CBD for Dementia Aggression: A Look at Efficacy and Safety

Written by: Daniel Fayad, Subject Matter Expert and Website President
Published: March 15, 2024; Last updated: April 6, 2024

Managing aggression in dementia poses a significant challenge. With the risks associated with traditional medications, caregivers and family members are increasingly considering ‘CBD for dementia aggression.’ This article unpacks the research on CBD’s role in mitigating aggressive behavior in dementia, offering a concise analysis of its effectiveness and safety profile. Learn what’s known so far and the critical questions that remain unanswered. Note: this article does not contain medical advice, we are simply reporting on the latest findings. Always consult with your medical doctor before adding CBD to a treatment plan!

Key Takeaways

• CBD, as a non-psychoactive cannabinoid, is being explored as an alternative treatment for managing aggression and other neuropsychiatric symptoms in dementia patients, given its potential neuroprotective, anti-inflammatory, and therapeutic properties.

• Clinical trials and systematic reviews indicate that CBD, especially in combination with THC, may reduce agitation and improve other neuropsychiatric symptoms in dementia patients, with a favorable safety profile and generally well-tolerated treatment-related adverse events.

• There is a need for individualized treatment plans, monitoring for potential adverse effects and drug interactions, and more research to establish evidence-based guidelines for the use of cannabinoids in treating dementia-related aggression and other symptoms.

• Currently, there are no evidence-based guidelines for the use of cannabinoids in treating dementia-related aggression

Understanding Dementia and Aggression

Dementia, a term used to describe a range of conditions characterized by cognitive impairment, affects a vast number of people worldwide. Alzheimer’s disease and vascular dementia are among the most common types. Aggression, one of the most challenging symptoms of dementia, profoundly impacts both patients’ quality of life and caregiver well-being. Often, this aggression is a result of neuropsychiatric disturbances, including agitation and other cognitive/perceptual issues. The root of these behavioral and psychological symptoms of dementia (BPSD) is biological changes in the brain, such as volume reductions and decreased metabolism in certain regions. ¹

While nonpharmacological interventions are the first line of treatment, they may not always suffice. There is a pressing need to identify and address unmet physical and emotional needs to manage these symptoms effectively. This need brings us to the ongoing research in the field of cannabinoids, particularly CBD, as a potential alternative to treat dementia.

The Nature of Aggressive Behavior in Dementia

Aggression in dementia patients can manifest in various forms, ranging from verbal outbursts like shouting to physical actions such as hitting. The triggers for these behaviors can emerge suddenly or in response to frustration. Over time, these aggressive behaviors can escalate, posing considerable challenges for caregivers and often leading to institutional placement. ²

Aggressive behavior in dementia patients can be attributed to several factors. Some common causes of aggression include:

• Physical discomfort, such as pain or fatigue

• Environmental factors like loud noises or a cluttered space

• Poor communication from caregivers

• Caregiver stress

These behaviors necessitate intensive management strategies and potential hospitalization, further underlining the need for effective treatments.

Current Pharmacological Treatments

Current pharmacological interventions for dementia come with their limitations. These range from a shortage of randomized clinical trials and the off-label nature of treatments to the prevalent use of antipsychotics for non-psychotic indications. However, the use of antipsychotics, especially for non-psychotic indications, poses a significant risk of severe adverse effects and increased mortality, particularly at higher doses. This risk is further elevated in patients with dementia with Lewy bodies, who may exhibit hypersensitivity to antipsychotic drugs.

Alternatives to psychotropic medications, such as antipsychotics, include:

• Selective serotonin reuptake inhibitors (SSRIs), but their adverse effects are comparable to placebo.

• Pharmacological treatment for pain, which may reduce agitation without negatively impacting cognition or physical function

• Off-label use of atypical antipsychotics or second-generation antidepressants in cases where nonpharmacological strategies prove inadequate

Amid these challenges, the quest for effective treatments persists, with CBD surfacing as a promising prospect.

CBD as a Potential Alternative

CBD, a non-psychoactive cannabinoid, is increasingly being recognized for its potential therapeutic benefits. In the United States, over 40% of states/localities that permit medical marijuana include dementia or, specifically, ‘agitation of Alzheimer’s disease’ as a qualifying condition.

