Using CBD (Cannabidiol) to Treat the Symptoms of Alzheimer’s & Other Dementias
What is CBD?
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 47 US States. The states where it remains illegal are Idaho, Nebraska, and South Dakota. 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.
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 2017 study has 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 for treating epilepsy.
There are three ways CBD can work to improve health outcomes for persons with dementia: by reducing inflammation, by reducing oxygen buildup, and by working as a brain stimulant and neuroprotectant. From a user’s perspective, CBD may reduce 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 much 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.
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.
Inflammation has been shown to increase the negative impact of Alzheimer’s disease. The inflammatory response happens when the brain’s immune cells fail to clear disorienting blockages. The inflammation that is a core cause of Alzheimer’s symptoms can often be reduced by using CBD oil.
Oxygen is released as a reactive, stress-induced component of Alzheimer’s disease. 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.
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.
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 that is safe and tolerable at high doses, CBD can be beneficial for managing Huntington’s disease.
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.
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 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, even when there is little or no THC included. Hemp-based CBD (with less than 0.3% THC) would not technically have this restriction, but the sourcing and labeling risks are many. Officials in three states (Idaho, South Dakota, and Nebraska) have said they still consider hemp-based CBD illegal. Medical-based CBD has been legalized in more than 30 states and is recreationally legal in a growing number of US locations. The US Federal Drug Administration recently has approved one CBD medication, Epidiolex, to treat rare forms of epilepsy in patients 2 years and older.
Forms of CBD Administration
CBD comes in many forms. It can be inhaled or taken in pill format as an oil, to name just a few options. Most CBD patients prefer non-inhalable options, such as CBD-rich cannabis oil products that can be consumed orally (such as gel caps), squeezed under the tongue (with liquid dropper) or delivered via patches on the skin (like Band-Aids). The effects of orally administered CBD can last for up to 4 hours, and the onset of effects has shown to take between 30-90 minutes.
In cases of acute symptoms that require immediate attention, inhalation of concentrated CBD-rich cannabis effects can be felt within 2-3 minutes and last up to 1 or 2 hours. Inhalation can be achieved either through smoking of CBD-rich cannabis flower, or through increasingly popular vaporizer ‘pens’. Both forms are widely available at medical marijuana dispensaries.
Legal Status of CBD in the U.S. (as of Feb. 2020)
Despite CBD being sold in health food stores, tobacco shops, on Amazon, etc., its legal status remains convoluted. The federal government has said since 2018 that CBD with less than 0.3%THC is federally legal. Individual states, however, have their own rules.
CBD and medical cannabis is legally available to all adult users (21+) in Alaska, California, Colorado, District of Columbia, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington. Legally recognized state ID is required for purchase.
CBD and medical cannabis is legally available by prescription only in Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Louisiana, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, Virginia, West Virginia, Wisconsin and Wyoming.
CBD is also available with limited THC content in states such as Indiana, Kansas, Kentucky, Louisiana, Mississippi, South Carolina, North Carolina, South Carolina, Tennessee, and Texas.
CBD in all forms is prohibited in Idaho, Nebraska and South Dakota.
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.
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 is suggested that one proceed 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 for behavior changes. Persons 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. However, 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.
Medicinal cannabis is not covered by Medicaid, private plans, group plans, the Veterans Administration (VA) or Obamacare plans.