From the Guidelines
Medicinal cannabis is not recommended as a first-line treatment for dementia due to limited evidence supporting its use for managing dementia symptoms. The current evidence suggests that while some patients may experience modest benefits for specific symptoms, the results are inconsistent and more robust clinical evidence is needed before medicinal cannabis can be broadly recommended for dementia management 1. The most recent and highest quality study, published in 2025, emphasizes the importance of non-pharmacological strategies as first-line management for individuals with vascular cognitive impairment, including those with dementia 1. Key points to consider when evaluating the use of medicinal cannabis for dementia include:
- Limited evidence supporting its use for managing dementia symptoms
- Potential for modest benefits for specific symptoms, such as agitation, aggression, and sleep disturbances
- Need for close supervision by healthcare providers experienced with both dementia and cannabis medicine
- Potential for interactions with common medications used by dementia patients, particularly those metabolized by the liver
- Theoretical basis for cannabis in dementia relates to the endocannabinoid system's role in neuroinflammation and neuroprotection, but more research is needed to fully understand its effects 1. In terms of treatment, non-pharmacologic interventions such as cognitive training, physical exercise, and diet may have a positive impact on cognition and physical function, and should be considered as part of a comprehensive treatment plan 1. For those considering medicinal cannabis, starting with low-dose CBD oil (5-10mg twice daily) with minimal THC is advisable, gradually increasing if needed while monitoring for side effects. Products like Sativex (nabiximols) or dronabinol (synthetic THC) may be prescribed in some regions, but treatment should be closely supervised by healthcare providers experienced with both dementia and cannabis medicine 1.
From the Research
Medicinal Cannabis in Dementia Management
Medicinal cannabis has been studied for its potential role in managing dementia symptoms, particularly behavioral and psychological symptoms of dementia (BPSD) [ 2, 3,4 ].
- Cannabinoids and BPSD: Cannabinoids, such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), may have a positive impact on BPSD symptoms, including agitation, anxiety, and sleep disturbances [ 2, 5 ].
- THC and CBD: THC might be beneficial for associated spasticity, pain, and lack of appetite, while CBD probably works better on sleep, agitation, and anxiety [ 2 ].
- Clinical Studies: Prospective clinical studies and randomized clinical trials have shown promising results for THC/CBD-based oral medication at higher doses, with feasibility and safety in elderly populations [ 2, 4 ].
- Long-term Safety: A long-term pilot observational study found that THC/CBD medication can be administered safely with overall positive clinical improvement to poly medicated older adults with severe dementia 4.
- Limitations and Future Research: While current evidence is promising, more research is needed to establish clinical efficiency, optimal dosing, and other outcomes, such as deprescribing other medications and facilitation of care [ 2, 3 ].
Comparison with Current Treatments
Current pharmacotherapies for BPSD have limited efficacy and high-risk profiles, making cannabinoids a potentially safer alternative 3, 6.
- Nonpharmacologic Approaches: Nonpharmacologic approaches, such as cognitively engaging activities and socialization, can also provide benefits for patients with dementia 6.
- Pharmacologic Approaches: Pharmacologic approaches, including acetylcholinesterase inhibitors and memantine, can provide modest symptomatic relief for Alzheimer's disease 6.