Preliminary studies suggest that combinations of CBD and THC (another cannabinoid) may have better therapeutic effects compared to the administration of each cannabinoid alone.

CBD’s Interaction with the Central Nervous System

CBD is a naturally occurring chemical in the cannabis plant that doesn’t cause a ‘high’ like its counterpart, THC. Preclinical studies have suggested that CBD has the following effects:

• Anti-amyloidogenic

• Antioxidative

• Anti-apoptotic

• Anti-inflammatory

• Neuroprotective

This indicates its potential as a therapeutic agent in neurodegenerative disorders like Alzheimer’s and Parkinson’s diseases.

CBD interacts with the CB1 and CB2 cannabinoid receptors. These receptors are part of the central and peripheral nervous system’s endocannabinoid system. This interaction holds significant interest for the treatment of neuropsychiatric symptoms in dementia, given its implications on aggression and other central nervous system functions. Clinical observations have suggested that a combination of THC/CBD medication can be safely administered with positive clinical improvements in older adults with dementia, indicating the potential of cannabinoids for dementia-related problems. ¹

Evidence from Clinical Trials

Clinical trials have reported positive results with the use of CBD in dementia patients. Some of the benefits include:

• High-CBD medical cannabis oil significantly reduced agitation in dementia patients compared to placebo.

• Systematic review confirming that cannabinoids lead to improvements in neuropsychiatric symptom (NPS) instruments for evaluating agitation in dementia

• Improvements in neuropsychiatric symptoms

• Reduced agitation and rigidity

• Facilitated care when using THC/CBD medications in patients with severe dementia

These findings suggest that CBD can be a valuable treatment option for dementia patients.

While the optimal dosing of CBD for dementia is still under investigation, the administration of CBD in trials often involved a CBD to THC ratio of 2:1, with varying dosages showing efficacy and good tolerance in severely demented patients. However, these studies emphasize the need for further investigation into the safety and effectiveness of CBD oil, particularly given its positive impact on aggression in dementia without the significant side effects often associated with antipsychotic drugs.

Safety Profile of CBD Treatment in Dementia Patients

One of the critical advantages of CBD treatment for dementia patients is its favorable safety profile. Unlike THC, CBD does not cause dependency or psychotomimetic effects. In other words, it doesn’t cause the ‘high’ associated with cannabis use. High trial completion rates and the lack of serious treatment-related adverse events bolster this safety profile.

However, it’s important to note that non-serious side effects were observed in patients with dementia during CBD treatment, notably when using Avidekel oil containing both CBD and a minor amount of THC. Adverse events during CBD treatments are closely monitored by healthcare professionals, ensuring rigorous assessment of their severity and relation to the treatment. Some common non-serious side effects of CBD treatment include:

• Dry mouth

• Drowsiness

• Fatigue

• Diarrhea

• Changes in appetite

• Nausea

If you experience any of these side effects while taking CBD, it is recommended to consult with your healthcare professional.

Monitoring Adverse Effects

Monitoring for adverse effects during CBD treatment is a crucial aspect of its safety profile. These effects are recorded by healthcare professionals who assess the severity and possible relatedness to the treatment. In one study, of the total 117 adverse events recorded, three were deemed severe, including hospitalization for high blood pressure, a surgical procedure, and a death. However, none of these extreme events were related to the cannabis treatment.

The safety outcomes of such monitoring involve measuring parameters like:

• blood pressure

• heart rate

• temperature

• weight

As well as laboratory checks of blood formulas. This continuous monitoring and evaluation by healthcare staff ensure high safety for patients undergoing CBD treatment.

Drug Interactions and Contraindications

A critical aspect of CBD treatment is its potential interaction with other drugs. CBD, when co-administered with THC, has been shown to cause a slight reduction in the enzymatic activity of CYP1A2 and CYP2C19. This implies that dosage adjustments may be required for concomitant medications metabolized by these pathways to prevent potential drug accumulation.

Despite these alterations in enzymatic activity, no critical drug-drug interactions were reported after evaluating the pharmacokinetics of cannabinoids in the study. Furthermore, the activity of the CYP3A4 enzyme remained essentially unchanged with CBD/THC treatment, indicating a generally weak impact of cannabis treatment on this particular enzyme system.

