"Should they use marijuana products that contain both THC and CBD? Or, is one more effective than the other? Are there better routes of administration (i.e. vaping, edibles, tinctures)?"
Cannabis is an extremely safe herb with no potential for overdose or toxicity. There is no danger in using cannabis oil in high doses for extended periods of time. I would try a whole plant tincture extract of cannabis that contains CBD and THC as well as the other naturally occuring components. A good starting dose would be 10 milligrams of cannabinoids two or three times per day. Observe closely for effects and adjust the dose as needed.
andrewvanmd
Remove excess saliva from the mouth. Allow the tincture to absorb in the mouth, to ensure direct absorption into the bloodstream. A good starting dose would be 10 milligrams of cannabinoids two or three times per day. Observe closely for effects and adjust the dose as needed.
andrewvanmd
I think Dr. Vanderveer’s recommendation for administering CBD oil to be spot on. If you wanted to try another option, you can try putting the same dosage/dropper amount in hot tea or drinks. Many of my patients report that the time to onset is just as rapid as if it were dosed sublingually. I hope this helps!
drpark
Since we are likely talking about a person who’s health has already been compromised, you must use caution administering any cannabis. The Alzheimer’s patient must have a recommendation and you must be the caretaker in order to administer the medicine. Please start with a low dose of around three drops, sublingually, four times per day and every 2 to 3 days you may add three more drops until you are up to 20 drops per day. At the second week as long as the blood pressure is steady you can try going to 10 drops twice daily and stay at that dose for 2 to 3 weeks. Ultimately the dosage may need to be increased just 30 drops per day and three divided doses. Since every person responds differently, please monitor and log this patient’s response to the medication an adjusted dosage appropriately and give us feedback on how this patient is doing. I do wonder about the other potential medical issues that caused the Alzheimers since this disease does not just fall out of the sky. Alzheimer’s has an underlying cause and appropriately targeting that cause will produce the best outcome, is it low Vitamin D3, diabetes, toxic chemicals, too many western drugs like statins or bladder medicines that are known to cause Alzheimers as the culprit?
drolson
The lowest effective doses of THC (that cause observable biologic change) are approximately 2.5mg, however, most patients do not report subjective of "self-perceivable" change until about 5mg. Elderly patients new to cannabis, may be more sensitive to the effects of THC due to body composition changes that occur with age as well as lack of exposure. THC has been show to be "neuroprotective" and is known to be anti-inflammatory as well as promotional of neurologic recovery in acute neurologic insults.
While THC shows benefit, the "whole plant" may be beneficial in producing relief for multiple symptoms that accompany Alzheimer’s Disease due to the "entourage" effect of the other cannabinoids and terpenes in the plant. There are many ways to obtain cannabis, but sublingual elixirs and tinctures or edibles may be the easiest delivery for elders.
Edibles are excellent and last longer, but use with caution in seniors as THC converts to a more potent derivative (11-hydroxy THC) after ingestion. I always recommend adults over the age of 70 start with lower than recommended doses of THC when using edibles until impact is determined.
Remember that it may take between 1-2 hours to see the effects of edible cannabis and the effects can last up to 8 hours. Sublingual (under the tongue) delivery takes effect in 10-20 minutes and may last an average of 4-6 hours. Edibles may work best for nighttime in some patients due to prolonged drowsiness.
Alzheimer’s patients, depending on stage of disease, may have severely impaired ability to discern reality versus cognitive experience, and I recommend you observe you Mother closely as you work out dosing as some hallucinatory effects of THC and 11 hydroxy-TCH could be disturbing. You may want to keep a journal of symptoms and behaviors over time to determine dosing and effectiveness.
As a Geriatrician by training, I am excited about the possibilities that cannabis may hold for treatment of age-related neuro-degenerative diseases and; look forward to more detailed studies and recommendations in this area.
drgerhart
There have been several preclinical studies showing that small amounts of THC can slow the production and inhibit the aggregation of beta-amyloid proteins, the hallmark of Alzheimer’s and key contributors to the progression of the disease. There is abundant anecdotal evidence that, in many patients, cannabis helps mitigate symptoms associated with Alzheimer’s – agitation, depression, anxiety, poor appetite, and insomnia. One recently published Israeli study, while small (10 patients), reported a significant decrease in the severity of delusions, agitation/aggression, irritability, apathy, sleep and caregiver distress. And they concluded that adding cannabis oil was safe and a promising treatment option.
drfrye
We are not qualified medical professionals to adequately assess the condition, but I did find an interesting article that might help shed some light on the subject: https://www.alzheimers.net/6-15-15-effects-of-medical-marijuana-on-alzheimers/
mari
Here is some more information on using marijuana and its effect on Alzheimers Disease:
https://www.hellomd.dev/search/Alzheimer/articles
https://www.hellomd.dev/search/Alzheimer
mark
Just to reiterate, I am not a medical professional and you should always speak with your doctor before adding cannabis or any medicinal herb into your health care regime. I have heard of patients having success with combining other herbs with cannabis to support healthy brain function.
