Cannabinoids for behavioral symptoms in severe dementia: Safety and feasibility in a long-term pilot observational study in nineteen patients

Frontiers in Aging Neuroscience

Neuroscience

François Curtin¹  Jules Desmeules²  Youssef Daali²  Barbara Broers³  Christian de Saussure⁴  James Wampfler⁴  Sophie Pautex⁵  Federica Bianchi⁶  Marc Augsburger⁷ 

[1] Faculty of Medicine, University of Geneva, Geneva, Switzerland;Clinical Pharmacology and Toxicology Division, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland;Faculty of Medicine, University of Geneva, Geneva, Switzerland;Clinical Pharmacology and Toxicology Division, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland;Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland;Faculty of Medicine, University of Geneva, Geneva, Switzerland;Primary Care Division, Geneva University Hospitals, Geneva, Switzerland;Long-Term Care Home “les Tilleuls”, Fondation pour l’Accueil et l’Hébergement de Personnes Âgées, Geneva, Switzerland;Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland;Faculty of Medicine, University of Geneva, Geneva, Switzerland;Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland;Long-Term Care Home “les Tilleuls”, Fondation pour l’Accueil et l’Hébergement de Personnes Âgées, Geneva, Switzerland;Unit of Forensic Toxicology and Chemistry, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland;Geneva University Hospital, University of Geneva, Geneva, Switzerland;

关键词: cannabinoids;    dementia;    symptoms relief;    long-term care;    medical cannabis;   

DOI  :  10.3389/fnagi.2022.957665

 received in 2022-05-31, accepted in 2022-09-07,  发布年份 2022

来源: Frontiers

【 摘 要 】

ContextThe management of behavioral symptoms and rigidity in patients with dementia constitutes a significant challenge. Short-term studies suggest an interest in the use of medical cannabis, but long-term data are lacking.ObjectivesThe objective of this study was to investigate the feasibility and long-term safety of administering tetrahydrocannabinol/cannabidiol (THC/CBD) treatment as an additional drug to a poly medicated population with severe dementia, evaluate clinical improvements, and collect information on the pharmacokinetics of cannabinoids and possible drug–drug interactions.MethodsA prospective observational study of patients with severe dementia living in a long-term care home to whom the physicians had prescribed a medical cannabis treatment. Data were collected over 2 years. We assessed the changes in medical cannabis dosages, safety parameters, variations in neuropsychiatric problems, agitation, rigidity, the most invalidating daily activity, and disabling behavior trouble scores. We evaluated the pharmacokinetics of cannabinoids by measuring plasma levels and analyzing the enzymatic activity.ResultsWe assessed 19 patients (81.4 years—17 women and two men) receiving an average of 12.4 mg THC/24.8 mg CBD per day for up to 13 months, with no reported problems related to the treatment and limited adverse drug reactions. Clinical scores showed a marked improvement that was stable over time, deprescription of other medications, and care facilitated. The pharmacokinetic evaluation showed an expected slight reduction in the enzymatic activity of CYP1A2 and CYP2C19.ConclusionA long-term THC/CBD (1:2) medication can be administered safely and with overall positive clinical improvement to poly medicated older adults with severe dementia and associated problems. The results must be confirmed in a randomized trial.

【 授权许可】

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Copyright © 2022 Pautex, Bianchi, Daali, Augsburger, de Saussure, Wampfler, Curtin, Desmeules and Broers.