If you’ve been reading this blog for longer than five minutes, you know I’ve been trying to manage my husband’s changing mood and crying spells – hoping to find a way to make him feel better. Exercise, more sleep, nutrition – none of these have seemed to do the trick. I’m working with his physician (GP) to find a magic pill that will help, but I’m also interested to know if medical marijuana might be an answer.
Here comes Teepa Snow – the Alzheimer’s and dementia guru with a VERY insightful article. No judgements . . . just the facts as we know them today. If you’re also struggling with these issues, maybe this will be helpful for you, too. If you’ve not looked into Teepa Snow and her WONDERFUL videos on caring for people with dementia, I can’t recommend them highly enough. They are marvelous.
Article By Teepa Snow, MS, OTR/L, FAOTA
As the US and Canada have begun opening their respective doors to the recreational and medical use of marijuana, those who are caring for someone living with dementia are considering using some form of cannabis to help with one or more of the following symptoms:
- Distress – emotional or physical
- Sleep disturbances or insomnia
- Social discomfort or anxiety
- Appetite loss
- Anger about the situation, care, or options being provided by life or care situation
- Fear or sense of isolation due to changes in social support, availability of social support, or limits of those around to respond to requests or demands
- Confusion about where the person is or where they should be or what they should be doing
- Confusion about when in the timeline of their life they are, and who they should be around or finding in their world
In my experience, as with any drug or medication, there are pluses and minuses to consider before diving headfirst into the pool. Additionally, the sources from which you get the medication or drug, the dosage strength, usage frequency, and the route of delivery, may very well matter.
To start, let’s review what we know about cannabis as an aid to help with these various symptoms in the general population, since the studies that are investigating the value of various forms of cannabis are in their infancy for people living with various forms and degrees of dementia.Before we dive in, let’s work on a few vocabulary words that might be important to know about:
Anecdotal – a single person reporting on their experience, a single case report by a provider or professional, or a report from a practitioner who has worked with several people, but has not actually conducted a study.
Furthermore, they have not collected specific evidence to compare other treatments, placebo treatments, or collected a panel of information about the person beyond the immediate impact on a particular symptom.
At this point in the US and Canada, most of the information that is available is still at the anecdotal level, as the clinical trials and studies are just getting started.
Clinical Trials – formal scientific studies that compare the impact of the chemical on one group of people who are taking the medication or drug, to the impact of taking a placebo or not taking anything at all on a similar group of people.
Sometimes the groups get reversed over time and sometimes they do not. In either case, the goal is to try to keep everything else the same, except the drug or treatment, so that cause and effect can be linked.
Although there are some internationally available studies on cannabis and various patient populations, there is very little available at this time related to people living with various dementias. This is primarily due to the historical view that marijuana was just a recreational drug and had been banned in the US as a legal substance for generations.
Psychoactive – chemical that when consumed in some way by humans (breathed in, eaten, applied, or swallowed), causes altered perceptions in some or all of the following areas: physical movement or sensation, vision, hearing, time, space, or relationships/interactions.
There are many chemicals that come from cannabis. These chemicals are called cannabinoids as a group, however each is unique. You will want to know about and understand what each is and what it potentially does. You may more easily recognize them by their abbreviations – CBD, THC, CBN, or CBG, as that is how they are widely reported and marketed. Some occur in the marijuana plant while others are formed when the resin is heated or extracted.
- CBD – cannabidiol – non-psychoactive element. In other words, it does not alter your perception of the world around you in a strong or exciting way. It has been demonstrated in preliminary studies, as well as anecdotally reported, to help in the treatment of nausea, anxiety, insomnia, convulsions, and various inflammations.
- THC – Delta9-tetrahydrocannabinol – psychoactive element. It alters perception and may heighten and intensify many senses and experiences. Anecdotally, THC has been noted to reduce or eliminate various types of pain, aid in relaxation, produce euphoria (positive and strong emotional reactions/sensations or effects), increase appetite, and possibly protect, neurologically, at least some functional areas of the brain.
- CBN – cannabinol – mildly psychoactive. It typically reduces anxiety while also producing an elevation of mood. We only have anecdotal reporting, but it has been used to aid with sleep by making you feel sleepy, helping you stay more deeply asleep, and as an aid in preventing anxiety.
- CBG – cannabigerol – non-psychoactive. It is considered to be a pre-defined or modified form, or preliminary form, of the two resulting chemicals THC and CBD. Some researchers are beginning to carefully study this form of cannabis to treat neurological conditions, skin conditions, chronic pain, and other concerns. It appears to act on specific site receptors throughout the body and may be helpful, without causing the mental state alterations that THC causes. Some studies have indicated it has impact on the serotonin system, so it may have an impact on depression.
