Learn about CBD oil, vapor and pills as a treatment for Alzheimer’s disease and other dementias. Effects of THC-Free CBD Oil on Agitation in Patients With Alzheimer’s Disease This is a randomized, double-blinded, placebo-controlled, crossover trial that aims to 1) determine the efficacy of
Using CBD (Cannabidiol) to Treat the Symptoms of Alzheimer’s & Other Dementias
CBD (aka Cannabidiol) is a compound derived from the Cannabis plant that has positive medicinal effects but does not make people feel “high” or anxious. CBD, in various forms, is legal in 48 US States. The states where it remains illegal are Idaho, and South Dakota, though in SD it will be legal beginning in July 2021. For much more on legality, see below.
CBD should not be confused with Marijuana or the THC (Tetrahydrocannabinol) compound which is known for generating a “high” with users. CBD is derived from Cannabis plants, similar to how caffeine is derived from the coffee bean, or aspirin from the bark of a Willow tree. CBD oil is the most common form of administration of the compound, with the oil contained in a gel cap or dropper bottle.
Another chemical in cannabis plants that shows medical benefits similar to CBD is called cannabigerol, or CBG. CBG comes from young marijuana plants and, like CBD, does not get users high. CBG may be useful for treating a specific type of dementia called Huntington’s disease. For more, see below.
CBD Health Benefits for Dementia
The dementia-related conditions that can be helped by CBD include: Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies (DLB), Parkinson’s disease, Frontotemporal dementia and Huntington’s disease.
According to researchers at California’s Salk Institute, their 2016 study found evidence that cannabinoids such as CBD could help remove dementia from, and increase connections between, brain cells. Those results were validated by other laboratories. While the US Food and Drug Administration has yet to approve a CBD drug for the purposes of treating dementia, it has approved a CBD-based drug called Epidiolex for treating epilepsy.
There are several ways CBD can work to improve health outcomes for persons with dementia: by reducing inflammation, by reducing oxygen buildup, by working as a brain stimulant and neuroprotectant, and by eliminating dead brain cells and the protein tangles that are believed to cause brain ailments including dementia. From a user’s perspective, CBD may improve movement while reducing stress and anxiety in the individual with dementia, as well as reduce the decline of memory and other brain functions.
It should be noted that controversy surrounds CBD and the claims companies have made as to its positive effects. The FDA warns that CBD can cause liver injury (as shown in some animal experiments with super high doses) and affect metabolism of other drugs. The agency also says that long-term side effects remain unknown because it has not been studied for a long enough period of time. In actions that are politically based instead of scientifically, the FDA has not approved the use of CBD.
The topic of CBD health benefits continues to grow with new CBD and Alzheimer’s research. In recent studies, CBD has been shown to reduce or remove the impact of inflammation, oxygen buildup and brain cell decline. CBD also increases levels of proteins that eliminate dead cells and plaques in brains with Alzheimer’s, improving both memory and motor function.
When the brain’s immune cells fail to clear blockages associated with Alzheimer’s disease, the result is an inflammatory response. When inflammation happens in the brain, oxygen is released as a result. The greater the inflammation, the greater the negative impact. Important brain functions such as memory are decreased as more oxygen is released in the brain’s cells. Memory loss and other brain deterioration indirectly leads to increased oxygen in the brain. CBD is an antioxidant, which helps reduce the problems associated with oxygen stress. Brain functions negatively impacted by oxygen stress can be improved by using CBD.
Alzheimer’s patients’ brain cells often show a path of rapid decline and destruction. The potential of stimulating brain tissue was recently discovered as a potential benefit of CBD. In clinical trials, CBD has shown the ability to reverse and even prevent the development of Alzheimer’s negative impact. A 2011 study by Australian researchers Tim Karl and Carl Group found that CBD promotes the growth and development of brain cells, reducing the decline of memory and other brain functions.
More recently, in a study researchers were able to increase levels of proteins in the brain (called IL-33 and TREM2) that maintain cognitive functions by eliminating dead cells and helping clear beta-amyloid plaque tangles associated with the disease. After CBD was regularly injected into mice afflicted with Alzheimer’s disease, scientists noticed major improvements in their ability to think. Specifically, the mice could better tell the difference between old objects and new ones. The mice’s movement improved, as well. People with Alzheimer’s often develop stiffness that affects their ability to walk, and mice with these same symptoms will continuously walk in a tight circle. After CBD treatments, that behavior stopped.
Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to one’s brain. To effectively treat vascular dementia, a 2016 study by the US National Institute of Health (NIH) found that activating CB2 (cannabinoid) receptors in the brain helped recover better blood flow to the brain. Activating the CB2 receptors with CBD has increased brain cell activity and helped reduce brain cell damage commonly associated with vascular dementia.
