Welcome to our 12th episode in our Medical Cannabis Now series where we are focusing on brain health, specifically dementia and Alzheimer’s Disease. With over 500,000 Canadians currently living with dementia, we know how important this topic is and we want to discuss how medical cannabis can possibly play a role in helping our patients manage their symptoms and improve their quality of life.
Can CBD help with Alzheimer’s Disease or Dementia?
There are still many things about medical cannabis we do not know, but it is clear that cannabis can affect our brain. You can find high levels of naturally occurring cannabinoid receptor-1 (or CB1) in the brain – especially in the cortical areas, midbrain, and hindbrain. However, few are found in the brainstem which is possibly why cannabis does not directly affect the breathing system. This suggests that naturally occurring cannabinoids, a part of our endocannabinoid system, play a role in emotion, memory, pain, and movement. Check out our previous blog post to learn more about the endocannabinoid system. Here, we discuss the different ways patients are utilizing medical cannabis to prevent and/or treat the symptoms of dementia such as Alzheimer’s and Parkinson’s, epilepsy, and/or improve overall cognitive functioning.
Alzheimer’s Disease & Medical Cannabis
Alzheimer’s Disease is a progressive brain disorder that is often characterized by 7 stages of decline in cognitive functioning. The prevention or treatment of Alzheimer’s disease is not currently a common reason for patients to use medical cannabis. However, it is interesting to note that in 2001, scientists employed by the US government, Department of Health and Human Services filed a patent for the applications of cannabinoids as possible neuroprotectants in neurodegenerative diseases and CBD (cannabidiol) was listed as a major proponent. In this patent, it is stated that CBD and other cannabinoids have antioxidant properties that can prevent oxidative cell death often seen in conditions, such as Alzheimer’s Disease. Some studies show that the endocannabinoid system is upregulated or “activated” when the brain starts to show changes in the disease progression of Alzheimer’s. Another study shows that CB2 receptors occur in high concentration, around amyloid plaques which are improperly folded proteins that are known to develop and accumulate specifically in Alzheimer’s disease.
When these cb2 receptors are activated, it calls on macrophages, which are cells that can come in and remove these plaques, or eat away at them. In addition, it is said the cannabinoids can help with inflammation and neurotoxicity seen in Alzheimer’s disease. A few clinical trials have identified that cannabis can help manage behavioral symptoms in people with dementia, including agitation and aggression. The Alzheimer’s Society of Canada is continuing ongoing research around the effects of cannabis on both mood and anxiety in dementia patients. They have noted that cannabinoids interact differently with the body and could be a safer alternative to traditional medicine that can cause harmful side effects.
In our practice, there are reports from our patients that CBD oil and low doses of THC help with symptoms of agitation, cognitive dysfunction, and improve appetite.
Dementia & Medical Cannabis
Medical cannabis has been noted to improve agitation, aggression, and poor appetite seen in patients diagnosed with dementias aside from Alzheimer’s Disease. There are reports that long term care patients suffering from dementia greatly improve when using CBD rich oils and sometimes a combination of THC:CBD oils. It can lessen the burden on the patient, their family, and care teams. There is also a growing body of patients using medical cannabis as a preventative measure, especially those with a family history of dementia or early-onset dementia. The reason for this is the possible role that CB1 receptors play in synaptic transmissions – ie. the connections in our brain. A dysfunction of this transmission is often implicated in dementia. Many patients will use CBD to prevent cognitive decline. There is not enough research to show that cannabis greatly improves cognitive function in healthy patients but there is evidence that cannabis, especially CBD, can improve cognition when there is a dysfunction.
Parkinson’s Disease has a unique set of symptoms. There are cannabis receptors in the putamen and globus pallidus areas that are affected in patients with Parkinson’s disease. CBD is shown to possibly improve the dystonia, which are uncontrollable, involuntary muscle contractions that are associated with Parkinson’s Disease, as well as improve other symptoms associated with any type of dementia.
Acquired Brain Injury
Acquired brain injury encompasses any injury to the brain that occurs after birth such as physical trauma, stroke, and/or alcohol or drug abuse. Patients who suffer from an acquired brain injury often experience a large range of symptoms and normally come to the clinic hoping to use cannabis for things such as insomnia, pain relief, anxiety, and depression. However, medical cannabis could potentially prevent further damage to the brain, namely with the use of CBD. This has been demonstrated in some studies on animal models. While it did not decrease the damage already done, it decreased further damage from inflammation, excitotoxicity, and other metabolic stresses on the brain after these types of injuries. CBD has been shown to act on other receptors outside of the endocannabinoid system to help with neurogenesis and stimulate synaptic plasticity. In simpler terms, there is potential for CBD to help generate new neurons and improve the ebb and flow of neuronal connections. Finding the right balance between CBD and low doses of THC may help brain injury patients with their mood symptoms, physical pain, sleep, and evidently brain recovery and health.
Epilepsy, A.D.H.D., & Medical Cannabis
Because of cannabis’s multifaceted effect on our brain and diverse arrangement of the endocannabinoid system, there are many more applications of medical cannabis. For years, researchers have been looking at the effects, both short and long term, of medical cannabis in the treatment of Epilepsy as it has made a profound positive impact on families with children suffering from treatment resistant Epilepsy.
Attention Deficit and Hyperactivity Disorder is another condition that may benefit from cannabis. Different strains have been shown to help our patients both pediatric and adults, in improving their focus and possibly help them wean off pharmaceutical medications for ADHD. We will look into the implications of cannabis on these conditions in future episodes.
Questions & Answers
Question: My dad has been diagnosed with early stages of dementia and his doctor doesn’t know if cannabis is a good treatment option. Do you have any recommendations on what we could do?
Answer: It is always a good idea to consult with your family doctor first as your dad has done. You can ask the doctor to send us a referral and we can book him in for a consultation with one of our healthcare practitioners who specialize in cannabis-based medicine. That said, you do not need a referral to have an appointment with us. During this consultation, we would discuss if cannabis is a good option as it is dependent on the individual. Barring any contraindications, most of our patients find there is no harm in trying medical cannabis for this especially CBD as it has a very low side effect profile.
Question: I have seen conflicting evidence that cannabis can impair memory. Would this be an issue for a patient with Alzheimer’s or dementia? How would this be addressed at your clinic?
Answer: The evidence is not necessarily conflicting. It is important to look at what strains are being used in the studies and the demographic being looked at. For example, a study looking primarily at the long term effects of CBD did not find any evidence of memory impairment. In fact, it may have improved memory. We would address this at the clinic by starting low and going slow, the cardinal rule of using medical cannabis. We can help make necessary adjustments based on the health profile and response to medical cannabis as you start treatment.
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