kivaanastasia
There was a study performed that showed promising results for Alzheimers resulting in a decrease in Alzheimer plaques. I would recommend a CBD:THC ratio of 20:1 twice daily every day. Any ratio of CBD:THC >10:1 will not make you "high." It will take about 2-3 weeks for full efficacy. Titrate your dose up as you see fit as you will build tolerance (1 drop twice daily, may increase to 2 drops twice daily for instance and more). This ratio also helps with decreasing aggression as seen with autistic children and is also used for anxiety, depression and muscle tension. For aggression, you may use it every 3-6 hours as needed on top of twice daily.
drb
A preclinical study published in the Journal of Alzheimer’s Disease found that very small doses of tetrahydrocannabinol (THC), a chemical found in marijuana, can slow the production of beta-amyloid proteins, thought to be a hallmark characteristic and key contributor to the progression of Alzheimer’s.
The study, published in 2014, is among others to support the effectiveness of THC in prohibiting the growth of toxic amyloid plagues.
Another study from the Salk Institute in La Jolla, California has also found that tetrahydrocannabinol and other compounds found in marijuana may reduce the amount of beta amyloid in the brain. Beta amyloid is a hallmark characteristic of Alzheimer’s and is commonly thought to cause the neurodegenerative disease.
While the findings are preliminary, researchers are optimistic about their findings. David Schubert, professor at the Salk Institute and senior author on the study says, “Although other studies have offered evidence that cannabinoids might be neuroprotective against the symptoms of Alzheimer’s, we believe our study is the first to demonstrate that cannabinoids affect both inflammation and amyloid beta accumulation in nerve cells.”
In the study, researchers found that by exposing beta amyloid proteins to THC, it reduced the levels of beta amyloid, stopped the inflammatory response from the nerve cells caused by beta amyloid and allowed the nerve sells to survive. Antonio Currais, a postdoctoral researcher and first author on the paper noted:
“Inflammation within the brain is a major component of the damage associated with Alzheimer’s disease, but it has always been assumed that this response was coming from immune-like cells in the brain, not the nerve cells themselves. When we were able to identify the molecular basis of the inflammatory response to amyloid beta, it became clear that THC-like compounds that the nerve cells make themselves may be involved in protecting the cells from dying.”
The take home from this article is that not only is there evidence that THC can slow the progression of AD, there is also some very exciting preliminary evidence that THC can also treat AD by reducing the levels of beta-amyloid plaques and the resulting inflammatory response which causes the death of brain cells and the resulting symptoms associated with AD.
Therefore, I strongly recommend a product with a healthy amount of THC such as the conventional indicas, hybrids and sativas or also the extract products such as the oils and tinctures. However, as noted, those products should have THC at a higher ratio than is standard for many of the more common maladies CBD oils are being used for.
drkim
Alzheimer’s can certainly be a devastating illness for both the patient and family, and since "traditional" medicines are often ineffective, it makes sense to try cannabis therapy. THC and CBD, the 2 most prominent active ingredients in cannabis, have quite different effects and are often used in combination for a more balanced effect. The product you choose will somewhat depend upon what symptoms you are looking to treat, and daytime vs. nighttime use for instance. CBD by itself does not have known intoxicating/psychoactive effects, and can have a calming effect in those suffering from anxiety/agitation. THC could be useful to help stimulate appetite and induce sleep, but also has psychoactive effects that can be difficult to predict for a patient who could already be suffering from distressing mental dysfunction. You would want to start with a small dose of THC, 2.5 mg or less, and increase only as tolerated. If you choose to use a THC-containing product, it would be wise to make sure it is combined with CBD to help mitigate side effects. In preliminary studies, cannabis shows promise in slowing Alzheimer’s plaque deposits, so in addition to relieving the symptoms of Alzheimer’s, cannabis may also be able to slow underlying disease progression. We wish you the best of luck in pursuing this therapy, and as other physicians have mentioned, it’s wise to make sure you have extra help on hand and keep close notes of the medication effects.
drbultman
As my physician colleagues have noted on this thread, cannabis preparations containing THC should be started at low doses when being taken by patients with Alzheimer’s disease, cautiously increasing the amount as tolerated. In addition, there is excellent published evidence showing CBD modifies THC effects, in particular reducing stimulation that can result in anxiety, so I would be careful to include significant amounts of CBD in whatever preparation is being used. Without knowing the degree of the patient’s cognitive impairment it’s hard to give more specific advice, and I would advocate significant caution in introducing psychoactive agents if a patient is already displaying severe cognitive impairment. As has been suggested, CBD may provide some calming effects without being psychoactive, and tinctures or lozenges with a 20:1 CBD:THC ratio might be a reasonable place to start, if medicinal cannabis is deemed appropriate.
drelkind
I agree with the other answers that say CBD. From the research I’ve done, CBD can be useful. I found some research here that might be useful, as well as some more medical studies from NCBI.
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alison leton
