Alzheimer’s and medical cannabis: a new hope for patients?

In the second extract from the Principles of Cannabinology Handbook, Viola Brugnatelli and Fabio Turco, explore how medicinal cannabis may offer new hope for patients with Alzheimer’s disease.

The medical use of cannabis and its derivatives among the elderly has seen a remarkable 300% increase in the last years, driven by evolving legislative landscapes and intensified research efforts.

One of the most prevalent neurodegenerative conditions that affect elderly people worldwide is Alzheimer’s. More than 35 million elderly people are currently diagnosed with Alzheimer’s disease, a condition for which, unfortunately, the only available remedies are symptomatic and fail to halt the progress of the disease.

The following is an excerpt from The Handbook Principles of Cannabinology by Viola Brugnatelli and Fabio Turco on Medical Cannabis for Alzheimer’s.

Alzheimer’s disease: a growing concern

The global ageing population, especially in developed countries, faces an alarming downside – a higher risk of neurodegenerative disorders. This has led to approximately 35 million elderly individuals currently diagnosed with Alzheimer’s disease (AD) worldwide, one of the most prevalent neurodegenerative conditions globally. Unfortunately, the available treatments for AD are merely symptomatic and fail to halt the disease’s progression.

To combat this alarming trend, the scientific community is redirecting its efforts towards finding more effective treatments. 

The role of Medical Cannabis in Alzheimer’s disease

Cannabis is gaining traction in Alzheimer’s research due to its neuroprotective, anti-inflammatory, and analgesic properties. Cannabinoids may play a role in improving brain function and reducing inflammation. With the growing interest in medical cannabis, researchers are uncovering promising avenues for alleviating Alzheimer’s symptoms and enhancing the overall quality of life for elderly patients.

The potential role of Medical Cannabis for Alzheimer’s

While extensive research is still ongoing, preliminary findings indicate that medical cannabis may offer several benefits for Alzheimer’s patients:

1. Reduction in Brain Inflammation: Cannabis compounds have shown promise in reducing brain inflammation, which is often associated with cognitive decline in Alzheimer’s disease.
2. Improved Cognitive Function: Early research suggests that medical cannabis may enhance cognitive function in Alzheimer’s patients, potentially mitigating memory loss and cognitive impairment.
3. Potential Mood and Behavior Enhancement: There is anecdotal evidence, supported by recent findings, suggesting that cannabis may have a positive impact on mood and behaviour in Alzheimer’s patients, potentially reducing anxiety and aggression.
4. Analgesic Properties: Medical cannabis is known for its pain-relieving properties, which could benefit Alzheimer’s patients dealing with discomfort or pain-related symptoms.
5. Sleep-improving properties: Some Alzheimer’s patients experience sleep disturbances and insomnia. Medical Cannabis has been explored for its potential to improve sleep patterns, offering the possibility of better rest and quality of life for those affected by the disease.

The research on cannabis for Alzheimer’s

Most of pre-clinical investigations on the potential therapeutic effects of cannabis-based drugs for AD have focused on modifying the deposition of Amyloid-beta (Aβ) peptides in the brain, a central factor in the onset and progression of AD. A systematic review of the existing body of research with animal models of AD, assessed the effects of cannabis compounds, including CBD and THC. (1) Cumulatively, these findings suggest that cannabis-based drugs may offer a promising avenue for slowing down AD progression through the modulation of Aβ modifications.

Going more in depth, findings indicate that CBD activates PPARγ receptors through the Wnt/β-catenin pathway, offering neuroprotective effects against AD by mitigating Aβ neurotoxicity, oxidative stress, tau protein hyperphosphorylation, and the activity of the enzyme Acetylcholinesterase (AChE). (2)

Additionally, CBD modulates microglial cell function, reducing the expression of proinflammatory molecules. (3) In-vivo studies suggest that combining CBD and THC may be more effective in improving memory in AD mouse models than using either compound alone. (2) Other studies indicate that the modulation of cannabinoid receptor 2 (CB2) exhibits anti-inflammatory effects in AD models and may contribute to the reduction of Aβ deposition, tau hyperphosphorylation, and neuroinflammation. (4)