Dementia with Lewy Bodies
Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, sleeping, movement, behavior, and mood. Unlike most pain, anxiety or behavior management drugs, CBD does not block acetylcholine, the main chemical that LBD attacks. Research has shown that CBD can be an effective anti-inflammatory agent, reduce motor symptoms (tremor, rigidity, bradykinesia) and maintain circadian (sleep) rhythms.
Parkinson’s is a chronic progressive disease of the nervous system chiefly affecting middle-aged and elderly people. Parkinson’s is linked to decreased dopamine production and marked by tremor, muscular rigidity, and slow, imprecise movement. Digestive imbalance may also play a role in the progression of Parkinson’s and the severity of symptoms. Cannabinoids such as CBD have been shown to contain effective brain protectors, antioxidants and anti-inflammatory properties which can be beneficial for managing Parkinson’s disease. Read more about Parkinson’s and CBD.
Frontotemporal Dementia / Pick’s Disease
Frontotemporal dementia (FTD) or frontotemporal degenerations refers to a group of disorders caused by progressive nerve cell loss in the brain’s frontal lobes (the areas behind one’s forehead) or its temporal lobes (the regions behind one’s ears) that leads to symptoms of depression and psychosis. Unlike most antipsychotic drugs, CBD does not lead to an increased risk of death. Research has shown that CBD can be an effective anti-inflammatory agent, reduce anxiety, reduce motor symptoms (tremor, rigidity, bradykinesia) and maintain circadian (sleep) rhythms.
Huntington’s disease (HD), also known as Huntington’s chorea, is an inherited disorder that results in death of brain cells. The earliest symptoms are often subtle problems with mood or mental abilities. A general lack of coordination and an unsteady gait often follow. According to 2016 research from the University of Madrid, due to CBD’s effectiveness as antioxidants and its anti-inflammatory properties, CBD can be beneficial for managing Huntington’s disease. Experiments with mice have shown that another chemical called cannabigerol, or CBG, in marijuana plants can help maintain brain health for people with Huntington’s (see next section).
What is CBG? (CBG vs. CBD)
Another cannabinoid (compound in cannabis) that has shown health benefits is cannabigerol, also known as CBG. Often taken as an oil, like CBD, CBG is rarer than CBD and THC because there is much less of it in a plant. Whereas cannabis strains usually contain about 25% THC and 20% CBD, the compound CBG makes up only about 1% of most plants. CBG can, however, be extracted at higher volumes if the plants are harvested at the right age, meaning younger. CBG turns into CBD and THC as the plant gets older.
CBG binds to cannabinoid receptors in the body, strengthening neurotransmitters (brain cells) that specifically function to do things like motivate us and regulate our appetites and sleeping patterns. Studies have even shown that CBG protects nerve cells in the brain.
Unfortunately, those studies were done on the brains of mice, not humans (specifically, mice with an experimental model of Huntington’s disease). There are actually fewer studies on CGB in humans than the other cannabinoids, so while there is a strong case to be made that CGB works as a neuroprotectant that preserves nerve cells in the brain, the evidence is slimmer.
Like CBD, CGB is non-psychotropic and won’t get you high. A key difference between CBD and CBG is that CBG is harder to extract and therefore more expensive.
Risks & Side Effects
The World Health Organization (WHO) stated that “no public health problems… have been associated with the use of pure CBD,” and there has been no known association with potential for dependence or abuse, unlike most pharma alternatives. The most commonly reported potential side effects of CBD usage were diarrhea and bloating, with some also reporting nausea. About 3% of patients in studies reported liver problems and had to discontinue CBD use. Specifically, in dementia, some patients reported increased tremor with high doses of CBD. As with any new treatment, patients and caregivers should monitor effects and outcomes closely.
Full-Spectrum vs. Isolated CBD
CBD comes in either “full-spectrum” or “isolated” form. The difference is that full-spectrum includes other compounds besides just CBD: cannabinoids (THC and others), terpenes (plant chemicals), and flavonoids (natural plant antioxidants). CBD isolate has been processed into a powder without those natural chemicals. Full-spectrum has more health benefits than isolate.
Misperceptions & Myths
1) CBD is non-psychoactive and medicinal while THC is recreational, not medicinal
CBD (cannabidiol) has been shown to have antipsychotic and anti-anxiety effects in humans. This does not mean it is non-psychoactive, but rather that the psychoactive effects are often beneficial and non-intoxicating vs. the “high” feelings of the THC (aka Tetrahydrocannabinol) compound. THC has also shown medicinal benefits for patients, particularly those suffering from pain or inflammation, especially when combined with CBD for consumption by patients.
2) CBD is a sedative and reduces awareness or alertness
Even in high doses (600mg), CBD has not produced sedating effects in healthy humans. CBD usually makes humans feel more awake and alert without negative impact on sleeping patterns. What is more likely happening is that cannabis strains being used by a patient that have high levels of CBD also contain a potentially sedating natural oil (terpene) such as myrcene.