Administration and Dosage Considerations

Like any medication, the effectiveness of CBD oil hinges on its administration and dosage. CBD oil is typically administered orally to dementia patients, owing to the ease of administration. A ‘start low, go slow’ protocol is frequently used for dosing to minimize potential side effects.

Over 13 months, the average daily CBD oil dosage increased from an initial 7.2 mg THC/14.4 mg CBD to 12.4 mg THC/24.8 mg CBD, indicating the need for careful dosage titration based on the individual’s response to treatment.

Finding the Therapeutic Balance

Finding the right therapeutic balance is crucial when administering CBD. The vital balance in the administration of CBD oil for dementia patients requires careful titration of dosage based on the individual’s response to treatment. Clinical studies have found that slowly increasing dosages of THC/CBD to a mean maximum, following a prescribed schema like Nabiximols, is generally well-tolerated among dementia patients with limited adverse reactions.

Improvements in agitation and aggressive behavior in dementia patients treated with CBD-based products became significantly noticeable after 14 weeks of treatment, underscoring the need for consistent monitoring and patience. The goal is to find a balance that effectively manages symptoms without causing undue side effects.

Individualized Treatment Plans

Given the variable nature of dementia and its symptoms, individualized treatment plans are crucial for optimizing the therapeutic effects of CBD oil. Factors such as the patient’s specific circumstances, including age, lifestyle, and the possible side effects of THC, need to be considered to tailor the therapy effectively.

In the Geneva study, CBD oil dosage varied among patients, necessitating an individualized approach to finding the optimal dosage for each patient. Long-term benefits such as reduced rigidity and improved behavior were observed in patients who received personalized assessments and treatments over two months. This underscores the importance of taking a customized approach to CBD treatment for dementia-related aggression.

The Role of Cannabinoids in Managing Other Dementia Symptoms

CBD is not only beneficial in managing aggression and agitation in dementia patients, but it also shows promise in managing other symptoms of dementia. Some of the potential benefits of CBD for dementia include:

• Reducing anxiety and depression

• Improving sleep quality

• Alleviating pain and inflammation

• Enhancing cognitive function

The ‘entourage effect’ suggests combining cannabinoids may produce more excellent therapeutic effects and fewer adverse reactions due to synergistic interactions.

Cannabinoid combination therapies utilizing a balanced CBD-to-THC ratio have shown promise in early evidence, reducing specific neuropsychiatric and behavioral symptoms associated with dementia.

Impact on Psychological Symptoms of Dementia

CBD has demonstrated potential benefits for managing anxiety, sleep disturbances, and other psychological symptoms in dementia patients. Cannabinoids, particularly CBD, may have anti-inflammatory, neuroprotective, antipsychotic, anxiolytic, and antidepressant properties, which could contribute to the improvement of behavioral disturbances in dementia.

High-CBD cannabis oil was found to be effective in reducing sleep disturbances in dementia patients, which is an essential aspect of their psychological symptoms. A systematic review found that synthetic cannabinoids may provide relief from behavioral and psychological symptoms of dementia, including:

• agitation

• aggression

• anxiety

• depression

• hallucinations

• delusions

This relief was observed across Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease.

Taken together, these findings suggest that CBD could play a significant role in managing various psychological symptoms associated with dementia.

Cognitive Function and Quality of Life

Beyond managing symptoms, dementia cannabis may also enhance the quality of life for patients. Early clinical trials suggest that the most therapeutic outcomes in cannabinoid therapy for dementia occur when treatment starts in the early symptomatic phase, potentially using multi-cannabinoid formulas with low THC content or a balanced 1:1 CBD: THC ratio.

The use of cannabinoids in dementia patients has been linked to the following benefits:

• Decreased agitation

• Improvements in global ratings of function

• Increased sleep duration

• Improved food intake

These benefits can contribute to an enhancement of quality of life. Additionally, cannabinoids are generally well-tolerated in dementia patients, with low occurrences of treatment-emergent adverse events. This suggests their potential use in enhancing quality of life without significant safety concerns.

Ethical and Legal Considerations

While the potential benefits of CBD for dementia-related aggression are promising, they also bring to the fore ethical and legal considerations. Ethical considerations in dementia care often involve addressing the progressive deterioration of cognitive functions, which affects patients’ daily activities and their ability to provide informed consent.

