Cannabidiol (CBD) for the Elderly

Introduction

In recent years, Cannabis has found a drastic shift in its uses. Contrary to the conventional use of the cannabis plant to make marijuana for smoking, some of the natural chemicals found in this plant such as cannabidiol (CBD) have been investigated to use them for medical purposes. The plant extracts, also known as the cannabinoids, have found immense medical importance that has been proven through immaculate medical research, which can be found online. The cannabinoids include cannabigerol, cannabidiol, cannabichromene, and tetrahydrocannabinol (THC) along with some other chemicals found in the extract from Cannabis sativa plant.

Cannabidiol (CBD) differs from other chemicals found in cannabis, as it has a different mechanism of action and a different effect on the body as compared to other chemicals such as the tetrahydrocannabinol (THC). The main substance behind the ‘high’ that the person gets after consuming marijuana is THC, which messes with the neuronal circuits to give hallucinations and euphoric feelings to the person who consumes marijuana. The chemicals having such types of results in the body are called ‘psychoactive’ substances. The top example of a psychoactive substance found in marijuana is tetrahydrocannabinol (THC). Contrary to THC, CBD is not psychoactive; it does not get a person high but grants an equal amount of cure against anxiety and nervousness.

CBD to Combat Drug Abuse Among the Elderly

There is an increasing trend of using drugs in the whole of the North American continent, particularly by the elderly people ranging in the ages 50 and above. The increased use of drugs has largely caused negative symptoms in the users, along with withdrawal-related illnesses. The fast lifestyle of the first world countries such as the United States has taken people to an extent that they find entertainment in drug abuse. This killer trend is proving fatal for the large part of the population and is more prevalent in elderly people having ages above 50.

A study was conducted by some amateurs to investigate the prevalence of illicit substance abuse in older adults. The results were published in PubMed. Among all the drugs used by older adults to gain psychoactive signs, Cannabis use by older adults is considerably more common. The increased prevalence of Cannabis among the adults for recreational use can be estimated from the fact that the adults aged 50 years and older, 4.6 million reported using Cannabis for recreational purposes in the previous year, while less than 1 million of the drug-using adults reported dependence upon other illicit substances such as cocaine, hallucinogens, methamphetamine, and heroin use in the past year. The results gained from this study were confirmed by the later studies conducted by independent sources. Nowadays, there is an increasing trend of legalization of medically important drugs such as medical marijuana not only in the United States but throughout the world. According to statistics gathered the previous year, 47 states out of all the states in the US have legalized at least one form of medical marijuana. The fact that marijuana is being rapidly legalized and the relaxation in the terms for the possession of marijuana explains that the substance abuse rate among older adults may increase. This is because this particular group of the population uses illicit substances in order to cope with the illnesses that usually come with normal aging or the mental degradation caused due to diseases that affect older people such as Alzheimer’s disease or Parkinson’s disease. 

The unchecked use of marijuana among the older people prove to be a pitfall for those who are already suffering from cardiovascular symptoms or terminal stage disease in their old age. Although the checked use of medicinal marijuana comes with its advantages, marijuana abuse can lead to impairment of short-term memory due to its ability to affect the vital brain circuits that are involved in short term memory formation and its reconsolidation at a later stage. The older patients who are suffering from certain cardiovascular symptoms already before abusing marijuana can report a consistent increased heart rate along with hyperventilation and elevated blood pressure. The unchecked marijuana use in the older patients who are already suffering from neurodegenerative brain damage due to diseases like Alzheimer’s and Parkinson’s disease may lead to the aggravation of the symptoms caused by those diseases, which not only drastically reduces the quality of the lifestyle of the patient, but is also exhaustive to the caregiver. The increased marijuana use may also result in cognitive disabilities among the patients leading to the impairment in the judgment making ability. The increased tobacco use among older adults is associated with greater mortality due to the lethal effects the use of tobacco has on the respiratory systems. The increased tobacco use elevates the risks of different cardiopulmonary events such as coronary events along with myocardial infarctions, and the danger of complete lung collapse due to the severe degradation of alveolar walls owing to prolonged smoking history. The risk from prolonged marijuana smoking in older adults may also manifest its results in the form of smoking-related cancers due to lung-related damage, along with chronic obstructive pulmonary disease (COPD) which then results in a large decline in pulmonary function. Moreover, continued smoking also inhibits the effective treatments used for the symptomatic treatment for these conditions.

