Cannabinoids for Agitation in Alzheimer's Disease.
Cannabinoids for Agitation in Alzheimer's Disease.
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DOI：
10.1016/j.jagp.2021.01.015
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Rosenberg PB
中科院分区：
文献类型：
--
作者：
Outen JD;Burhanullah MH;Vandrey R;Amjad H;Harper DG;Patrick RE;May RL;Agronin ME;Forester BP;Rosenberg PB
躁动是阿尔茨海默病(AD)的一种常见神经精神症状，极大地影响生活质量并增加照顾者的负担。阿尔茨海默病的躁动可能与前扣带回皮质、后扣带回皮质、脑岛、杏仁核和额叶皮质的体积减少有关，也与单胺能神经传递的退化、昼夜节律紊乱和虚弱有关。目前的药物选择存在令人担忧的安全性问题，而且疗效不高。由于临床前和早期的临床研究表明，大麻类化合物可以产生缓解焦虑、抗抑郁和/或抗炎的作用，因此人们对大麻类药物的前景越来越感兴趣。大麻素可能通过调节神经递质，改善合并症和昼夜节律，以及增加大脑循环来缓解焦虑。在这里，我们讨论了AD激越的可能机制，以及包括CBD和THC在内的大麻素类药物的治疗相关性。这篇综述考察了导致阿尔茨海默病激越的神经生物学机制，包括脑萎缩、神经传递退化、昼夜节律紊乱和虚弱。临床前和早期临床研究的综合表明，大麻类化合物可以通过减少神经炎症、调节神经递质、改善合并症和昼夜节律而提供治疗益处。然而，大麻类药物增加了癫痫发作、镇静和可能的药物相互作用的风险，因此证实了在这一人群中进行进一步研究的必要性。
Agitation is a common neuropsychiatric symptom of Alzheimer’s disease (AD) that greatly impacts quality of life and amplifies caregiver burden. Agitation in AD may be associated with volume loss in the anterior cingulate cortex, posterior cingulate cortex, insula, amygdala, and frontal cortex, as well as with degeneration of monoaminergic neurotransmission, disrupted circadian rhythms, and frailty. Current pharmacological options have troubling safety concerns and only modest efficacy. There is increasing interest in cannabinoids as promising agents due to pre-clinical and early clinical research that suggest cannabinoids can elicit anxiolytic, antidepressant, and/or anti-inflammatory effects. Cannabinoids may relieve agitation by regulating neurotransmitters, improving comorbidities and circadian rhythms, and increasing cerebral circulation. Here we discuss the possible contributory mechanisms for agitation in AD and the therapeutic relevance of cannabinoids, including CBD and THC. This review examines the neurobiological mechanisms that contribute to agitation in Alzheimer’s disease, including brain atrophy, degradation of neurotransmission, disrupted circadian rhythms, and frailty. A synthesis of preclinical and early clinical research suggests that cannabinoids could provide therapeutic benefit by reducing neuroinflammation, regulating neurotransmitters, and improving comorbidities and circadian rhythms. However, cannabinoids pose an increased risk of seizures, sedation, and possible drug interactions, thus confirming the need for further investigation in this population.
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