In countries like Canada, the use of medical cannabis for dementia patients requires a prescription from an authorized healthcare professional and registration with a licensed producer or Health Canada.

Informed Consent and Ethics Statement

Ensuring informed consent from dementia patients or their legal guardians is crucial for ethical treatment with medical cannabis. Ethical considerations for treating dementia patients with medical cannabis are compounded by their severe cognitive impairments, which limit their ability to provide informed consent. When dementia patients are deemed incapable of giving informed consent due to cognitive decline, informed consent is obtained from a legal guardian or family member.

In the informed consent process for studies involving human participants, a caregiver in regular contact with the patient is crucial for supervision and additional support. This is particularly important given the current research limitations, such as low-quality evidence and the necessity for more rigorous trials.

Regulatory Landscape for Medical Cannabis

The legal framework for medical cannabis use in dementia care varies widely by country, with regulations differing on its allowance, prescription, and registration. Unfortunately, licenses granted for medical cannabis use in the context of dementia are less than 0.5%.

For patients with dementia, the decision to use medical marijuana often falls to surrogate decision-makers due to the patient’s inability to make their own medical decisions. In Canada, medical cannabis is available for dementia patients with a prescription from a healthcare professional authorized by the government.

Perspectives from Healthcare Providers

Healthcare providers play a crucial role in the management of dementia-related aggression. They acknowledge preliminary evidence supporting the efficacy of CBD in treating neuropsychiatric symptoms, including agitation in dementia. However, they also recognize the need to evaluate cannabinoids beyond insufficient evidence to ascertain their feasibility in clinical practice for dementia aggression.

Clinical Experiences and Anecdotal Evidence

From a clinical perspective, healthcare providers have noted anecdotal evidence that medical cannabis may reduce neuropsychiatric symptoms such as agitation and other disruptive behaviors in dementia patients. Clinical experiences with CBD have shown some improvements in rigidity and cognitive function in dementia patients, although these outcomes are based on limited and anecdotal evidence.

However, it’s also important to note that in clinical practice, cannabinoids are sometimes used off-label for dementia symptoms like tremors and agitation, notwithstanding the limited clinical trial evidence supporting these applications. As such, organizations like the Alzheimer’s Society advise consulting with healthcare professionals about using cannabis for dementia due to the current lack of substantial evidence regarding its effectiveness for treatment or prevention.

Professional Guidelines and Recommendations

As it stands, there are no established evidence-based clinical guidelines for the use of medical cannabis, including CBD, for treating dementia. This signifies a gap in the regulatory framework, presenting challenges for healthcare providers considering this treatment option for patients.

Professional guidelines or recommendations specifically endorsing the use of CBD oil for treating behavioral disturbances in dementia patients do not exist yet due to mixed results from studies and the necessity for further research. The need for more research underscores the importance of ongoing and future studies in this area to provide definitive answers about the efficacy and safety of CBD for dementia-related aggression.

Addressing Caregiver Concerns

The use of CBD for dementia-related aggression raises several concerns for caregivers. These range from potential side effects of CBD, such as sedation, gastrointestinal issues, and changes in mood or appetite, to possible drug interactions, especially with medications that influence cognitive function.

Efficacy and Expectations

Regarding efficacy, emerging yet limited clinical evidence supports CBD’s effectiveness for dementia aggression. This requires cautious interpretation and expectation management by caregivers. Caregivers need to understand that CBD is not a cure for dementia but may help manage specific symptoms like aggression and anxiety.

Furthermore, legal considerations surrounding the use of CBD must be addressed, including ensuring the product is sourced legally and contains less than 0.3% THC. Caregivers must also understand the ethical implications of administering CBD to a person with dementia, including informed consent and the right to decline treatment.

Support and Resources

Caregivers seeking support and resources can find additional information through dedicated organizations specializing in dementia. The Alzheimer Society of Canada provides eLearning modules for healthcare providers and articles on cannabinoids for reducing agitation in dementia patients. For more detailed information and assistance, caregivers can contact the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center directly.

This support can provide valuable information to caregivers, helping them to:

• Understand the potential benefits and risks of CBD treatment for dementia-related aggression

• Navigate the challenges of caring for a loved one with dementia

• Receive the support they need during this challenging journey.

