Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Kimberly Erikson

Abstract

Introduction: Dementia is a disease that affects the brain and can cause serious deficits in the life of the patient and their family or caregivers.The current mainstay of treatment for agitation and aggression symptoms is atypical antipsychotics, and occasionally off-label SSRIs. Though these methods have shown good efficacy, the number and severity of adverse events that occur with these medications is concerning to patients, families, and providers. Due to the high side-effect profile, many clinicians are looking for an alternative approach with more safety and potentially more efficacy. Among the candidates is tetrahydrocannabinol (THC). This paper investigates the efficacy and safety of THC compared to traditional pharmacotherapy in treating agitation and aggression symptoms of dementia.

Methods: A literature search was conducted on Google Scholar and PubMed to find qualifying research articles to analyze. A total of seven articles were chosen based on publication date, recruitment criteria, and study design. Studies must be from the past 5 years, were only randomized-controlled trials, retrospective analyses, or open-label studies, and must have directly investigated either THC or antipsychotics/SSRI's as treatment for agitation/aggression.

Results: Most of the studies showed statistically significant efficacy of THC in this treatment, and one study showed a statistically significant decrease in CGI with THC compared to atypical antipsychotics (p = 0.001). Only two studies demonstrated a statistically significant decrease in adverse events.

Discussion: The results seen from these seven studies are promising. The studies somewhat lack in sample size and direct comparison between THC and other medications, but much of the data shows a lack of bias due to double-blinding. Most of the studies used common outcome measures like NPI-NH, CGI, MMSE, and number of adverse events. More research is needed to overcome the faults of the present studies available.

Conclusion: There is not sufficient evidence to suggest that THC is more effective or safer than other medications like atypical antipsychotics and citalopram. The results from these studies demonstrate promising efficacy with the use of THC, but there is small evidence of a decrease in adverse events. More research is needed to change practice, including more double-blind RCTs with higher sample sizes, and more studies directly comparing THC and traditional pharmacotherapy.

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The Efficacy and Safety of Tetrahydrocannabinol (THC) Compared to Traditional Pharmacotherapy in Treating Agitation and Aggression Associated with Dementia

Introduction: Dementia is a disease that affects the brain and can cause serious deficits in the life of the patient and their family or caregivers.The current mainstay of treatment for agitation and aggression symptoms is atypical antipsychotics, and occasionally off-label SSRIs. Though these methods have shown good efficacy, the number and severity of adverse events that occur with these medications is concerning to patients, families, and providers. Due to the high side-effect profile, many clinicians are looking for an alternative approach with more safety and potentially more efficacy. Among the candidates is tetrahydrocannabinol (THC). This paper investigates the efficacy and safety of THC compared to traditional pharmacotherapy in treating agitation and aggression symptoms of dementia.

Methods: A literature search was conducted on Google Scholar and PubMed to find qualifying research articles to analyze. A total of seven articles were chosen based on publication date, recruitment criteria, and study design. Studies must be from the past 5 years, were only randomized-controlled trials, retrospective analyses, or open-label studies, and must have directly investigated either THC or antipsychotics/SSRI's as treatment for agitation/aggression.

Results: Most of the studies showed statistically significant efficacy of THC in this treatment, and one study showed a statistically significant decrease in CGI with THC compared to atypical antipsychotics (p = 0.001). Only two studies demonstrated a statistically significant decrease in adverse events.

Discussion: The results seen from these seven studies are promising. The studies somewhat lack in sample size and direct comparison between THC and other medications, but much of the data shows a lack of bias due to double-blinding. Most of the studies used common outcome measures like NPI-NH, CGI, MMSE, and number of adverse events. More research is needed to overcome the faults of the present studies available.

Conclusion: There is not sufficient evidence to suggest that THC is more effective or safer than other medications like atypical antipsychotics and citalopram. The results from these studies demonstrate promising efficacy with the use of THC, but there is small evidence of a decrease in adverse events. More research is needed to change practice, including more double-blind RCTs with higher sample sizes, and more studies directly comparing THC and traditional pharmacotherapy.