READ MORE: How cannabis can improve quality of life for dementia patients – a case study

Regarding clinical studies, a limited number of randomised controlled trials (RCTs) have been conducted, primarily involving patients with dementia. A systematic review of these trials has yielded inconclusive results. Specifically, an evaluation of data from four small, short-duration, and heterogeneously designed placebo-controlled trials has not provided sufficient evidence to ascertain whether cannabinoids exert beneficial or detrimental effects on dementia. (5)

Conversely, individual case reports present indications that cannabis and cannabinoid compounds may hold therapeutic potential for addressing AD symptoms. Of particular interest in this context is the case study involving a patient from Brazil who received a micro-dose of cannabis oil featuring an 8:1 THC:CBD ratio. (6)

This treatment significantly alleviated the patient’s Alzheimer’s symptoms both rapidly and in the long term. Cognitive and memory improvement persisted for over a year after starting the experimental treatment and remained stable throughout the patient’s follow-up evaluations, spanning more than a year. In this study, no significant side effects were reported, with the exception of mild initial drowsiness.

READ MORE: Multiple sclerosis and medical cannabis

The promise and challenges of Medical Cannabis for Alzheimer’s

There is a hope that medical cannabis could provide Alzheimer’s patients with a ray of hope, but more research is required to gauge its benefits and risks. The ability to manage Alzheimer’s disease effectively represents a critical step toward improving the quality of life for the elderly population.

It is crucial to approach each patient’s treatment on an individual basis, taking into consideration factors such as genetics, lifestyle, and overall health. The slow titration method, gradually increasing the dose over time, helps monitor potential side effects and allows for treatment adjustment, ensuring patient safety and efficacy.

Conclusion

Data emerging from studies and clinical cases confirm the safety profile of cannabis-based medications for the elderly, especially when they combine balanced THC levels with high CBD concentrations or when they are microdosed. The results of cannabis-based treatments reported by medical professionals and scientists appear highly promising for elderly patients suffering from AD, who can benefit from this therapy to address various symptoms and enhance their overall quality of life. With the continued exploration of cannabis in Alzheimer’s treatment, there is newfound hope for those living with this challenging condition.

To gain a deeper understanding of how medical cannabis may be utilised in the treatment of Alzheimer’s disease, we recommend that you consult ‘The Handbook Principle of Cannabinology’ by Viola Brugnatelli and Fabio Turco. An overview of medical cannabis in Europe, including science, regulations, medicine, and products, can be found in the book.

The book also offers case studies and practical evidence from experienced prescribers, shedding light on the challenges and successes of including Medical Cannabis into AD treatment regimens.

References

1. Tahereh Farkhondeh, Haroon Khan, Michael Aschner, et al. Impact of Cannabis-Based Medicine on Alzheimer’s Disease by Focusing on the Amyloid β-Modifications: A Systematic Study. CNS Neurol Disord Drug Targets. 2020;19(5):334-343.

2. Seok Hee Kim, Jin Won Yang, Kyung Han Kim, et al. A Review on Studies of Marijuana for Alzheimer’s Disease – Focusing on CBD, THC. J Pharmacopuncture. 2019 Dec;22(4):225-230. 
3. Shaobin Yang, Yaqin Du, Xiaoqian Zhao, et al. Cannabidiol Enhances Microglial Beta-Amyloid Peptide Phagocytosis and Clearance via Vanilloid Family Type 2 Channel Activation. Int J Mol Sci. 2022 May; 23(10): 5367.
4. Ester Aso and Isidro Ferrer. CB2 Cannabinoid Receptor As Potential Target against Alzheimer’s Disease. Front Neurosci. 2016; 10: 243.
5. Bosnjak Kuharic D, Markovic D, Brkovic T, et al. Cannabinoids for the treatment of dementia. Cochrane Database Syst Rev. 2021 Sep 17;9(9)
6. Ana Carolina Ruver-Martins, Maíra Assunção Bicca, Fabiano Soares de Araujo, et al. Cannabinoid extract in microdoses ameliorates mnemonic and nonmnemonic Alzheimer’s disease symptoms: a case report. J Med Case Rep. 2022; 16: 277.