Cannabinoids May Improve Appetite, Behavior in Dementia

For patients with dementia, cannabinoids may be a promising intervention for treating neuropsychiatric symptoms (NPS) and the refusing of food, new research suggests.

Results of a systematic literature review showed that cannabinoids were associated with reduced agitation, longer sleep, and lower NPS. They were also linked to increased meal consumption and weight gain.

Refusing food is a common problem for patients with dementia, often resulting in worsening sleep, agitation, and mood, study investigator Niraj Asthana, MD, a second-year resident in the Department of Psychiatry, University of California, San Diego, told Medscape Medical News. Asthana noted that certain cannabinoid analogues are now used to stimulate appetite for patients undergoing chemotherapy.

Filling a Treatment Gap

After years of legal and other problems affecting cannabinoid research, there is renewed interest in investigating its use for patients with dementia. Early evidence suggests that cannabinoids may also be beneficial for pain, sleep, and aggression.

The researchers note that cannabinoids may be especially valuable in areas where there are currently limited therapies, including food refusal and NPS.

"Unfortunately, there are limited treatments available for food refusal, so we're left with appetite stimulants and electroconvulsive therapy, and although atypical antipsychotics are commonly used to treat NPS, they're associated with an increased risk of serious adverse events and mortality in older patients," said Asthana.

Asthana and colleague Dan Sewell, MD, carried out a systematic literature review of relevant studies of the use of cannabinoids for dementia patients.

"We found there are lot of studies, but they're small-scale; I'd say the largest was probably about 50 patients, with most studies having 10 to 50 patients," said Asthana.

In part, this may be because until very recently, research on cannabinoids was controversial, he added.

To review the current literature on the potential applications of cannabinoids in the treatment of food refusal and NPS in dementia patients, the researchers conducted a literature review.

They identified 23 relevant studies of the use of synthetic cannabinoids, including dronabinol and nabilone, for dementia patients. These products contain tetrahydrocannabinol (THC), the main psychoactive compound in cannabis.

More Research Coming

Several studies showed that cannabinoid use was associated with reduced nighttime motor activity, improved sleep duration, reduced agitation, and lower Neuropsychiatric Inventory scores.

Several studies revealed a link between cannabinoids use and increased appetite and the consumption of more meals. One crossover placebo-controlled trial showed an overall increase in body weight among dementia patients who took dronabinol.

This suggests there might be something to the "colloquial cultural association between cannabinoids and the munchies," said Asthana.

Possible mechanisms for the effects on appetite may be that cannabinoids increase levels of the hormone ghrelin, which is also known as the "hunger hormone," and decrease leptin levels, a hormone that inhibits hunger. Asthana noted that in these studies, the dose of THC was low and that overall, cannabinoids appeared to be safe.

"We found that, at least in these small-scale studies, cannabinoid analogues are well tolerated," possibly because of the relatively low doses of THC, said Asthana. "They generally don't seem to have a ton of side effects; they may make people a little sleepy, which is actually good, because these patents also have a lot of trouble sleeping."

He noted that more recent research suggests cannabidiol oil may reduce agitation by up to 40%.

"Now that cannabis is losing a lot of its stigma, both culturally and in the scientific community, you're seeing a lot of grant applications for clinical trials," said Asthana. "I'm excited to see what we find in the next 5 to 10 years."

Commenting for Medscape Medical News, Kirsten Wilkins, MD, associate professor of psychiatry, Yale School of Medicine, New Haven, Connecticut, who is also a geriatric psychiatrist at the VA Connecticut Health Care System, welcomed the new research in this area.

"With limited safe and effective treatments for food refusal and neuropsychiatric symptoms of dementia, Drs Asthana and Sewell highlight the growing body of literature suggesting cannabinoids may be a novel treatment option," she said.

American Association for Geriatric Psychiatry (AAGP) 2021: Poster EI 36. Presented March 16, 2021.

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