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Cannabis and Dementia: Prevention and Planning
- 1. Delivery Methods and Dosing: Making the most of your medicine Medical Cannabis and Dementia Presenters: Karin McDonald, RN, BSN, CHPN New Hope Hospice Becky DeKeuster, M.Ed, Director of Education Producer: Ben Gelassen, Marketing Associate An introduction for patients, families, and caregivers
- 2. What is dementia? A decline in mental and social function to a degree that interferes with daily life Alzheimer’s (60-80% of cases) Frontotemporal dementia Dementia with Lewy bodies Huntington’s disease Parkinson’s dementia Creutzfeldt-Jakob disease Includes
- 3. Alzheimer’s Affects the Brain’s Neurons Source: www.alz.org Plaques build up, made of beta-amyloid proteins Tau proteins disintegrate and tangle Memory Focus Reasoning Judgement Language & Communication Visual changes
- 4. Neuronal Damage in Alzheimer’s Source:NationalInstitutesofHealth Mitochondria (the “engine” of our calls) are damaged Electrical impulses cannot travel along damaged neurons
- 5. Brain Volume Changes in Alzheimer’s Source: www.alz.org
- 6. Commonly Used Pharmaceuticals Source: www.alz.org Drug Early to moderate Moderate to advanced Side Effects Cholinesterase inhibitors Donepezil Yes Yes Nausea, vomiting, loss of appetite and increased frequency of bowel movements. Rivastigmine Yes No Galantamine Yes No Memantine No Yes Headache, constipation, confusion and dizziness. Antipsychotics (i.e., Risperidone) Drowsiness, dizziness, constipation, dry mouth, low b.p., tics Antidepressants Nausea, vomiting, weight gain, diarrhea, sleepiness, aggression, panic attacks, suicidal thoughts These drugs delay progression of symptoms by 6 to 12 months for about 50% of patients who try them 96.6% of clinical pharmaceutical trials fail
- 7. Promising Cannabis Research Meta-analysis 1999-Present: 36+ studies In vitro and in vivo studies Cannabidiol (CBD) has anti-inflammatory, anti-oxidant, and neuroprotective properties “If (cannabinoid) compounds were to become medicines, we would expect them to have a good margin of safety even under conditions of longer-term prescription use.” -Grant et al, 2005
- 8. Promising Cannabis Research 2006: Eubanks et al In vitro (lab/Petri dish) study “Δ9-tetrahydrocannabinol (THC) is a considerably more effective inhibitor of AChE-induced beta amyloid deposition than the FDA-approved drugs for Alzheimer’s disease treatment, donepezil and tacrine.” 1. Prevents neurotransmitter degradation 2. Reduces Aβ protein aggregation, treating both symptoms and progression of AD
- 9. Promising Cannabis Research 2006: Walther et al Small (n=6), in vivo (human) study Low doses of dronabinol (Marinol, synthetic THC) resulted in significantly reduced nighttime agitation and motor activity Results were immediate Results were persistent No adverse effects were reported
- 10. Promising Cannabis Research 2014: Cao et al In vitro study (in a Petri dish) “THC (is) effective at lowering Aβ levels… at extremely low concentrations in a dose-dependent manner.” 1. THC interacts directly with Aβ peptide to inhibit protein buildup 2. No toxicity was observed 3. Low doses of THC also enhance mitochondria function
- 11. But Remember…. Brain cells with Alzheimer’s being grown in a Petri dish (www.discovermagazine.com) Female cannabis flowers are covered with small crystals which contain dozens of active therapeutic compounds
- 12. Symptom Management with Cannabis Areas Affected: Memory Focus Reasoning Judgement Language & Communication Vision changes Anxiety Agitation Aggression “Sundowning” Sleep Changes Irrationality Mood changes Hallucinations Fear Paranoia
- 13. Cannabis Side Effects Cannabis has no known LD50 No known negative drug interactions Euphoria Motor coordination problems Short term memory loss Red eyes Dry mouth Low blood pressure Heart palpitations Anxiety/panic/paranoia Hallucinations Remember, while unpleasant, too much cannabis alone is not fatal. Time, water, food, and a relaxing environment all help. Remember: Start low, Go slow
- 14. Methods of Administration Inhalation Ingestion Topical 30 sec – 1 min. Smoking/Vaping Easy titration Wide variety: Tincture, foods, beverages 5 to 10 min20 to 120 min. Can be helpful for neuropathic pain, psoriasis Can be difficult to titrate No psychoactivity Flower & concentrated oils
- 15. Determining Dosage Labs typically measure levels of THC (which causes the psychoactive effects of cannabis) 5mg THC per dose = entry level dose 10mg THC per dose = average consumer
- 16. What is the process? 1. Talk to your primary or specialist doctor Any MD, DO or NP can certify Some work for practices or groups that do not allow them to certify. Their patients must go to a cannabis specialist doctor. Qualifying conditions in Maine: Cancer Glaucoma HIV+/AIDS Hepatitis C ALS Crohn’s disease Agitation of Alzheimer’s Nail-patella syndrome Intractable pain Post-traumatic Stress Disorder
- 17. What is the process? 2. Choose a provider Grow at home, Designate a dispensary, or Designate an individual to be a cannabis “caregiver” A quality provider should: Offer many options (product & potency) Be able to coach and explain products clearly Lab test all products Give receipts, track inventory, charge sales tax Use no pesticides Make you feel safe
- 18. The Mark Bushey Program: Case Data Patient “Joan” is 76 In home hospice care Advanced dementia Essentially non-verbal Frequently agitated More often bedridden of late Pain in shoulder/hip Pressure wound on heel Joan’s story is real. To protect her privacy we have changed her name and are using Open- License images to represent her.
- 19. The Mark Bushey Program: Case Data First dose 5/27/16 ½ dropper CBD tincture, 1x/day Off almost all pharmaceuticals Affect and engagement + Mobility and balance + Verbalizations + Pressure wound: Applied topical salve; wound is healing
- 20. Resources www.pubmed.com www.alz.org/maine Support groups, education, care providers and more
- 21. Delivery Methods and Dosing: Making the most of your medicine Thank you for your time and attention! What are your remaining questions & concerns? www.mainewellness.org @wellconnectme www.facebook.com/mainewellness Instagram: @mainewellness
Editor's Notes
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.
- Becky: Recent federal developments are promising, but not enshrined in law. They are communicated via memos like these. This is quite frustrating for patients, physicians, and providers because memos provide flimsy defense if an agency chooses to change its mind. For example, our new Attorney General who replaced Eric Holder has made clear that she is not a fan of cannabis, but she’s said she won’t use agency funds to undermine well-regulated programs/she will uphold the Cole memo. But she could change her mind.