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Patients with dementia frequently develop behavioral and psychiatric symptoms that are difficult to manage.

On admission to adult living facilities, they frequently are placed on psychotropics for behavior control.

Psychotropics can help on occasion but constrict the remaining personality and come with black box warnings.

Cannabis is showing increasing promise in helping control the disturbing symptoms dementia patients exhibit.

You pass them by all the time: some fancy, some more modest, buildings dotting cities, suburbs, and rural areas. They have names that evoke tranquility, luxury, or at least competent care. They are the thousands of assisted living facilities scattered around the country, particularly those with memory care units for residents with varying degrees of cognitive impairment.

Many people go by these places without much thought. Aside from the families, caregivers, and staff at these facilities, no one really knows, or thinks about, what is going on inside: the end-of-life dramas of people whose memories are eroding, no longer recognizing loved ones or themselves. Unless someone is acquainted with a person with dementia, they will have no idea about the painful scenarios that are playing out every day in these facilities and elsewhere.

Over the past six years, I’ve had the privilege of caring for patients with varying degrees of cognitive impairment. As a medical cannabis doctor, I often visit these patients in memory care units, seeing these once self-sufficient individuals, their personas now diminished, no longer able to care for themselves. They become angry and anxious as they confront the fact that their minds, their memories, what made them who they were, recollections of all that they have lived through and accomplished, are slipping away from them.

Increasingly, we are seeing how cannabis can afford these patients an increased ability to cope with these issues and interact with their loved ones, caregivers, and staff. In my role, I have gotten to know and develop warm relationships with them and their families, and find myself privy to the most personal details, wonderful stories, and fascinating accomplishments of people who now need my help.

Memory care units can be unsettling places. They house men and women at very different levels of awareness, some engaged in daily activities, others striving to follow the simplest conversation, accepting help with meals, and responding as best they can to attentive staff. Others have become completely disengaged or wander the halls without purpose.

When I visit a new patient in memory care, I first meet with the patients, families, and caregivers to discuss how or if medical cannabis might help their loved one with dementia. We talk at length about their specific concerns, with the consultation centered on the patient’s and family’s needs and goals, and I observe the patient’s interactions. After our initial meeting, if and when appropriate, I certify the patient for medical cannabis and arrange a discussion with the family and the pharmacist at a medical dispensary to review product options. Together, we establish an initial plan, and the selected products are delivered.

Over the last six years, I have helped to educate and encourage a number of adult living facilities with memory care units to recognize the value of incorporating cannabis into their therapeutic approach. Many report improvements in residents’ behaviors and a reduced reliance on psychotropic medications, which often provide only modest benefit in managing aggressive or assaultive outbursts and can do so at the cost of dulling personality and limiting meaningful interaction. Cannabis, by contrast, may ease anxiety and allow aspects of the individual to reemerge. Families describe greater engagement, improved quality of life, and facilities note that calmer environments contribute to less turnover in staff.

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At the same time, caring for individuals with dementia requires vigilance. Beyond difficulty expressing emotions, many patients cannot clearly articulate physical discomfort. Illness may present in unexpected ways. One resident developed pneumonia and, as his oxygen levels fell, became aggressive. His symptoms were initially attributed to dementia-related behavior, and calming medications were administered. Because his condition worsened, he was sent to the emergency room, where the correct diagnosis was made, and he was admitted for treatment.

Experiences like this underscore how fraught caring for these patients can be. In my work and in the experience of colleagues engaged in this field, we have seen how medical cannabis can help patients, families, and caregivers cope with worsening behavioral and psychiatric symptoms as dementia progresses. We’ve observed improvements in mood, appetite, sleep, and interpersonal connections.

One 88-year-old woman, newly admitted and exhibiting acute aggression that threatened her placement, began cannabis therapy. A year later, she is comfortably ensconced in the facility, calmer, pleasant, and more interactive, with only minimal and manageable outbursts.

Another patient, an 83-year-old woman I have followed for several years, was initially self-medicating with large amounts of alcohol. Within days of starting medical cannabis, she reduced her intake to an occasional glass of wine with dinner. She too became calmer and more focused, began eating better, and appeared healthier overall.

A man I have seen for two years recently sat with me for a conversation. Though his answers remained tangential, he used appropriate gestures, tone, and facial expression. He was noticeably calmer and more engaged than at prior visits.

An 85-year-old man who had struggled with persistent wandering and attempts to leave the facility was asked how cannabis gummies made him feel. “Fine,” he said, a serene expression crossing his face. His aide later told me that his wandering had markedly decreased.

Several patients who had been largely nonverbal have regained some speech, sometimes only a few words or brief sentences, but enough to suggest that parts of them have returned. I recall speaking with the wife of one such patient. When I first met him, he was aggressive and nonverbal. After beginning cannabis, he became calm, made eye contact, and responded to questions. His wife told me that, even if only for a time, she felt she had him back.

Often, these improvements are temporary. It can feel as though we are holding back an inevitable tide. Yet for families who believed they had permanently lost the ability to connect with their loved one, even brief moments of clarity and calm are profoundly meaningful.

We do not yet fully understand the mechanisms behind these changes. They may relate to cannabis’s anti-inflammatory properties, its potential effects on neuroplasticity, or its anxiolytic benefits. What is clear is that when agitation lessens and calm returns, the emotional atmosphere in these facilities shifts for patients and families alike.

Our understanding of cannabis in the treatment of cognitive and other neuropsychiatric conditions remains in its early stages. Much more rigorous research is needed. Reducing regulatory barriers to large-scale clinical trials would help clarify its role. The emerging clinical experience, however, suggests that cannabis may hold meaningful promise in the care of individuals living with dementia.

© Psychology Today