Clarifying the Role of Cannabinoids in Agitation Management for Alzheimer Disease: Brent Forester, MD, MSc

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"Agitation is a symptom—it’s a syndrome. It doesn’t tell us anything about etiology. It could be the disease itself, the time of day, or even the way a loved one spoke to them in the morning. It could be as simple as someone assisting with bathing. This variability is what makes agitation so difficult to treat."

Agitation is a common and challenging symptom in Alzheimer disease (AD) that significantly affects both patients and caregivers. Traditional treatments, such as antipsychotics, have demonstrated limited effectiveness and pose serious risks, including stroke-like events and increased mortality. The THC-AD trial, a randomized, double-blind, placebo-controlled study, evaluated the effects of dronabinol (oral delta-9-tetrahydrocannabinol; THC) at a dose of 5 mg twice daily in 80 patients aged 60 to 95 years with severe agitation due to AD.

Preliminary findings from the trial indicated that dronabinol treatment led to improvements in agitation symptoms. These results were presented at the 2024 Clinical Trials on Alzheimer’s Disease (CTAD) conference, held October 29 to November 1, in Madrid, Spain, by lead author Brent Forester, MD, MSc, director of behavioral health at Tufts Medicine, and senior author Paul Rosenberg, MD, professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine. Researchers emphasized that these findings supported the need for further investigation into cannabinoid therapies for agitation in AD, aiming to refine treatment strategies and enhance future clinical trials.

At CTAD 2024, Forester, who also serves as the chair of psychiatry at Tufts University School of Medicine, sat down with NeurologyLive^® to discuss the implications of these findings and the next steps for research. He emphasized the need to better identify predictors of response to cannabinoid treatment in AD-related agitation. Additionally, he highlighted the challenges of relying on caregiver reports and rating scales to assess agitation. As the availability of dispensary cannabinoids continues to grow, Forester also addressed the urgent need for updated clinical guidelines to help clinicians navigate this evolving treatment landscape with evidence-based recommendations.

Click here for more coverage of CTAD 2024.

REFERENCES
1. Forester B, Leoutsakos JM, Agronin M, Vandrey R, Rosenberg P. The THC-AD Study: The Efficacy and Safety of Dronabinol Treatment for Agitation in Alzheimer’s Dementia. Presented at: 2024 CTAD; October 29-November 1; Madrid, Spain. LBS4. Presentation 2.