Abstract
BackgroundDementia is a neurological condition that affects the cognitive and functional ability of the brain and is the leading cause of disability among those aged 65 years and above. More effective ways to manage dementia symptoms are needed because current treatment options (antidepressants and antipsychotics) can be ineffective and are associated with substantial side effects, including increased rate of mortality. Cannabinoid-based medicine (CBM) has shown an ability to inhibit some symptoms associated with dementia, and the adverse effects are often minimal; yet, little research has explored the use of CBM among this population.AimTo monitor the safety of a purified dose of CBM oil (3:2 delta-9-tetrahydrocannabinol:cannabidiol) on behaviour symptoms, quality of life and discomfort caused by pain.Methods/designWe will carry out an 18-week, randomised, double-blind crossover trial that consists of a 2-week eligibility period, two 6-week treatment cycles, and two 2-week washout periods (between both cycles and after the second treatment cycle). We aim to recruit 50 participants with dementia who are living in residential aged-care facilities. The participants will be randomised into two groups and will receive a dose of either CBM oil or placebo for the first treatment cycle and the opposite medication for the second. Data will be collected using the Neuropsychiatric Inventory Questionnaire, the Cohen-Mansfield Agitation Inventory, the Quality of Life in Alzheimer’s Disease questionnaire, and the Abbey Pain Scale on seven occasions. These will be completed by the participants, aged-care staff, and nominated next of kin or family members. The participants’ heart rate and blood pressure will be monitored weekly, and their body composition and weight will be monitored fortnightly by a research nurse, to assess individual dose response and frailty. In addition, pre- and post-surveys will be administered to aged-care staff and family members to understand their perceptions of CBM and to inform proposed focus groups consisting of the aged-care staff and next of kin.DiscussionThe study design has been informed by medical professionals and key stakeholders, including those working in the residential aged-care industry to ensure patient safety, collection of non-invasive measures, and methodological rigor and study feasibility.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12619000474156. Registered on 21 March 2019
Highlights
Dementia is a neurological condition that affects the cognitive and functional ability of the brain and is the leading cause of disability among those aged 65 years and above
Dementia is a collection of symptoms that progressively reduces the cognitive and functional ability of the brain [1] and affects memory, intellect, rationality, social skills and physical functioning [2]
Residential aged-care staff and of kin perceptions towards the use of Cannabinoid-based medicine (CBM) oil will be evaluated via surveys administered prior to and upon completion of the study
Summary
This is one of the first trials within Australia to evaluate the use of a purified CBM oil at the individual level among those with dementia to examine behavioural effects, QOL, and pain and discomfort. It may be difficult to find those with a dementia diagnosis who have the cognitive capacity to give informed consent, because many experience a loss of short-term memory, intellectual reasoning, rationality, and social skills [1, 2] This may lead to difficulty in recruiting participants into the trial and excluding those who do not have the capacity to give informed consent; yet, they are potentially the ones who exhibit a greater number of behavioural occurrences. The pharmacodynamics of the medication will be monitored during the treatment cycles through the use of noninvasive body composition measures and monitoring of heart rate, blood pressure and weight These measures will be collected by a research nurse external to the aged-care facilities to improve the feasibility of the study, to avoid additional workloads placed on the aged-care staff, and to ensure that each participant is receiving their best tolerated dose. The approximate date that the recruitment will be completed is 20 July 2020
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