Alzheimer’s Disease and Cannabis
Alzheimer’s and marijuana?
According to the Mayo Clinic, “Alzheimer’s disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer’s disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person’s ability to function independently.” Alzheimer’s Disease not only impacts the patient, but also those around.
At AR MMJ Cards, some of our patients are in the early stages of this disorder. We wanted to lay the groundwork for how the intrinsic pharmacology of cannabis medicines counteract the neuroinflammatory process characterizing Alzheimer’s Disease (AD). Starting with a brief history, we delve into the science behind the disease process and how cannabis may hold immense promise AD patients. This installment closes up with guidelines on dosing, methods of ingestion, and which cannabis strains may be most helpful in dealing with symptoms associated with AD.
History of Cannabis Use for Alzheimer’s:
As far back as 1890, Sir John Russell Reynolds, MD, Physician to Queen Victoria, published his findings on cannabinoid treatment on dementia patients. He describes patients wandering and fidgety at night or what Sir Reynolds referred to as sundowning – that is, until they were given a small dose of Cannabis Indica at bedtime. Through Sir Reynold’s research and testing, he determined that cannabis decreased the effect of sun-downing.
“I have found nothing comparable in utility to a moderate dose of Indian hemp given at bedtime. It has been absolutely effective for months and indeed years, without any increase in the dose.” – Sir Reynolds
Pathophysiology of Alzheimer’s Disease:
AD usually begins by attacking the brain’s hippocampus, which is a critical brain region for memory processing. The 3 hallmark characteristics of the Alzheimer’s brain include:
- The buildup of amyloid-ß (Aß) plaques
- Tangles of fibers inside brain cells called neurofibrillary tangles
- The activation of support cells in the brain called microglia
Over time, neurofibrillary tangles from degenerated axons (the long projections from nerves that transmit electrical impulses) form webs. These dense misfolded webs form at the junction of nerves called synapses, thus preventing communication from one nerve to another. In this manner, there is a functional decrease in the amount of available Acetylcholine, the neurotransmitter that is chronically deficient in Alzheimer’s dementia. This forms the basis of nerve degeneration driving the clinically observable manifestations seen in Alzheimer’s dementia including recent memory dysfunction, executive dysfunction, disruption in sleep/wake patterns, personality changes, depression, and irritability.
The Science Behind Cannabinoid Action on the Alzheimer’s Patient:
The increase in endocannabinoid tone in Alzheimer’s patients reflects the adaptive homeostatic response to nerve inflammation. This leads to improvements in neuroinflammation, oxidative stress, neurogenesis, and cerebral blood flow. Cannabinoids exert a multiplicity of actions to modulate neuronal dysfunction. Central to this adaptive process is the critical presence of CB2 receptors on microglia. These vital support cells act as scavengers for the nervous system and clear out inflammatory debris. CB2 receptor activation on microglial cells initiates a cascade of events that potentiates beta amyloid removal as well as reducing nerve inflammation. Please note carefully the concept of cannabis medicines restoring cellular balance by mitigating oxidative stress will be revisited again ad nauseum as this mechanism is central to to the concept of cannabinoid rescue.
- Activated CB1 receptors on the surface of microglial cells decrease harmful inflammatory glutamate release from nerve cells. This is the mechanism underlying MMJ’s beneficial effect on Alzheimer’s dementia
- CB1 receptor activation also inhibits acetylcholine esterase, the enzyme responsible for breakdown of acetylcholine. Inactivation of this degrading enzyme increases the amount of Acetylcholine available at the nerve endings (synapses). Ironically, the same mechanism is employed by pharmaceutical drugs used to increase acetylcholine concentration in the nerve terminals of the central nervous system of Alzheimer’s patients.
- Anandamide and 2-Acyl glycerol (2-AG) are increased in affected areas of the brain, as well as their metabolizing enzymes – Fatty acid amino hydrolase (FAAH) and monoacyl glycerol lipase (MAGL).
