Can we do better?
According to the WHO, there are nearly 10 million new cases of dementia every year, worldwide. It is estimated that the incidence in the general population aged 60 and over is 5–8%. The WHO recognizes dementia as a public health priority because its frequency is on the rise; it can be overwhelming for the families of affected people; it has significant social and economic implications: The direct and indirect cost of dementia to society is at the order of 1.1% of global GDP (0.2%-1.4% depending on how rich is the country).
The WHO recognizes that people with dementia are frequently denied the basic rights and freedoms available to others. An appropriate and supportive legislative environment, based on internationally-accepted human rights’ standards, is required to ensure the highest quality of care for people with dementia and their care providers.
The most common manifestation in patients with severe dementia is disturbed and anxious behavior, which sometimes develops into a combination of violence (physical or verbal), anxiety and mental tension. Therapeutic options for this syndrome are limited to a “dope them up” policy which leads to serious adverse effects, often in the direction of worsening the disorder with its development into an organic (pharmaceutical) mental syndrome. Animal experiments as well as clinical studies in adults show that cannabinoids have a beneficial effect on behavioral disorders in general and dementia-related disorders in particular.
Demented patients treated with cannabis products often experience that medicinal cannabis also alleviates their pain (the elderly often suffer from painful syndromes, eg arthritis), improves their appetite and calms their petulance. Other favorable side effects include improved sleep and reduced need for medication, such as anti-hypertensives, hypnotics etc. Caution is required in interactions with other necessary medications and in the event of tachycardia, should the patient be sensitive to THC.
At the recent 10th IACM conference, Dr @Ethan Russo presented early results on patients with Alzheimer’s disease who were treated with cannabis. The team of @Lihi Bar-Lev Schleider from Israel presented results similar to Russo’s in a randomized, phase II, double-blind, placebo-controlled study of patients with dementia. The active drug was CBD:THC oil in a 20:1 ratio, administered sublingually 3 times a day for 16 weeks (112 days). They found a statistically significant difference concerning the levels of anxiety and worry (as recorded with the Cohen-Mansfield Agitation Inventory) compared (a) to patients’ prior condition and (b) to the control group. Cannabis treatment was found to be safe and effective in reducing arousal and aggression.
Typically, care facilities for the elderly do not allow the use of cannabis as medicine; they cannot afford to lose income from state sources for adopting unlawful or marginally lawful practices. Instead, they administer heavy tranquilizers and psychotropic medications to calm the agitated demented down. But scientific data accumulate and tell us we can do better. Access to medically supervised cannabis treatment seems to be one of the things that a supportive legislative environment should take care of; action is needed now.