Abstract

RationaleWhile cannabis-based medicinal products have been shown to be effective for numerous neurological and psychiatric disorders, the evidence base regarding their adverse cognitive effects is poorly understood. The cannabinoid 1 receptor modulates memory performance via intracellular and extracellular mechanisms that alter synaptic transmission and plasticity. While previous literature has consistently shown that chronic cannabis users exhibit marked cognitive impairments, mixed findings have been reported in the context of placebo-controlled experimental trials. It is therefore unclear whether these compounds inherently alter cognitive processes or whether individuals who are genetically predisposed to use cannabis may have underlying cognitive deficits.ObjectiveWe conducted a meta-analysis to investigate the effects of full and partial cannabinoid 1 receptor (CB1R) agonists, antagonists, and negative allosteric modulators on non-spatial and spatial memory.MethodsIn accordance with the PRISMA guidelines, the EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining the effects of CB1R agonists, antagonists, and negative allosteric modulators on memory performance.ResultsWe systematically reviewed 195 studies investigating the effects of cannabinoid compounds on memory. In humans (N = 35 studies, comprising N = 782 subjects), delta-9-tetrahydrocannabinol (THC) (1.5–5 mg/kg) relative to placebo impaired performance on non-spatial memory tests, whereas only high THC doses (67 mg/kg) impaired spatial memory. Similarly, THC (0.2–4 mg/kg) significantly impaired visuospatial memory in monkeys and non-human primates (N = 8 studies, comprising N = 71 subjects). However, acute THC (0.002–10 mg/kg) had no effect on non-spatial (N = 6 studies, comprising 117 subjects; g = 1.72, 95% confidence interval (CI) − 0.18 to 3.63, p = 0.08) or spatial memory (9 studies, comprising 206 subjects; g = 0.75, 95% confidence interval (CI) − 1.09 to 2.58, p = 0.43). However, acute, full CB1R agonists significantly impaired non-spatial memory (N = 23 studies, 519 subjects; g = − 1.39, 95% CI − 2.72 to − 0.06, p = 0.03). By contrast, the chronic administration of CB1R agonists had no effect on non-spatial memory (N = 5 studies, comprising 146 subjects; g = − 0.05, 95% confidence interval (CI) − 1.32 to 1.22, p = 0.94). Moreover, the acute administration of CB1R antagonists had no effect on non-spatial memory in rodents (N = 9 studies, N = 149 subjects; g = 0.40, 95% CI − 0.11 to 0.92, p = 0.12).ConclusionsThe acute administration of THC, partial CB1R agonist, significantly impaired non-spatial memory in humans, monkeys, and non-human primates but not rodents. However, full CB1R agonists significantly impaired non-spatial memory in a dose-dependent manner but CB1R antagonists had no effect on non-spatial memory in rodents. Moreover, chronic THC administration did not significantly impair spatial or non-spatial memory in rodents, and there is inconclusive evidence on this in humans. Our findings highlight species differences in the effects of cannabinoid compounds on memory.

Highlights

  • Recent changes in legislation in many countries around the world, including the UK, Canada, and 30 states across the USA, have led to the widespread availability of cannabisbased medicinal products

  • Since THC is a partial cannabinoid 1 receptor (CB1R) agonist (Huestis et al 2001) that has dose-dependent effects on memory (D’Souza et al 2005), we aimed to investigate the effects of THC as well as compounds acting as agonists, antagonists, and negative allosteric modulators

  • In a meta-analysis of 29 studies, CB1R agonists (N = 261) relative to vehicle (N = 258) significantly impaired memory performance on non-spatial memory paradigms (g = − 1.79, 95% confidence interval (CI) − 3.13 to − 0.45, p = 0.009)

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Summary

Introduction

Recent changes in legislation in many countries around the world, including the UK, Canada, and 30 states across the USA, have led to the widespread availability of cannabisbased medicinal products. Emerging evidence indicates that cannabis-based medicinal products may have analgesic (De. Vita et al 2018; Fitzcharles et al 2016), antiemetic (Chang et al 1979; Orr and McKernan 1981), antidyskinetic (Fox et al 2002), antispasmodic (Zajicek et al 2003), antiepileptic (Devinsky et al 2014), and antipsychotic effects (McGuire et al 2017; Boggs et al 2018). The concentration of THC is higher relative to CBD in street cannabis (THC:CBD ratio, 1:13) (ElSohly et al 2016) and medical cannabis (THC:CBD ratio, 1:3) (Belendiuk et al 2015). Since these two compounds have opposite pharmacological effects, the effects of THC are likely to outweigh the effects of CBD in the context of recreational or medicinal cannabis use

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