Data Availability and Research Transparency

Just like any scientific research, the study of CBD’s efficacy for dementia-related aggression requires data availability and transparency. The survey of cannabinoids for behavioral symptoms in severe dementia was funded by an anonymous donor without connections to pharmaceutical industries or commercial interest, ensuring freedom from potential conflicts of interest.

Following accepted academic practice, the study’s authors did not receive any financial compensation for their work, highlighting an absence of direct economic bias in the research.

Access to Study Data

A data availability statement informs the reader where the research data associated with a paper is available and under what conditions the data can be accessed. This is crucial for transparency and allows other researchers to validate, replicate, or extend research findings.

However, journals with data-sharing policies often require data availability statements and should be included in the manuscript before the ‘References’ section. These statements may vary depending on the nature of the data and any ethical, legal, or commercial restrictions that apply to the data.

Financial Relationships and Disclosure

Maintaining research integrity and readership trust necessitates transparency in funding sources, commercial or financial relationships, and potential conflicts of interest. Financial relationships and disclosures in research are significant because they can influence the research outcomes, and non-disclosure may lead to conflicts of interest.

Financial disclosures can improve the integrity of science by managing conflicts of interest and ensuring that economic interests are openly reported. Open reporting of financial interests allows readers and reviewers to form their own opinions on whether a conflict of interest exists and its relevance to the study.

Summary

In conclusion, CBD shows promise as a potential alternative for treating dementia-related aggression. While current treatments have limitations, CBD offers a favorable safety profile with limited side effects. However, it’s crucial to tread carefully, given the ethical and legal considerations surrounding its use. The perspectives of healthcare providers, backed by clinical experiences and anecdotal evidence, underline the need for further research. Caregivers have valid concerns about potential side effects, drug interactions, and the efficacy of CBD treatment. The availability of support and resources can help address these concerns and provide necessary assistance. As the exploration of CBD for dementia-related aggression continues, the focus should remain on optimizing patient care and improving their quality of life.

Frequently Asked Questions

How do you calm an aggressive dementia patient?

To calm an aggressive dementia patient, stay calm, focus on their feelings, offer respect and validation, limit distractions, and consider physical activity, soothing music, and gentle touch therapy. Remember to identify the immediate cause, rule out pain, and try to shift the focus to another activity to decrease agitation and aggression. Avoid getting upset and reassure the person.

What type of CBD oil is best for dementia?

The best type of CBD oil for dementia is a broad- or full-spectrum CBD oil, as it contains many phytocannabinoids and other plant compounds that work together to create an entourage effect.

What medication is used for dementia anger?

Antipsychotic medications like risperidone and anxiolytics are often used to address aggression and agitation in dementia patients. They can help ease symptoms such as paranoia and confusion.

Are there any side effects of CBD treatment in dementia patients?

CBD treatment in dementia patients may lead to non-serious side effects like fatigue and dizziness. Still, these are closely monitored, and the treatment is generally safe when overseen by healthcare professionals.

How is CBD administered to dementia patients?

CBD oil is typically administered orally to dementia patients, with the dosage carefully titrated based on the individual’s response to treatment, following a ‘start low, go slow’ protocol for dosing. This approach helps ensure safety and effectiveness.

References

Hermush, V., Ore, L., Stern, N., Mizrahi, N., Fried, M., Krivoshey, M., Staghon, E., Lederman, V. E., & Bar-Lev Schleider, L. (2022). Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial. Frontiers in medicine, 9, 951889. https://doi.org/10.3389/fmed.2022.951889

Hermush, V., Ore, L., Stern, N., Mizrahi, N., Fried, M., Krivoshey, M., Staghon, E., Lederman, V. E., & Bar-Lev Schleider, L. (2022). Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial. Frontiers in medicine, 9, 951889. https://doi.org/10.3389/fmed.2022.951889

Cannabis, CBD oil and dementia. Alzheimer’s Society. (2018, August 31). https://www.alzheimers.org.uk/about-dementia/treatments/alternative-therapies/cannabis-cbd-oil-and-dementia

Written by Daniel Fayad - Subject Matter Expert and Website President

Dan Fayad is a results-driven healthcare administration expert and content writer. With a Master of Health Administration from the University of Southern California, he’s carved a niche for himself in the dynamic world of healthcare and business development. Dan uses his experience to educate and empower people on their wellness journeys.