Cannabidiol has found effective uses in treatment for substance use disorders, particularly due to the same mechanism through which psychoactive substances get the user ‘high’, such as THC found in marijuana. However, cannabidiol (CBD) differs largely from THC in its psycho-activity. The non-psychoactive nature of cannabidiol enables it to achieve similar effects to THC in getting rid of anxiety and other nervous symptoms, without the person losing self-control or getting ‘high’ through marijuana use. Studies have suggested that it has been found that CBD may even act to counter the psychoactive effects of THC, thereby providing the important prospect for CBD being used in the treatment for getting rid of withdrawal symptoms. Owing to its anti-psychotic effects, this compound has found itself being used for many pharmaceutical purposes.  CBD is not psychoactive and differs from THC due to the difference in the effects of CBD on brain activity in regions such as the striatum, hippocampus, and prefrontal cortex. Many studies conducted by laboratories around the world, along with controlled clinical trials, have confirmed that CBD can be adopted as a well-tolerated, safe, and effective drug for antipsychotic purposes. The THC has an impairing effect on the body while granting the characteristic euphoric feelings, while all the effects of CBD are non-impairing. 

CBD in cannabis has some effects on the body where it serves to release overall stress on the body, thereby serving as an efficient therapeutic measure to alleviate the symptoms of withdrawal in people suffering from substance abuse. These effects are different from the euphoric or ‘high’ sensations induced in our bodies due to THC, and serve to alleviate the stress and anxiety. This makes CBD as the best alternate to marijuana to seek an escape from pain and anxiety.  23 states and the District of Columbia have legalized marijuana to be used for a variety of medical conditions. 15 other states have also formed laws that are intended to allow access to CBD oil and strains of marijuana containing a high CBD to THC ratio.

Several studies have been conducted to investigate the use of CBD for discouraging marijuana abuse in people. A study was conducted on a 27-year-old patient suffering from bipolar disorder along with a prolonged history of excess marijuana use.  The presenting complaints from the patient included all of the withdrawal symptoms which included nervous symptoms such as anxiety, erratic behaviors, insomnia, and irritability. The patient also presented sundowning symptoms and particular nervous episodes which triggered only at particular times in the day during the evening or late afternoon. The patient history also included several hospitalizations due to the symptoms of bipolar syndrome. The patient was increasingly dependent on marijuana use in order to get rid of anxiety. Resultantly, physicians decided to administer controlled quantities of cannabidiol (CBD) to the patient to see whether the use of CBD discouraged marijuana use or not.

The experiment initially included administering 24 mg of CBD oil through sprays. The dose was gradually decreased in steps from 24 mg to 18 mg, at which the patient was using no sprays during the daytime but only before bedtime. The results were fascinating. The patient was able to get rid of anxiety symptoms without the use of marijuana, and CBD also helped the patient maintain an almost perfect sleep schedule. The social behavior of the patient also changed drastically, with the patient being better able to interact with the people around him at his workplace. The erratic behavior and anxiety symptoms gradually subsided, all of this achieved without the use of marijuana. This proved the potential of CBD acting as a potent agent to counter the withdrawal symptoms, and also to act as an effective agent for replacing illicit and harmful substances in substance abuse cases.

Using CBD for Age-Related Brain Disorders

The ability of CBD to act on the central nervous system through the endocannabinoid system of the brain has increased people’s confidence in it being used as an effective drug to counter brain damage related to aging such as neurodegenerative diseases like Alzheimer’s disease or Parkinson’s disease. The therapeutic effects of CBD have carried it out to the field to be tested against various disorders related to the brain, and also against the congenital brain damage. However, the use of cannabinoids greatly needs to be cautious, as each and every illness the cannabis extracts are being used to treat requires a different combination of cannabinoids. CBD exerts its effect due to its action on the cannabinoid receptors. The endogenous cannabinoid system, or more commonly known as the endocannabinoid system, serves to regulate a wide array of physiological and psychological processes and possesses considerable potential targets for the potential treatment of numerous disease states. These diseases include disorders that affect the mental state of the person, including schizophrenia, Huntington’s disease, and other disorders. 

