, and the effects persisted after 2 months.
Conclusions : An oral cannabis extract with THC/CBD, in higher dosages than in other studies, was well tolerated and greatly improved behavior problems, rigidity, and daily care in severely demented patients.
Keywords : Cannabinoids · Dementia · Treatment · THC/CBD
Dementia is a syndrome characterized by a deterioration in memory, thinking, behavior, and autonomy in daily life activities. According to the World Health Organization , there were around 50 million persons worldwide suffering from dementia in 2017, and this number is increasing with the global aging of the population in most countries. Dementia has different causes, but Alzheimer disease is the most common form (two-thirds of cases). Approximately 5 out of 6 patients with dementia will develop behavioral and psychological symptoms of dementia (BPSD) during the course of the disease. These disturbances, namely agitation, depression, delusions, and hallucinations, are strongly correlated with each other.
Currently, the options for treating BPSD 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 . Several clinical trials, conducted in patients with severe dementia and BPSD, with one randomized study giving up to 4.5 mg THC daily, demonstrated that this can be safely administered to patients with dementia, but did not demonstrate any effect on BPSD [4–6]. Recent studies suggest that medications combining THC and CBD might have benefits over pure (synthetic) THC preparations .
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.