Krista Lanctot, PhD: Treating Agitation in Alzheimer Disease

“These results should not encourage you to use medical marijuana or recreational marijuana to try and treat these symptoms in Alzheimer disease.”

Krista Lanctôt, PhD, psychiatry and pharmacology professor at the University of Toronto, Sunnybrook Health Sciences Centre researcher spoke to NeurologyLive at the 2018 Alzheimer’s Association International Conference in Chicago, Illinois, to discuss treating agitation in Alzheimer disease.

At the conference, Lanctôt presented preliminary results of a placebo-controlled, double-blind, cross-over trial that assessed the efficacy and safety of nabilone, a synthetic cannabinoid, for the treatment of agitation in moderate-to-severe Alzheimer disease. The 14-week trial compared 6 weeks of nabilone 1 mg—2 mg to 6 weeks of placebo, with a 1-week washout between phases.

The primary outcome was agitation, measured by the Cohen Mansfield Agitation Inventory; secondary outcomes included safety, overall neuropsychiatric symptoms (NPI total), cognition (sMMSE) and global impression (Clinician’s Global Impression of Change (CGIC). In addition, researchers assessed subjects’ pain (Pain Assessment in Advanced Dementia Scale (PAINAD)) and nutritional status (Mini-Nutritional Assessment-Short Form (MNA-SF)).

The results showed significant differences in NPI-agitation/aggression (b = -1.5, 95%CI -2.3 to -0.6, P = .001), NPI total (b = -4.6, 95%CI -7.5 to -1.6, P = .004) and sMMSE (b = 1.1, 95%CI .1 to 2, P = .026) in favor of nabilone.

Lanctôt stresses that while the preliminary results are positive and showed that nabilone significantly improved agitation, neuropsychiatric symptoms, cognition and nutrition in subjects, clinicians should not use medical marijuana or recreational marijuana to try and treat these symptoms. A large confirmatory phase III trial is needed to verify the evidence regarding the safety and efficacy of nabilone in this patient population.