Каннабиноиды снижают агрессию и психические симптомы у пациентов с болезнью Альцгеймера

Cannabinoid-based therapies vs placebo demonstrate lower agitation and neuropsychiatric symptom scores in patients with Alzheimer disease (AD), according to study findings published in The American Journal of Geriatric Psychiatry. Researchers conducted a systematic review and meta-analysis to assess whether cannabinoid-based therapies lower agitation and neuropsychiatric symptom scores among patients, without consistent cognitive worsening or safety risks other than sedation-related adverse events. Using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, researchers selected eligible randomized placebo-controlled trials that evaluated cannabinoid-based therapies for clinically documented agitation or validated neuropsychiatric symptoms in adults with moderate to severe AD. Researchers used the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF), and the Mini-Mental State Examination (MMSE) to assess global neuropsychiatric burden. These findings support continued investigation in larger [randomized clinical trial]s with formulation-specific protocols, longer follow-up, active comparator arms, and systematic safety monitoring. Researchers included 5 types of cannabinoid formulations: dronabinol (2.5-10 mg/day), nabiximols (tetrahydrocannabinol [THC] 10.8 mg and cannabidiol (CBD) 10 mg/day), nabilone (1-2 mg/day, THC medical cannabis oil (2.5-7.5 mg/day), and THC-CBD extract (0.35 mg THC and 0.25 mg CBD/day). The studies (k=7) had 221 participants (mean age range, 72.7 to 87.0 years) from a variety of facilities across 6 countries. Of studies identified, 6 were randomized controlled trials and 1 was open-label prospective cohort. The trial durations ranged from 2 to 26 weeks. Primary outcomes included global neuropsychiatric burden, NPI agitation/aggression domain, and safety outcomes. Secondary outcomes were additional NPI subscales and cognitive performance. Cannabinoid-based therapies vs placebo showed lower neuropsychiatric symptom and agitation scores in randomized between-group analyses. In 4 studies, there was a lower NPI total score (standard mean difference [SMD], -0.31; 95% CI, -0.47 to -0.15). Additionally, in 3 studies CMAI-SF scores were lower (SMD, -0.40; 95% CI, -0.69 to -0.10; P =.009), and in 3 studies, the NPI agitation/aggression scores were lower (SMD, -0.47; 95% CI, -0.69 to -0.25; both P <.001). MMSE findings were not supportive of consistent cognitive benefit, and somnolence, including sedation and lethargy, was found to be the principal safety outcome (risk ratio [RR], 2.25; 95% CI, 1.43 to 3.54; P =.0005). Somnolence was also the only adverse event that was consistently observed at higher rates in the cannabinoid group. Study limitations include a small meta-analysis, which is susceptible to overestimation of treatment effects as well as imprecise heterogeneity estimates, a short trial duration, and trials differed in cannabinoid formulations, doses, treatment durations, settings, and NPI versions, which introduces clinical and methodological heterogeneity that may not be captured. “These findings support continued investigation in larger [randomized clinical trial]s with formulation-specific protocols, longer follow-up, active comparator arms, and systematic safety monitoring,” the study authors concluded. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. This article originally appeared on Psychiatry Advisor