3) All CBD sources are the same
There are multiple sources of CBD such as hemp, medical cannabis and isolate. Hemp-based CBD is plagued by mislabeling and recent studies have found that only 31% of 84 tested hemp-based CBD products were accurately labeled. Medical, locally sourced cannabis has consistently produced the best CBD source as it is held to stricter laboratory testing for potency and contaminants. If you’re ordering CBD online, know that mislabeling is common, and look for products that have been third-party tested, meaning independent testing has shown the stated percentages are correct.
4) CBD is legal in all 50 States
Despite CBD being sold in health food stores, tobacco shops, on Amazon, etc., and legalization by many US States, the Federal government has not legalized CBD-rich medical cannabis. Hemp-based CBD (with less than 0.3% THC) would not technically have this restriction because it is legal at the state and federal level everywhere except for South Dakota and Idaho. In these two states, CBD is only legal with zero THC. Medical-based CBD has been legalized in more than 30 states and is recreationally legal in a growing number of US locations.
Avoid CBD Scams! Legitimate CBD products will be precisely labeled with information including:
– Amount of active CBD per serving
– Other ingredients
– Manufacturer name
– Suggested use
– Lab testing results
Every batch of CBD should be tested before it’s put into stores to sell.
Forms of CBD Administration
CBD comes in many forms. They range in variety from being consumed orally, inhaled or absorbed into the skin. The most popular are:
-Oil (either to go on the skin or under the tongue)
-Patches (like Band-Aids)
Vape Pen Danger – CBD oil in vape pens sometimes contains a solvent called “propylene glycol,” which degrades when burned at high temperatures and can have serious side effects. Look for “solvent free” CBD vape pens.
|Forms of CBD Administration|
|Form||Time Until Effects Are Felt||Duration of Effects|
|Oral: via Pill or Liquid Drops||15-90 minutes||4 hours|
|Skin: via Oil or Patches (like Band-Aids)||15-120 minutes||5 hours|
|Inhaled: via Vaporizer||2-3 minutes||1 to 2 hours|
Legal Status of CBD in the U.S. (as of May 2022)
CBD is widely available and can be found anywhere from local health food stores and tobacco shops to online retailers like Amazon; making it unclear as to its legality. In 2018, the U.S. legalized CBD through the Farm Bill. That gave a national legal standard with guidelines dictating it contains less than 0.3% THC and made from hemp (not marijuana). Because of differences between state and federal laws, each state can have their own requirements on its legality.
In spite of the diverse legal status in different states, CBD can be purchased online and delivered legally to all 50 states.
A table below breaks down the different requirements by state (as of May 2022) to CDB’s legality.
|Legality of CBD by State (Updated May 2022)|
|Conditions of Legality||States in which these Conditions Apply|
|CBD and medical cannabis is legally available to all adult users (21+)||Alaska, Arizona, California, Colorado, District of Columbia, Illinois, Maine, Massachusetts, Michigan, Nevada, New Jersey, Oregon, Vermont and Washington.|
|CBD and medical cannabis is legally available by prescription only||Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Louisiana, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, Virginia, West Virginia, Wisconsin and Wyoming.|
|CBD with limited THC content (less than 0.3%) and made from hemp is legally available||Indiana, Kansas, Kentucky, Mississippi, Nebraska, South Carolina, North Carolina, Tennessee and Texas.|
|CBD with zero THC and made from hemp is legally available||South Dakota and Idaho.|
CBD can also be used legally in most states by residents of assisted living and memory care communities. Read more.
FDA Approval Under Consideration
Not giving CBD federal approval made lawmakers write a bill that would force the FDA to do so. Introduced in early 2021, H.R.841 would make hemp and its byproducts legal and labeled as a dietary supplement under the FDA’s protection and jurisdiction.
This potential law is important for two major reasons. First, FDA approval is the key to making it more accessible to patients in all states and all care facilities. In addition, this leads to potentially being covered by insurance as Medicare and Medicaid have set precedence that they normally approve coverage for all FDA approved medicines.
At this point, it is unknown if this Bill will make a difference. H.R.841 has a long time before it will be signed into law; it is estimated at two years before the FDA is forced to decide on CBD’s legality.
The most common means to obtain CBD rich medical marijuana is from a state licensed dispensary. These dispensaries can be found by searching on any number of dispensary directories (Leafly, Yelp, etc.) or Google Maps.
For those that have trouble with transportation, another increasingly available option would include delivery-based options. However, while convenient for senior patients, these options are not available in every city or town.
Finally, CBD can be legally purchased over the Internet and delivered to all 50 states. One reputable seller is CBDPure. One can visit their website here.