The endocannabinoid system is just another neurotransmitter system in our bodies just like the acetylcholine system or adrenaline system. Like these systems, the eCb system of our bodies secretes some neurotransmitters, which bind to the cannabinoid receptors in the system and exert specific effects. The endocannabinoid system is composed of neurotransmitters known as endocannabinoids. Endocannabinoids are one of the most widely known, potent, and versatile signaling molecules known up to now. The eCb system consists of two receptors (i.e., CB₁ and CB₂ receptors) and enzymes regulating their endogenous ligands. Cannabidiol, CBD, binds to these receptors and then alters the function of these receptors and the resulting actions of the body on which these receptors and their ligands affect. 

 CB₁ receptors are highly expressed on neurons in the central nervous system (CNS) in the inner brain areas such as the cerebral cortex and basal ganglia. These receptors affect the brain areas that are concerned with the formation and reconsolidation of memory. CB₂ receptors are most commonly are expressed on immune cells, microglia in the CNS, and macrophages, monocytes, CD4+ and CD8+ T cells, and B cells in the periphery. Additionally, CB₂ receptors are also expressed on neurons, but to an extent that is almost as negligible as compared to the CB₁ receptors. The abundant distribution of CB₁ and CB₂ receptors throughout the brain and periphery accounts for their ability to impact a diverse variety of physiological and psychological processes and other emotions such as memory, anxiety, and pain perception. So, the receptors through which cannabinoids such as cannabidiol and tetrahydrocannabinol (THC) exert their effects are primarily the CB1 receptors. 

CBD for Dementias in the Elderly

Dementia is the gradual decline in memory formation and recalling and other mental abilities in a person who is suffering from neurodegenerative disorders like Alzheimer’s disease. Dementia may also simply be caused due to the natural age-related degeneration of the nervous tissue in the areas of the brain controlling memory states and emotional along with cognitive behavior. Dementia is pretty common: about 7% of adults aged 60 and older suffer from dementia or other cognitive disabilities. The primary symptom of dementia is frequent memory losses leading to utter confusion and a deranged state of personality in the patient. However, there may be signs of cognitive impairments, along with the decline of the brain function in decision-making abilities.  The patient also might have to face emotional mood changes along with increased irritability, depression, and anxiety.

One of the most common diseases that lead to dementia in older patients is Alzheimer’s disease. Alzheimer’s disease is a neurodegenerative disorder that causes gradual cell death in various areas of the brain, thereby leading to a gradual loss of memories and disability to store new memories. The most commonly affected area of the brain by Alzheimer’s disease is the central area, which includes vital brain circuits such as the basal ganglia and hippocampus which are involved in memory formation, storage, and reconsolidation at later stages. Damage or cell death in these areas then cause the symptoms of dementia, which include confusion, memory loss, and cognitive impairment along with behavioral changes in the patient. 

Although Alzheimer’s disease is the most common cause of dementia today all over the world, there is a very common misconception that dementia almost always occurs due to Alzheimer’s, which is largely a misleading fact. There are many forms of dementia, including AD, Lewy body dementia, carbon monoxide induced dementia, paralytic dementia, memory loss due to traumatic brain injury, and loss of memory due to undersupply of blood to various areas of the brain. Lewy body dementia is the gradual deposition of concentrates in the central brain. These deposits are known as the Lewy bodies and are known to be probably caused due to the deposition of a protein known as alpha-synuclein. This protein tends to deposit in the brain in the later stages of life after late adulthood and is also a fairly common cause of dementia in the people who are over 60 years of age. 

Dementia is a very progressive disorder of the brain, and the progressive course of dementia is very difficult to stop since the exact mechanism is not very well understood. Due to this reason,  there is no known cure or therapy for the symptomatic treatment of dementia. However, there are specific drugs that may be used to manage the neuropsychiatric symptoms in the patients. Neuropsychiatric symptoms usually include anxiety and confusion. These neuropsychiatric symptoms, if left unattended, may further aggravate to cause sundowning symptoms in elderly patients. The treatment of choice for aggravated symptoms of dementia including sundowning symptoms consists of a diverse range of unconventional drugs and techniques, which are not included in conventional pharmacology. These drugs mainly focus on getting rid of unmet physical and emotional needs, the sense of which arise due to confusion and personal neglect disorder in dementia, such as inadequately treated pain and unpleasant environmental factors, which may trigger the symptoms. Pharmacological therapies can act as other drugs other than unconventional drugs, and they have an effect that is almost negligible as compared to unconventional methods used to treat dementia symptoms.  The treatment of choice in the case of pharmacological methods usually consists of a range of atypical antipsychotics which are used stand-alone or along with second-generation antidepressants, usually in combination the nonpharmacological and unconventional methods to cope with the symptoms of dementia.

