Can cannabinoids improve the symptoms of dementia?

Dementia encompasses a range of neurological conditions characterised by the gradual degeneration of the brain and subsequent decline in cognitive function. The most prevalent form is Alzheimer's disease, which accounts for 60-70% of cases. Other common types include vascular dementia, frontotemporal dementia, and Lewy body dementia. As individuals with dementia age, they may encounter substantial memory loss, confusion, and difficulties with communication.

So, what are cannabinoids, and can they help improve the symptoms of dementia?

Cannabinoids come in two distinct forms – endocannabinoids and phytocannabinoids.

• Endocannabinoids are the naturally-occurring molecules that our bodies manufacture. They interact with the endocannabinoid system (ECS) receptors to help regulate many essential functions, such as sleep, mood, appetite and pain sensation.
• Phytocannabinoids are the cannabinoids found in cannabis plants, like CBD (Cannabidiol) and THC (Tetrahydrocannabinol). These cannabinoids a remarkably similar in structure to the endocannabinoids produced by our bodies, which allows them to also interact with the ECS.

Based on current research, there is no substantial evidence to suggest that cannabinoid-based therapeutic options have the ability to halt, reverse, or prevent the onset of dementia.

While some studies have explored the potential therapeutic effects of these substances, further investigation is required to fully understand their impact on cognitive decline and neurodegenerative diseases.

What the ever-growing body of research is showing is that medical cannabis may be effective in reducing the severity of certain neuropsychiatric symptoms associated with dementia. This includes the agitation, disinhibition, irritability, irregular motor behaviour, and abnormal vocalizations that are displayed by dementia patients. Improvement in rigidity and cognitive scores has also been observed in patients undergoing medical cannabis treatment. But again, more research is needed to fully understand the mechanisms and implications of cannabinoid treatment for dementia patients.

In today's article, we will delve into the current conventional treatment options available for dementia patients, and also discuss the potential that medical cannabis may hold for those looking for an alternative or complementary treatment option.

Dementia: understanding risk factors and current treatment options for symptomatic control

Over 1 million people in the UK are affected by dementia. Researchers suspect a combination of environmental and genetic factors contribute to its onset, although the exact cause remains unknown. Some factors associated with an increased risk of dementia are lifestyle-related like smoking, poor diet and exercise routines, and lower educational levels. Other factors include recurring stress and exposure to certain toxic substances.

And while there is no cure for dementia, patients can take steps to help reduce and control the symptoms relating to their condition, while also lowering the risk of developing dementia in the first place. These include life changes such as:

• Engaging in regular physical activity – even light exercise such as walking or swimming can help. Dementia patients may find it difficult to join a gym or exercise class, but movement doesn't need to be strenuous to provide benefits
• Eating a varied, healthy diet – research indicates that a Mediterranean-style diet rich in vegetables, fruits, and healthy fats may help to reduce the risk of developing dementia
• Staying socially and mentally active – participating in activities such as chess, crosswords, or a book club can make a marked difference in cognitive decline. Even just staying in regular contact with family and friends can be beneficial.
• Quitting cigarettes – smoking has been linked to an increased risk of developing dementia and other neurodegenerative diseases. Quitting smoking as early as possible can help protect from the long-term damage caused by tobacco consumption.
• Reducing alcohol consumption – Recent research has shown that heavy drinking may contribute to an increased risk of developing dementia. 

How cannabinoids work

Cannabinoids work by interacting with the endocannabinoid system (ECS). This is widely accepted as the body's master regulator of homeostasis, the state of internal balance that is essential for optimum health.

The ECS comprises three main components:

• Endocannabinoids – molecules that are produced by our bodies that act as the system's chemical messengers
• Cannabinoid receptors (CB1 and CB2) – the cannabinoids bind with these receptors, causing a range of events that help regulate many of the body's essential functions
• Metabolic enzymes – these enzymes both synthesise and then break down the endocannabinoids once they have completed their function

Cannabinoids produced by the cannabis sativa L. genus of plants, such as THC and CBD, are similar in structure to the endocannabinoids produced by our bodies, which allows them to also interact with the ECS.