Some preliminary investigations have noted the following possible benefits: stimulates bone formation and healing, slows tumor growth, treats fungal or bacterial infections, relieves pain, reduces inflammation, calms overactive bladders, reduces the impact of glaucoma, decreases anxiety, reduces depressive symptoms, and can be neuroprotective for mice altered to have Huntington’s disease.
When it comes to treating dementia with cannabinoids, there is still a good bit of work to be done.
This past year, however, one study on mice found that a synthetic form of THC kept the mice from building up plaque at the rate of those who did not get the chemical. It also allowed them to be able to perform the tests as well as mice who did not have the dementia-related symptoms. This article was reported on the BeingPatient website by Emily Woodruff on November 7, 2018.
There is also a newly approved study underway by the University of Saskatchewan. They will be looking at cannabis in the treatment of various pain issues related to dementia.
Warning – Alert – Be Careful
As with any medication, individual reactions and responses can vary widely and wildly! Just because one person benefits from eating candy with a specific dosage of CBD or THC chemical in it, at set intervals, at specific times, does not mean another person will have the same responses or reactions.
We have no data at this point that would cause me, personally, to begin consuming any dosage of some form of cannabis to keep my brain fit and well. Many have been tricked before by the promises of protection with vitamin E and gingko, only to find it actually had no benefit.
I, personally, have heard of success stories, as well as problematic situations when cannabinoids are used. Data seems to be mixed. There is also mixed information on which form of cannabis should be used by which person, for what symptom, under which circumstance, at what dosage.
Certainly, given the challenges that many drugs pose for People Living with Dementia, it might be worth a trial with a target in mind and some measurement system being used.
This is particularly true for people living with Lewy Body disease and insomnia, who live with high levels of distress and anxiety, have problems with eating, difficulty with pain, or have severe visual disturbances or thinking issues that are very disturbing for that person. For that group, more traditional medications can and do cause tremendous harm and problems.
Considering this option may be less risky than some other alternatives. It would, however, be important to have a supply source that is both reliable and consistent in quality and intensity for the safety of all involved.
As with so many medications and drugs, it really is a buyer/manager beware situation. If it is too good to be true, then it is probably not true. It is more than likely either a lie or a partial truth.
Get prepared before you move forward, if you determine that this course of action would work better than what you have now, then proceed with caution. But please, build a team so you can move forward with awareness, knowledge, and some skill.
As time passes and more people use the various options, we will undoubtedly become more aware and knowledgeable about what makes sense. Given the massive and deadly fentanyl and opioid epidemic gripping both the US and Canada at the moment, as well as drug surprises from our past, I would urge some degree of caution and take precautions to minimize risk while seeking benefit.
Resources used for this article:
Peprah K, McCormack S. Medical Cannabis for the Treatment of Dementia: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jul 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546328/ – a 2019 report out of Canada regarding literature review.
Timler, A., Bulsara, C., Bulsara, M. et al. Use of cannabinoid-based medicine among older residential care recipients diagnosed with dementia: study protocol for a double-blind randomized crossover trial. Trials 21, 188 (2020). https://doi.org/10.1186/s13063-020-4085-x – a 2020 research study that will take place in Australia, starting in February, to evaluation the effectiveness and risks when using a cannabis product with NH residents who are living with dementia and have symptoms of behavioral distress. – To monitor the safety of a purified dose of CBM oil (3:2 delta-9-tetrahydrocannabinol:cannabidiol) on behaviour symptoms, quality of life and discomfort caused by pain.
Harvard Health Blog -Older adults and medical marijuana: Reduced stigma and increased use https://www.health.harvard.edu/blog/older-adults-and-medical-marijuana-reduced-stigma-and-increased-use-2-2020040119321
Learning About Marijuana – Science-based information for the public
Cannabis treatment for dementia to be studied at University of Saskatchewan
Leaf Science – What is CBG (Cannabigerol)?
Growing Marijuana Tips Website – Best Marijuana Strains for Alzheimer’s
Medscape Website (you will need to create a user id if you wish to read)
WebMD Website – Could Medical Pot Help Curb the Opioid Crisis?
The Lewy Body Roller Coaster Blog – LBD and Marijuana, Part 1
The Lewy Body Roller Coaster Blog – LBD and Marijuana, Part 3
Excellent and helpful, thank you. I second your recommendation of Teepa Snow. Spirit dropped a video of Teepa onto my screen, seemingly out of nowhere, right when I needed it and what I learned from her in one video was better than anything I have learned from books.