A study was conducted in order to investigate the role of using medical cannabis in elderly patients to get rid of dementia symptoms. The results, published on PubMed Central in a research article, favored the medical cannabis use in dementia patients largely. The evidence from the research comprised of one systematic review and one uncontrolled before-and-after study. The results showed that medical cannabis may be effective in treating dementia and sundowning symptoms in older people. These symptoms included erratic emotional behavior such as agitation, nervousness, and irritability. The cannabis use also relieved the subjects of aberrant motor behavior, and nocturnal behavior disorders, which were particularly caused due to sundowning phenomenon. The cognitive impairments such as disabilities in judgment making as well as aberrant vocalization and resting care, which are neuropsychiatric symptoms associated with dementia were also found to be alleviated after administering medical cannabis. The data collected during this research was obtained from four of its primary studies. The remaining studies did not find favorable or unfavorable evidence regarding the effectiveness of cannabinoids in the treatment of dementia. 

Of all the causes of dementia in the elderly, dementia due to Alzheimer’s disease is the most common one. Alzheimer’s Disease is a disorder caused due to the gradual degeneration and the resultant death of cerebral cortical cells, and the effect of the death of these cells is visible in the form of dementia in the patient. The most common symptom of AD is memory loss, which is the characteristic of dementia. The memory loss in dementia due to Alzheimer’s disease may be so severe that personal neglect occurs in some of the patients. Another significant manifestation of Alzheimer’s disease is the sundowning, which is an utter state of confusion that kicks in at very particular times of the day, usually around late afternoon or in the evening, and may span further into the night. Sundowning in Alzheimer’s disease presents problems not only for the patient but also is very exhaustive for the caregivers. This disease may also lead to impaired cognitive abilities of a person. Acquired cognitive disabilities caused by this disease have a diverse effect on the social life, overall behavior, and day to day activity of the patients. 

Although there is no effective treatment for Alzheimer's disease at the present, certain medications such as anti-depressants do exist for easing the symptoms and research is ongoing in every corner of the world to find its cure. Another thing that makes Alzheimer’s particularly scary is the fact that there are no drugs that can temporarily slow the worsening of dementia symptoms and the neurodegeneration of the patient, in other words, the progression of this disease is inevitable and cannot be stopped. The disease is prone to get worse in elderly patients day by day, so this particular group of the population is at greater risk of falling a victim to this disease. Cannabidiol has recently found an effective use in treating the symptoms and even the disorder itself in Alzheimer’s disease due to its promising effects owing to its anti-inflammatory and neuroprotective properties. Cannabidiol offers bright prospects in the field of providing treatment for the symptoms of Alzheimer’s disease, and indirectly providing relief from the sundowning symptoms in the patients suffering from dementia due to Alzheimer’s that trigger sundowning. 

The effect of cannabinoids such as CBD on the central nervous system on various vital brain circuits in the nervous system has found bright prospects in the treatment of various forms of dementia including Alzheimer’s. In this regard, a study was conducted and the results were published on PubMed. The study consisted of a total of 21 cases in which cannabinoids particularly CBD obtained from Cannabis plants were used as a therapeutic measure against Alzheimer’s disease. The in vitro studies conducted to examine the effect of CBD on a patient with Alzheimer’s were carried out on the PC12 neuronal cells. These cells are profusely found in the areas of the brain that are heavily concerned with the formation of new memories and their reconsolidation and storage. Research also suggests that these cells in the basal ganglia have an important role in providing perfect cognitive abilities to the subject. Anything that interferes with the normal nourishment in these areas might cause sudden cell death thereby causing dementia-like symptoms in the elderly along with some cognitive impairments.

The results emphasized that cannabidiol activated the Peroxisome Proliferator-Activated Receptor through an intrinsic pathway in the central nervous system. This pathway is essential for the protection of vital parts and circuits of the central nervous system from toxins that might even trigger tumor production in the brain. When this pathway was activated, it protected the neuronal PC12 cells from degradation due to oxidation and neurotoxicity, thereby indirectly reducing the risk of Alzheimer’s disease and alleviating the symptoms of those who are already a victim of this disorder. The in vivo studies pursued a more proactive approach toward the healing and anti-inflammatory properties of CBD. This included the administration of CBD to the right dorsal hippocampus of a rodent. The administered CBD was supplemented with a component human alpha beta peptide, a chemical found in the human central nervous system. The studies showed that CBD actively inhibited the expression of glial fibrillary acidic protein due to its effect on the mRNA encoding GFAP. The CBD administered to the mouse also actively inhibited the expression of several inflammation-causing factors such as interleukin 1-beta protein. The healing properties of phytocannabinoids such as cannabidiol (CBD) for Alzheimer’s disease and their effect in controlling and preventing further degeneration from happening in the central nervous system to prevent dementia were well pronounced.

