Due to the sheer numbers of people who have and will develop a dementia-like condition, like Alzheimer’s disease, and especially those who will suffer from undiagnosed pain related to agitation, there is a real need for a safe and effective treatment, free of the potentially life-threatening side effects of many psychotropic medications in use today. Recently, groups of researchers examined the effects of a THC/CBD-based oral spray called Sativex and found that it may be a safer treatment for pain and agitation in severe dementia.
Severe Dementia, Pain and Agitation: What’s the Connection?
It is well known that over 80% of residents in nursing homes who are diagnosed with dementia experience chronic pain, and nearly 100% experience some type of neuropsychiatric symptom, the main one being agitation, which is by far the most difficult to treat. This is significant because quality of life is deeply affected by disorders of thought, mood and behavior. To make matters worse, individuals diagnosed with dementia are of advanced age and present with multiple co-occurring conditions like heart disease, stroke and diabetes, making effective treatment difficult. Most nursing home residents with dementia receive little to no therapy for pain.
Current Medications for Dementia with Agitation
Before the latest drug, Rexulti, there was no dementia with agitation-specific treatment, therefore healthcare providers turned to antipsychotic medications that were used off-label, meaning that they were not originally meant to treat dementia with agitation. Rexulti was originally prescribed for treatment-resistant depression, but studies revealed that it may help older adults with dementia-induced agitation. The problem with Rexulti and antipsychotics is the potential for severe side effects including:
- Risk of suicidal thoughts and actions
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- High blood pressure
- Induce diabetes
- Increase cholesterol
- Weight gain
- Compulsive behaviors
- Low white blood cell count
- Falls
- Seizures
- Fatigue
- Death
Of special note, Rexulti comes with a black box warning: “Increased risk of death in elderly people with dementia-related psychosis. Medicines like REXULTI can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). REXULTI is not approved for the treatment of people with dementia-related psychosis without agitation that may happen with dementia due to Alzheimer’s disease.”
Can Sativex Help Manage Symptoms of Dementia with Pain and Agitation?
It makes logical sense that if a treatment can reduce inflammation and pain, agitation associated with dementia, may diminish as well. That’s the theory behind some current research on this topic. Scuteri and others in 2022 reported that “Pain and NPS [neuropsychiatric symptoms] remarkedly reduce the patients’ HRQL [health-related quality of life] and contributed to increase their risk of mortality due to inappropriate pharmacological treatments, therefore safer and more effective therapies are needed”.1
Another study by Christopher P. Albertyn and others in 2023 supported the use of Sativex as a potential alternative to traditional medications for dementia, agitation and aggression for residents in nursing homes. “Although no statistically significant treatment effects were observed, indications of positive clinical effects were noted. These findings support further investigation into cannabinoid-based therapies for agitation.”2 It should be noted that Sativex is currently licensed for the treatment of multiple sclerosis-induced spasticity.
Bianchi and others in 2023 point out that pain may be associated with the overall deterioration of the individual’s condition due to dementia and this can be related to the onset or worsening of behavioral symptoms like aggression and agitation. Optimizing pain treatment may reduce such behaviors and enhance overall quality of life. Non-pharmacological interventions such as activities and social support may work for a while and the use of antidepressants, antipsychotics or benzodiazepines unfortunately present too many possibly dangerous and life-threatening side effects. Medical cannabinoids may be safer and more effective.3
Finally, Chelsea and others in 2018 in their article “Cannabinoids for the Treatment of Neuropsychiatric Symptoms, Pain and Weight Loss in Dementia” reviewed studies that found positive results in the use of cannabinoid-based medications. Among their findings, decreased agitation, improvements in sleep, increased food intake and healthy weight.4
Final Thoughts on Sativex
Dementia and other like conditions affect millions of Americans and those from all around the world. Many co-occurring symptoms such as memory impairment, loss of communication, agitation and aggression, make evaluating pain a serious challenge. Although there are prescription drugs available for symptom management, they all have the potential for serious and life-threatening side effects, including death. It is therefore imperative to find a better, all-natural cannabinoid-based treatment for these symptoms alleviating side effects and improving quality of life.
References
- Scuteri, D. et al. 2022. Nabiximols Clinical Translation to the Treatment of Pain and Agitation in Severe Dementia (NACTOPAISD): Clinical Trial Protocol. Biomedicine & Pharmacotherapy, 153:113488.
- Albertyn, C.P. et al. 2023. Sativex (Nabiximols) for the Treatment of Agitation & Aggression in Alzheimer’s Dementia in UK Nursing Homes (STAND): A Randomized, Double-Blind, Placebo-Controlled Feasibility Trial. Health Open Research, 5:18.
- Bianchi, F. et al. 2023. Medical Cannabinoids for Painful Symptoms in Patients with Severe Dementia: A Randomized, Double-Blind Cross-Over Placebo-Controlled Trial Protocol. Frontiers in Pain Research, 4:1108832.
- Chelsea, S. et al. 2018. Cannabinoids for the Treatment of Neuropsychiatric Symptoms, Pain and Weight Loss in Dementia. Current Opinion in Psychiatry, 31(2): p. 140-146.