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Multiple Sclerosis Watch Time: 38 mins

touchROUNDTABLE Cannabinoids and Cognition in Multiple Sclerosis

Watch this activity discussing the effects of cannabis on adult cognition, how multiple sclerosis affects cognition, and the impact of cannabis on cognition in multiple sclerosis.

Gain insights into these topics with leading experts, Drs Francesca Filbey, Ralph Benedict, and Sarah Morrow.

Dr Francesca Filbey

The University of Texas at Dallas, Dallas, TX, USA

CHAIR

Panelists:
Dr Ralph Benedict, Dr Sarah Morrow
 
Introduction

Chair, Dr Francesca Filbey, introduces the expert panel and agenda for this discussion on cannabinoids and cognition in multiple sclerosis.

Regulated cannabis products are FDA-approved or seeking FDA approval. Unregulated cannabis products are not FDA-approved nor seeking FDA approval. There are currently no FDA-approved cannabis products for MS in the USA.

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Differentiating the effects of cannabis vs cannabinoids on adult cognition

Dr Francesca Filbey provides an overview of the current understanding of the different effects of acute and chronic use of cannabis and specific cannabinoids on cognition, the differences between regulated and unregulated cannabis products, and the limitations of published data.

Regulated cannabis products are FDA-approved or seeking FDA approval. Unregulated cannabis products are not FDA-approved nor seeking FDA approval. There are currently no FDA-approved cannabis products for MS in the USA.

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Cognitive decline in MS

Dr Ralph Benedict outlines the prevalence of cognitive decline in multiple sclerosis, the specific domains typically impaired, impact of decline on daily living, and recovery from decline.

Regulated cannabis products are FDA-approved or seeking FDA approval. Unregulated cannabis products are not FDA-approved nor seeking FDA approval. There are currently no FDA-approved cannabis products for MS in the USA.

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Cannabis and cognition in persons with MS

Dr Sarah Morrow discusses the details of studies that have assessed the effect of cannabis on cognition in persons with multiple sclerosis, both as a primary and secondary endpoint, in addition to the impact of discontinuing unregulated cannabis in these individuals.

Regulated cannabis products are FDA-approved or seeking FDA approval. Unregulated cannabis products are not FDA-approved nor seeking FDA approval. There are currently no FDA-approved cannabis products for MS in the USA.

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Overview & Learning Objectives
Overview

Cannabis contains more than 500 components, of which over 100 cannabinoids have presently been identified.1 Cannabis and the specific cannabinoids Δ-9 tetrahydrocannabinol and cannabidiol have been investigated for their effects on cognition.2–23

Watch three leading experts discuss the effects of cannabis and cannabinoids on the cognitive processes of adults, how multiple sclerosis affects cognition and the impact of cannabis on cognition in multiple sclerosis.

Learning Objectives

After watching this activity, you should be able to:

  • Differentiate the effects of cannabis vs. specific cannabinoids on adult cognitive processes
  • Discuss how multiple sclerosis affects cognition
  • Summarise the data regarding the impact of cannabis on cognition in persons with multiple sclerosis

Regulated cannabis products are FDA-approved or seeking FDA approval. Unregulated cannabis products are not FDA-approved nor seeking FDA approval. There are currently no FDA-approved cannabis products for MS in the USA.

Faculty & Disclosures
Dr Francesca Filbey

The University of Texas at Dallas, Dallas, TX, USA

Dr Francesca Filbey, PhD, is a Professor of Cognitive Neuroscience and Director of Cognitive Neuroscience Research of Addictive Disorders at the Center for BrainHealth, School of Behavioral and Brain Sciences at The University of Texas at Dallas, and an Adjunct Associate Professor at the University of Texas Southwestern Medical School, Department of Psychiatry.

Disclosures: Dr Filbey discloses: research funded by the National Institute of Drug Abuse and through the Bert Moore Endowed Chair; Consultancy Fees from Greenwich Biosciences, Inc.

Dr Ralph Benedict

University at Buffalo, State University of New York, Buffalo, NY, USA

Dr Ralph Benedict, PhD, is a professor of neurology and psychiatry at the University at Buffalo, State University of New York (SUNY) where he directs clinical neuropsychology and provides services for the Jacobs Multiple Sclerosis Center and the UB Alzheimer’s Disease and Memory Disorders Center.

Disclosures: Dr Benedict discloses: received honoraria, speaking, or consulting fees from Greenwich Biosciences, Inc, Biogen, Celgene, EMD Serono, Genentech, Medday, Novartis, and Roche; research support from Biogen, Genentech, and Novartis; and royalties from Psychological Assessment Resources.

Dr Sarah Morrow

Western University, London, ON, Canada

Dr Sarah Morrow, MD, is an Associate Professor in the Department of Clinical Neurological Sciences at Western University (London, ON) and Director of the London (ON) MS Clinic.

Disclosures: Dr Morrow discloses: received consulting fees from Greenwich Biosciences, Inc; served on advisory boards for Biogen Idec, EMD Serono, Genzyme Canada, Novartis, and Roche; has received Investigator Initiated Grant Funds from Biogen Idec, Novartis, and Roche; has acted as site PI for multi-center trials funded by Novartis, Genzyme, Roche, and AbbVie.

References
References
  1. Lafaye G, Karila L, Blecha L, et al. Cannabis, cannabinoids, and health Dialogues Clin Neurosci. 2017;19:309–16.
  2. Alessandria G, