Nabilone for Behavioural and Psychological Symptoms of Dementia

Key Messages

What Is the Issue?

• Nabilone may have neuroprotective effects that could reduce BPSD.
• Decision-makers are interested in understanding whether nabilone could be used as a potential alternative to antipsychotics for the treatment of BPSD in people with dementia.

What Did We Do?

• We conducted a focused literature search and issued a targeted call for input from interested parties to inform our understanding of the current treatment landscape for BPSD, interpretation of the literature, and outcomes that are important to patients and clinicians.
• We engaged 2 clinical experts in the management and treatment of certain health conditions in older adults to provide input on the project protocol and peer review the draft report.

What Did We Find?

• A small placebo-controlled trial, in which patients with moderate-to-severe Alzheimer disease received both nabilone and placebo at different times, showed that compared to placebo, nabilone:
  • moderately decreased agitation; however, it is unclear whether this effect is meaningful to patients
  • improved neuropsychiatric symptoms and overall behavioural symptoms; however, the clinical meaningfulness of this is unknown
  • resulted in small improvements in cognition, nutritional status, and caregiver burden, though the clinical meaningfulness of these observations remains to be determined
  • resulted in a higher clinically meaningful frequency of sedation.
• We found an evidence-based guideline that suggests that synthetic cannabinoids, including nabilone, may be used for severe agitation in people living with Alzheimer disease or related dementia if other pharmacological treatments have been unsuccessful.
• We did not find any studies on the cost-effectiveness of nabilone or data on potential cost offsets associated with nabilone use in long-term care settings.

What Does This Mean?

• The effects of nabilone on agitation in patients with moderate-to-severe Alzheimer disease were moderate, and it is unclear whether this improvement is meaningful to patients.
• Evidence from larger studies with robust methodology and a longer follow-up period is needed to validate these observations.