Microdosing Cannabis Extract Shows “Encouraging” Results in Patient with Alzheimer’s Disease
A 75-year-old man with Alzheimer’s disease is successfully managing his symptoms with microdoses of cannabis, according to a new case report published in the Journal of Medical Case Reports.
Under the supervision of an international team of investigators from The Federal University for Latin American Integration in Foz do Iguaçu, Brazil, and John Hopkins University in Baltimore, Maryland, the patient began to take small doses of a cannabis extract dietary supplement that had been imported by the patient’s family.
In the months following treatment, the patient’s scores on the Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) assessments improved. The patient also self-reported improvements in mood and overall quality of life.
Based on this case report, which demonstrates a potential use for cannabinoids as a therapeutic for Alzheimer’s disease, the researchers believe that further placebo-controlled clinical trials are needed on this topic to confirm and extend these observations.
“I used to feel forgetful, not once after the treatment”
The patient at the center of this case report had been diagnosed with Alzheimer’s disease two years prior. He had initially been prescribed memantine, a medication used to slow the progression of Alzheimer’s. But after suffering with unpleasant adverse effects and rapid disease progression, this treatment was halted at the recommendation of a neurologist.
The patient’s family then imported a cannabis extract labeled as a dietary supplement and approached the Brazilian university researchers about chemically analyzing the extract and taking a patient history.
Analysis revealed that the THC:CBD ratio of the extract was 8:1, with some other cannabinoids such as cannabigerol (CBG), cannabinol (CBN), and tetrahydrocannabivarin (THCV) also detected in small amounts.
Initial treatment consisted of daily doses equivalent to 0.5 milligrams (mg) of THC, though the actual dose given varied between 0.3 and 1 mg of THC over the course of treatment. Overall, the 0.5 mg dose was the most used dose.
The MMSE is designed to evaluate memory and thinking ability, where lower scores indicate worse mental skills. During the 22-month treatment window observed in this case study, the patient’s MMSE score improved from a low of 21 points at baseline to a peak of 27 points between the third and fifth month. At the 22-month mark, this score had stabilized to around 24 points, out of a possible 30 points.
“I used to feel forgetful, not once after the treatment. Sometimes, I did not know where I was, it has not happened to me anymore,” the patient is quoted as saying in the case report. “I used to find myself lost on the streets, I could not leave home unassisted; today, I took the bus by myself to perform my clinical evaluation.”
The ADAS-Cog evaluates memory as well as other cognitive functions, such as language and praxis. ADAS-Cog scores range from 0 to 70, with scores higher than 18 generally indicating greater levels of impairment. In this case study, the patient’s ADAS-Cog score improved significantly, from 25 points at baseline to 12 points by month 22.
Treatment effects were long-term and not limited to memory
While the official treatment window of the case report covered 22 months after beginning treatment with microdoses of cannabis extract, the patient chose to continue using the extract at the 0.5 mg equivalent THC dose well after the conclusion of the experiment.
Forty-two months after initiating treatment, the patient was still reporting good health. Additional health assessments at this time confirmed normal thyroid, liver, and kidney function. Electrolytes and complete blood count tests were also normal, with imaging tests and neurological exams confirming the patient’s Alzheimer’s symptoms had remained stable.
Reassessment using the MMSE and ADAS-Cog tests also showed this stability, with the patient scoring 24 and 10 points on each test respectively.
“The treatment here described mitigated AD [Alzheimer’s disease] symptoms, with rapid onset and long-term consequences,” the researchers wrote.
“In this report, cognitive and memory enhancement lasted for more than 1 year following the start of treatment, and remained stable while we progressively evaluate/follow up with the patient, for more than 1 year after the official report ended.”
While the researchers did predict that cannabinoid treatment would have a positive outcome on memory and cognition, they also found unexpected improvements in mood swings and aggressiveness over the course of the observation window. However, these effects were self-reported by the patient and not assessed by any kind of validated or standardized psychiatric scale. The addition of such assessments should be considered for future studies, the researchers advise.
Cannabis and Alzheimer’s disease
While these findings come from a single patient, with no control or placebo case for comparison, the researchers still describe the findings as encouraging. Further placebo-controlled clinical trials are now needed to confirm these observations, the researchers say, and determine the mechanisms behind such an effect.
For example, it is conceivable that the improvement could be a result of the cannabinoid treatment improving other domains of well-being, such as mood, sleep, and anxiety. The patient himself did also report improvements to overall wellbeing, stating: “shortly after the beginning of the treatment, I already felt more alert and excited during daily activities, and I have noticed I have been sleeping much better.”
However, given the significant size of the improvements in MSSE and ADAS-Cog scores, the researchers behind this case study believe that there must also be a drug effect that is contributing to this improvement.
While this case study is somewhat unique in its use of cannabinoid microdoses, other in vitro and in vivo studies using greater amounts of CBD and THC have suggested the possibility of a relationship between cannabinoids and Alzheimer’s disease symptoms.
A recent review of cannabis for Alzheimer’s disease concluded that CBD “could suppress the main causal factors” of Alzheimer’s disease through its activation of the peroxisome proliferator-activated receptor-γ (PPARγ), which can protect against Aβ-induced neuroinflammation and oxidative stress. The review also found that combinations of CBD with THC may be more effective than THC alone.
Still, there is a general lack of research in this area, with other studies producing inconclusive results. The Alzheimer’s Association advises that, until more research is done to evaluate the benefits and harms of cannabis use for people with Alzheimer’s and dementia, caution must be exercised.
“From a medical perspective, we still don’t understand the benefits and risks of taking cannabis-derived products,” the Alzheimer’s Association’s director of scientific engagement, Rebecca Edelmayer, PhD, said in a recent news piece for the Association’s ALZ Magazine.
“If you make the choice to take one, your physician should be involved to assess any potential side effects or interactions with other medications.”