The following is a guest post by CCNA researchers Nathan Herrmann MD FRCPC, and Krista Lanctôt PhD (Sunnybrook Health Sciences Centre, and University of Toronto).
Alzheimer’s disease and other dementias are known for their effects on memory and other cognitive functions. What is less well known, but of great importance to quality of life and care, is the effect these illnesses can have on the behavior and psychological well-being of the impacted individual and their care partner(s). Some of the most significant symptoms include agitation and aggression, which occur in about 25% of patients at some point in their illness, and much more frequently in individuals who require long-term care. Agitation and aggression are also frequent motivators for care partners to seek out institutional supports and options. In part, that is because most medical treatments for agitation and aggression are only modestly effective, and the more effective treatments (e.g. antipsychotic medications) are often associated with the risk of stroke and even death.
The goal of the team that we lead (with Dr. Dallas Seitz) within the Canadian Consortium on Neurodegeneration in Aging is to prevent and treat the behavioral and psychological symptoms of dementia through non-medical approaches (like music and art therapy) and tailored educational interventions for care partners. At the same time, we are working to discover new drug treatments that are safer and more effective for people living with dementia.
In a trial involving moderate to severely cognitively impaired people living in long-term care residences, we are using synthetic marijuana as a treatment for agitation and aggression. By comparing the effects of a drug called nabilone with a placebo, we hope to show that the drug can reduce agitation without causing significant side effects.
Currently, nabilone is used in Canada to treat nausea associated with cancer chemotherapy. Because marijuana-type compounds (called cannabinoids) have also been known to help with pain and increase appetite, we hope to see improvements in these symptoms as well. After all, pain and weight loss are significant problems for people with Alzheimer’s disease, especially in the more advanced stages of the illness, and few effective and safe treatments exist.
What’s more, pain and weight loss appear to be closely linked to agitation and aggression, so targeting all of these symptoms with a single treatment could dramatically improve quality of life and quality of care for people with dementia.
As we have just finished recruiting participants, we will begin examining the results of our trial in 2018. In preparing for our study, we reviewed all of the literature that was previously published on cannabinoids and Alzheimer’s disease, and were struck by how little evidence was available on its use and impact. While we are hopeful that our study will provide guidance for physicians on the use of cannabinoids for Alzheimer’s disease, we also caution physicians, people with lived experience of dementia, and families that – at the present time – there is insufficient evidence to recommend the use of medical marijuana or any other cannabinoids to treat the illness. Looking forward, we believe our research will go a long way in supporting guidelines, policies, and standards for practice that focus less on short-term attempts to curb behaviour and more on the psychological and psychosocial well-being of residents.
To learn more about this exciting work, visit the CCNA’s news section where updates are regularly posted, as well as Dr. Nathan Herrmann’s blog, the Memory Doctor