Given the lack of regulation in the CBD marketplace and given the challenges of self-reporting of the benefits with persons with dementia, getting the CBD dosage correct is especially challenging. Even though no prescription is required to purchase CBD, many doctors are still knowledgeable about the product and can provide dosage recommendations. Furthermore, given many persons with dementia take multiple medications, it is worth researching drug-drug interactions when considering CBD. CBD dosage consultations can be arranged online with a doctor for about $60. This is a preferable approach to proceeding without professional medical input. However, it is unlikely one’s insurance would pay for these online dosage consultations.
Should one proceed in testing CBD’s impact on a loved one’s dementia, it’s best to start with the gel cap form of administration as the levels of CBD are consistent (when compared to a dropper) and the act of swallowing a pill is familiar. A further benefit is the once-daily scheduling. While many of CBD’s hypothetical benefits cannot be easily observed, loved ones should pay careful attention to behavior changes. People with dementia who appear calmer or experience less severe sundowning symptoms may be benefitting from CBD. Another area in which CBD’s impact may be observed is in reducing sleeplessness.
Finding the Right Dose
It’s a good idea to start small and slowly increase the dosage. Begin with between 1 and 2 milligrams per day for one week, and increase by 2 to 3 milligrams weekly until you notice improvements in symptoms. Base the dosage on body weight: go smaller if your loved one is particularly light, and give a slightly larger dose for a heavier person. A normal dose for an average adult is around 5 milligrams. You may not want to exceed that number. Again, consult a doctor as you would with any other new supplement or medication.
Insurance Coverage of CBD
At this early stage of development, there are few options covered by insurance. The Food and Drug Administration would need to sign off, and as of now there is only one CBD drug (Epidiolex, for epilepsy) with FDA approval. New legislation is in congress that would force the FDA’s approval. However, currently, when compared to the prices of alternative pharmaceuticals, patients and caregivers may still find that CBD-based medical marijuana is a more cost effective and safer option.
Does Medicare cover CBD? Because of the federal prohibitions on prescribing Schedule 1 substances, there is no Medicare coverage for the purchase of medical marijuana or CBD derivatives. Any out-of-pocket costs one would incur purchasing marijuana for medical use will not count toward any deductibles under Part B or a Medicare Prescription Drug Plan. If congress will pass H.R.841 that will force the FDA to decide on CBD. In that case, coverage could potentially change to include it.
Medicinal cannabis is not covered by Medicaid, private plans, group plans, the Veterans Administration (VA) or Obamacare plans. Again, when FDA approval happens there could be coverage of CDB.
Effects of THC-Free CBD Oil on Agitation in Patients With Alzheimer’s Disease
This is a randomized, double-blinded, placebo-controlled, crossover trial that aims to 1) determine the efficacy of THC-free cannabidiol (CBD oil) in reducing the severity of agitation among participants and 2) determine whether THC-free CBD oil can reduce the burden on caregivers and increase the participants’ quality of life.
|Condition or disease||Intervention/treatment||Phase|
|Alzheimer Disease Dementia Major Neurocognitive Disorder With Aggressive Behavior||Drug: THC-free CBD Oil Drug: Placebo||Phase 2|
Individuals with Alzheimer’s and other forms of dementia often go through a period of significant behavioral and psychological symptoms of dementia (BPSD). It is estimated that up to 90% of persons with dementia (PWD) experience behavior problems at some point. BPSDs can be challenging for both unpaid family caregivers as well as paid caregivers. Family caregivers provide the bulk of care for PWD and number over 15 million. One of the most common types of BPSDs is agitation with a prevalence of up to 87%, based on a recent systematic review. Agitation can lead to impaired daily functioning, prolongation of hospitalization, reduced time to institutionalization, and is associated with higher mortality. Additionally, agitated behavior is associated with increased injury to both patients and caregivers. Based on the 2018 Alzheimer’s disease drug development pipeline report almost 70% of clinical trials related to BPSD are dedicated to agitation behavior. Finding ways to address agitation is necessary to improve overall quality of life for PWD and their caregivers. Currently, there are no medications available specifically for the treatment of BPSDs. The use of benzodiazepines, antipsychotics and mood stabilizing agents are common, but the risks and side effects often outweigh any benefits.
Several small studies have investigated the use of cannabinoids in the treatment of pathology and symptomology of Alzheimer’s disease (AD), as well as treatment of the agitation component of BPSD. A handful of these studies showed that the symptoms of BPSD were decreased with the use of cannabinoids. However, due to small sample sizes, study design, and short trial duration of these studies, the efficacy of these agents on BPSD cannot be confirmed. In addition, cannabinoids have demonstrated anti-oxidant and anti-inflammatory effects, and both processes have been indicated as major contributors to the neurologic effects of AD. Some evidence exists that agitation is related to this neuroinflammatory process. This study will examine the effects of cannabinoids on the behavioral and psychological symptoms of individuals with a dementia diagnosis.