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;
1adequate 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.
- Cummings J.
- Mintzer J.
- Brodaty H.
- et al.
Agitation in cognitive disorders: international Psychogeriatric Association provisional consensus clinical and research definition.
Int Psychogeriatr. 2015; 27: 7-17
2Unfortunately, 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.
- Antonsdottir I.M.
- Smith J.S.
- Keltz M.A.
- et al.
Advances in the treatment of agitation in Alzheimer's Disease.
Expert Opin Pharmacother. 2015; 16: 1649-1656
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- Agitation in cognitive disorders: international Psychogeriatric Association provisional consensus clinical and research definition.Int Psychogeriatr. 2015; 27: 7-17
- Advances in the treatment of agitation in Alzheimer's Disease.Expert Opin Pharmacother. 2015; 16: 1649-1656
- Amyloid proteotoxicity initiates an inflammatory response blocked by cannabinoids.NPJ Aging Mech Dis. 2016; 2: 16012
- Dronabinol for the treatment of agitation and aggressive behavior in acutely hospitalized severely demented patients with noncognitive behavioral symptoms.Am J Geriatr Psychiatry. 2014; 22: 415-419
- Safety and efficacy of medical cannabis oil for behavioral and psychological symptoms of dementia: an-open label, add-on, pilot study.J Alzheimers Dis. 2016; 51: 15-19
- Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: a randomized controlled trial.Neurology. 2015; 84: 2338-2346
- Medical board expectations for physicians recommending marijuana.JAMA. 2016; 316: 577-578
Published online: August 31, 2016
Accepted: August 29, 2016
Received: August 26, 2016
© 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.