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Journal Article Review Epublish 15 citations

PubMed: 36552056 DOI: 10.3390/brainsci12121596

Cannabinoids in Late Life Parkinson's Disease and Dementia: Biological Pathways and Clinical Challenges.

Brain Sci 12(12)

Authors: Alana C Costa, Helena P G Joaquim, João F C Pedrazzi, Andreia de O Pain, Gustavo Duque, Ivan Aprahamian

Affiliations

  • Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-903, Brazil.
  • Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo 05403-010, Brazil.
  • Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil.
  • Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 05403-903, Brazil.
  • Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí 13202-550, Brazil.
  • Division of Geriatric Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
  • Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9712 Groningen, The Netherlands.

Abstract

The use of cannabinoids as therapeutic drugs has increased among aging populations recently. Age-related changes in the endogenous cannabinoid system could influence the effects of therapies that target the cannabinoid system. At the preclinical level, cannabidiol (CBD) induces anti-amyloidogenic, antioxidative, anti-apoptotic, anti-inflammatory, and neuroprotective effects. These findings suggest a potential therapeutic role of cannabinoids to neurodegenerative disorders such as Parkinson's disease (PD) and Alzheimer. Emerging evidence suggests that CBD and tetrahydrocannabinol have neuroprotective therapeutic-like effects on dementias. In clinical practice, cannabinoids are being used off-label to relieve symptoms of PD and AD. In fact, patients are using cannabis compounds for the treatment of tremor, non-motor symptoms, anxiety, and sleep assistance in PD, and managing responsive behaviors of dementia such as agitation. However, strong evidence from clinical trials is scarce for most indications. Some clinicians consider cannabinoids an alternative for older adults bearing Parkinson's disease and Alzheimer's dementia with a poor response to first-line treatments. In our concept and experience, cannabinoids should never be considered a first-line treatment but could be regarded as an adjuvant therapy in specific situations commonly seen in clinical practice. To mitigate the risk of adverse events, the traditional dogma of geriatric medicine, starting with a low dose and proceeding with a slow titration regime, should also be employed with cannabinoids. In this review, we aimed to address preclinical evidence of cannabinoids in neurodegenerative disorders such as PD and AD and discuss potential off-label use of cannabinoids in clinical practice of these disorders.

MeSH

Cannabinoids, Aged, Parkinson Disease, Dementia, Nervous System Diseases, Aging, Therapeutics, Off-Label Use, Neurodegenerative Diseases

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