LBD and Marijuana, Part 1

Now that marijuana (MJ) is legal in many states, we are beginning to get questions and comments about its use.

Bottom line, medical MJ is probably safer for the person with LBD than most pain, anxiety, or behavior management drugs and is therefore worth considering. It is not a cure and probably won't work to improve cognition, even short term.

MJ is NOT an anticholinergic. This is perhaps its biggest attraction for LBD families. It doesn't block acetylcholine,  the main brain chemical that LBD attacks. Thus, MJ starts out being more compatible with LBD than many drugs, including most of those for pain, anxiety and psychosis.

But what about MJ's high? Couldn't that cause more problems instead of fewer? Well, it turns out that there are two types of MJ: Recreational and medicinal. MJ is a naturally grown plant, that produces several "cannabinoids" or chemical compounds, the two main ones being THC* and CBD*. In nature, these two compounds balance each other.

• THC is psychoactive, and can trigger a high, with hallucinations, paranoia and other psychotic behaviors. If a person is already displaying psychotic behaviors, such as hallucinations or anxiety, it may increase them. Although it is only mildly addictive chemically, it can be psychologically addictive. That is, it doesn't change body chemistry to where it requires more and more of the drug to get the same result the way alcohol does. However a person can become psychologically attached to the process of its use and the enjoyment of the high.
• CBD is an antipsychotic that acts to counteract the high caused by THC. In some cases, it may decrease already present BPSD* such as hallucinations, delusions, depression and anxiety. However, we believe that CBD's value in this area is more about what it isn't than what it is: it isn't psychoactive and it isn't addictive.

Plants can be bred selectively to produce varying amounts of each compound.

• Recreational marijuana is produced by cannabis plants bred to have such a high ratio of THC to CBD that the latter cannot stop the psychoactive qualities of the drug.
• Medicinal marijuana is produced by cannabis plants bread to have such a high ratio of CBD to THC that it prevents any psychoactive effects.
• Marinol, a synthetic marijuana, is mostly THC with no CBD at all.
• CBD oil is oil made from low-THC, high-CBD plants. So far as we know, there is no straight CBD product. That is not a bad thing. While both THC and CBD act to treat a variety of issues, THC, with its psychoactive qualities buffered, is often the most effective of the two.

Marijuana has long been used as an effective treatment for:

• Pain, including chronic nerve pain which is common with Lewy body disorders.
• Poor appetite
• Intestinal upsets, such as nausea.

Research is showing that it may also be useful:

• As an anti-inflammatory agent. It appears to block the release of cytokines, substances that signal the production of inflammation. Thus, it may help with autoimmune diseases such as arthritis.
• To decrease motor symptoms, such as tremor, rigidity and bradykinesia. The research for this is still very limited, but side effects appear minimal and so it might be worth a try. It only treats symptoms--its effect stops when the drug is no long used.
• For maintaining circadian (sleep) rhythms. CBD works to improve alertness, especially in lighted areas. Medical MJ may help with excessive daytime sleeping, but it should not be taken before bedtime. THC tends to promote nighttime sleep, but medicinal MJ probably won't be effective and the recreational MJ's psychoactive qualities make it a poor choice for someone with LBD.

Next week, more about marijuana, how to find it and how to use it.

Reference:
Medical cannabis. Wikipedia. https://en.wikipedia.org/wiki/Medical_cannabis

* Acronyms:
MJ: Marijuana, or cannabis. A plant grown for its psychoactive and medicinal qualities.
RMJ: Recreational marijuana
MMJ: Medical marijuana
THC: tetrahydrocannabinol, the cannabinoid or chemical compound in marijuana that provides a high.
CBD: cannabidiol, the cannabinoid in marijuana that does not provide a high.
BPSD: behavioral and psychological symptoms of dementia

LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.