CBD as a Drug for Parkinsonism in the Elderly

Among other neurodegenerative diseases that might affect people in their old age, Parkinson’s disease is probably the most common one. It is a disorder that involves the degradation of a part of the brain known as substantia nigra, which is involved in producing a substance called dopamine. Dopamine is a neurotransmitter involved in executive functions of the brain such as coordinating the motor control of muscles, as well as lower-level functions including lactation, sexual function, and nausea. Of all these functions, the most pronounced effect of dopamine is on the coordination of muscle movements, thereby providing efficient muscle control. Any kind of deficiency or impairment in the dopamine-producing system of the body is first visible as the decline in the motor function, like involuntary tremors occurring throughout the body. This is the very characteristic sign of Parkinson’s disease. The exact cause of cell death in the areas that produce dopamine in the brain is still not understood to the scientists and continues to be the hotspot of Parkinsonism research.

Administering controlled doses of Cannabis extracts, particularly CBD, to the elderly patients suffering from Parkinsonism has been found to be useful for the treatment of visible symptoms such as uncontrolled and frequent muscle tremors. Parkinsonism in the old age is the sign of degeneration of nervous tissue due to aging, and the neuroprotective properties of the nervous system need to be enhanced in these cases. CBD, owing to its neuroprotective properties, has proven to be a useful chemical to protect the central nervous system from oxidative stress and degradation due to aging. The pain-reducing properties of CBD help reduce pain but also are found to be useful in managing the involuntary tremors. The dose-related improvement due to the administration of CBD in Parkinson’s disease was observed in all patients, and the collective effect of CBD ranged from relieving pain to getting rid of tremors throughout the body. Another complication that might occur in Parkinson’s disease is psychosis, and the symptoms of psychosis gradually aggravate over time. Psychosis can prove to be a big issue primarily if the patient is old, and CBD has proven itself to be the best alternate to marijuana to combat psychosis without giving the characteristic ‘high’.

 A small study conducted in 2009 found CBD to have particularly canceling effects on the symptoms of psychosis in older people due to Parkinson’s disease, thereby improving the sleep and general lifestyle of the patients having this disorder. A study conducted at the University of Louisville, Kentucky shows that CBD acts as an inverse agonist on the CPR6 receptors that are found in the brainstem and are responsible for controlling movement, emotions, and learning - all of which are affected by Parkinsonism. This means that CBD responds to these receptors, and can act as a therapeutic agent in relieving the symptoms of this disease. Studies also show a promising effect of CBD in treating psychosis and resulting in insomnia due to Parkinsonism’s Disease Dementia (PDD). 

REFERENCES

1. Kuerbis, Alexis et al. "Substance Abuse Among Older Adults". Clinics In Geriatric Medicine, vol 30, no. 3, 2014, pp. 629-654. Elsevier BV, doi:10.1016/j.cger.2014.04.008. Accessed 8 Sept 2020.
2. Peprah, Kwakye, and Suzanne McCormack. Medical Cannabis For The Treatment Of Dementia.
3. "Effects Of THC-Free CBD Oil On Agitation In Patients With Alzheimer's Disease - Full Text View - Clinicaltrials.Gov". Clinicaltrials.Gov, 2020, https://clinicaltrials.gov/ct2/show/NCT04436081.
4. Bliwise, Donald L. et al. "Disruptive Nocturnal Behavior In Parkinson's Disease And Alzheimer's Disease". Journal Of Geriatric Psychiatry And Neurology, vol 8, no. 2, 1995, pp. 107-110. SAGE Publications, doi:10.1177/089198879500800206. Accessed 6 Sept 2020.
5. “Cannabidiol Oil for Decreasing Addictive Use of Marijuana: A Case Report” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718203/#:~:text=One%20prior%20case%20study%20by,marijuana%20without%20unwanted%20side%20effects.
6. https://commons.wikimedia.org/wiki/File:Marijuana_Buds.jpg
7. https://commons.wikimedia.org/wiki/File:Schizophrenia_brain_large.gif