How Cannabis Can Help Alzheimer's Patients
The pathophysiology and science of Alzheimer’s leads to devastating effects on patient’s orientation including person, place, and time. As a result, they are easily confused by familiar places and even distrust family members close to them. Caregivers also suffer miserably with combative patients who oftentimes have other comorbid conditions (one or more diseases or conditions that occur with another condition in the same person at the same time) that complicate management. Visual and hearing loss also contribute to disorientation and resultant mood disorders. In addition, sundowning can be particularly frightening for patients. Because there are deficits in recent memory once the sun goes down, patients can’t discern whether the day has just finished or is just beginning:
- Imagine your anger when being denied morning coffee by stranger claiming to be their grown child
- You go to grab your car keys, but are told you don’t drive
- You want to take your dog for a walk, but are told you don’t have a dog
- Everyone telling you what to do is just annoying and undignifying
The disconnect lies in that AD patients have conscious awareness that memories exist, they just can’t access them. This maddening scenario for the patient and caregivers spins into a vicious cycle of constant apprehension and confusion. To alleviate some of these feelings, there are Alzheimer symptoms that may respond to low dose cannabis including: sleep problems, paranoia, anxiety, pain, poor appetite, and weight loss.
Cannabis Studies, Dosing, and Strains for Alzheimer’s Patients:
- A 2016 study published in Journal of Alzheimer’s Disease looked at nursing home patients with Alzheimer’s dementia who had THC oil added to their current meds[1,2]. All patients reported improvements in sleep, agitation, irritability, and caregiver distress.
- Check out this YouTube video on cannabis and an Alzheimer’s patient – the video is taken by a son of his mom before and after cannabis dosing.
- Preliminary studies in rodents show the ideal response at a one to one (1:1) THC to CBD ratio in terms of reducing harmful Alzheimer’s amyloid plaque.
- Maximal dampening of neuroinflammation is achieved with the following dosing schedule for Alzheimer’s patients:
- 2.5 milligrams THC at bedtime and 1.5 milligrams at breakfast and lunch
- The target dose is 5 milligrams THC two to three times daily
- Balloon vaporizers are the favored delivery method for elderly Alzheimer’s patients. Smoking is not recommended for these patients due to fire hazard – Vaporizing balloons are a better option
- Great care must be exercised with the administration to the demented elderly. They are at greater risk for injury with falls. Oral forms are excellent for these patients, but attention must be paid to not make cannabis inaccessible, so they don’t mistake it as a snack.
This clinic suggests that patients or caregivers look for cannabis strains with high myrcene and linalool content for their sedative properties and THC synergy. Myrcene enables the cannabinoids to transfer from the blood to the brain more quickly and linalool promotes relaxation. These strains include high CBD varieties like ACDC and are great options for neuroprotective properties. Other viable cannabis options are Purple Urkle, Granddaddy Purple, and Bubba Kush.
Cannabis can help Alzheimer’s patients with symptoms, but results are dependent on the patient and their bodies. If you need help determining if cannabis may be right for you or a family member, please visit www.armmjcards.com.
1.) Shelef, A., Barak, Y., Berger, U., Paleacu, D., Tadger, S., Plopsky, I., & Baruch, Y. (2016). Safety and Efficacy of Medical Cannabis Oil for Behavioral and Psychological Symptoms of Dementia: An-Open Label, Add-On, Pilot Study. Journal of Alzheimers Disease, 51(1), 15–19. doi: 10.3233/jad-150915
2.) Woodward, M. R., Harper, D. G., Stolyar, A., Forester, B. P., & Ellison, J. M. (2014). Dronabinol for the Treatment of Agitation and Aggressive Behavior in Acutely Hospitalized Severely Demented Patients with Noncognitive Behavioral Symptoms. The American Journal of Geriatric Psychiatry, 22(4), 415–419. doi: 10.1016/j.jagp.2012.11.022