THC has been shown to strongly bind with the CB1 receptors, which are located mainly in the brain, while CBD is believed to interact more with the CB2 receptors, which are predominantly found in the immune system. This is why THC is intoxicating (while also offering a range of therapeutic benefits), while CBD has no psychoactivity and only provides therapeutic effects.

Do cannabinoids have the potential to help with dementia?

We mentioned above that emerging studies are indicating medical cannabis administration improved a variety of dementia’s neuropsychiatric symptoms. But, there is simply not enough research to give a full understanding of whether medical cannabis can have a direct effect on dementia, or slow the progression of the disease.

With that said, researchers have been studying cannabis (and the contained cannabinoids) for over 70 years, and a wealth of studies have demonstrated the potential benefits of cannabinoids for treating various medical conditions, and some of these benefits may have a direct impact on dementia patients.

Of particular interest in the neuroprotective potential of cannabis, and in particular CBD, a non-intoxicating cannabinoid. While THC can leave patients feeling mentally lethargic, and even decrease cognition scores, CBD is associated with improved mental clarity and alertness at certain doses, and may have the potential to provide neuroprotective effects in dementia patients.

Cannabinoids have also been shown to have the ability to reduce anxiety, which is a common symptom of dementia, and can make life much more manageable for both the patient and their families. The mental fog and confusion that dementia causes can leave patients feeling like they are no longer in control of their own lives, and the anxiolytic effects of cannabis may help to, at least partially, mitigate this.

Medical cannabis can help to promote better sleeping habits, which may also help to improve dementia patients' quality of life. Multiple pieces of research have shown that, when dosed correctly, both CBD and THC can help to improve sleep quality.

In terms of specific pieces of research on cannabis and dementia control, we have this exciting study from 2022 that was published in 'Frontiers in Ageing Neuroscience'. While only small in scale (only 19 patients were included, who were administered 12.4 mg THC/24.8 mg CBD per day for up to 13 months), it found that

"Clinical scores showed a marked improvement that was stable over time", and that there were "positive overall results on rigidity, care, and behaviour".

The study also noted that "The caregivers, initially showing reluctance (to MC), particularly appreciated the improved quality of the contact with their patients. Furthermore, families were enthusiastic about offering their relatives an alternative and accepted the treatment without concern"

With all of that said, there is simply not clinical evidence to promote the application of medical cannabis in dementia patients at this time, and it is essential to note that more research must be done before any concrete conclusions can be made.

Are there any possible risks and side effects related to cannabinoid therapy?

As with all medications, medical cannabis does come with certain risks and possible side effects. It is essential to be aware of these before considering adding them to your treatment plan.

The most commonly reported side effects of medical cannabis are generally mild, and include:

• Feeling tired
• Dizziness
• Dry mouth
• Nausea
• Loss of Appetite or increased appetite (depending on the product and contained cannabinoids)
• Red, itchy eyes
• Increased heart rate

When looking at dementia more specifically, the decline in cognitive function that can go hand in hand with high doses of THC can be a major concern. Although the vast majority of studies have indicated that cannabis-based medications are generally safe, well tolerated and effective, more research is certainly needed on how cannabinoids impact elderly patients and other vulnerable populations.

Cannabinoids can also interfere with the normal activity of medications, so patients and their caregivers should discuss the application of cannabinoids with the prescribing physician and neurologist.

Conclusion

While the emerging data is pointing towards certain cannabinoids, CBD in particular, being potentially beneficial for dementia, much more research, clinical trials, and long-term studies are needed before any definitive findings can be drawn. Thankfully, with the current wave of decriminalisation sweeping the globe, researchers are increasingly gaining access to medical grade cannabis, and the work being done on cannabinoids and their potential medical benefits is starting to be taken seriously.

However, while the anecdotal reports and preliminary research data is encouraging – it is essential to obtain the appropriate prescription and consultations with a certified medical professional before making any changes to a treatment plan.

If you, or a loved one, require an alternative approach to managing your health condition, Releaf is here to help. Our monthly medical cannabis packages are based on your cannabis prescription, and we offer specialist consultations for medical cannabis and a unique medical cannabis card for protection.