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Dazed and Confused: Medical Cannabis in Alzheimer Disease

Published:August 31, 2016DOI:https://doi.org/10.1016/j.jagp.2016.08.015
      Neuropsychiatric symptoms in Alzheimer disease (AD) are associated with adverse outcomes for patients and their caregivers. Agitation, one of the most distressing neuropsychiatric symptoms, involves emotional distress, excessive psychomotor activity, aggressive behaviors, disruptive irritability, and disinhibition;
      • Cummings J.
      • Mintzer J.
      • Brodaty H.
      • et al.
      Agitation in cognitive disorders: international Psychogeriatric Association provisional consensus clinical and research definition.
      adequate options for alleviating these neuropsychiatric symptoms are lacking. Although nonpharmacological interventions are suggested as first-line treatment, they are not effective in managing symptoms for every patient, resulting in pharmacological interventions for some patients. Traditionally, these interventions include off-label use of antipsychotics, sedative/hypnotics, anxiolytics, acetylcholinesterase inhibitors, memantine, and antidepressants, where the efficacy doesn't necessarily outweigh the associated risks.
      • Antonsdottir I.M.
      • Smith J.S.
      • Keltz M.A.
      • et al.
      Advances in the treatment of agitation in Alzheimer's Disease.
      Unfortunately, given a modest efficacy offset by relatively poor adherence, safety, and tolerability, these treatments have limited utility. Finding more effective and better-tolerated interventions for neuropsychiatric symptoms is a major challenge for investigators and clinicians and must become an urgent priority. Research has been limited regarding the use of cannabinoids as alternative pharmacological therapy for agitation related to Alzheimer disease, although this condition is listed as a qualifying indication for medical marijuana in some states where it has been legalized.
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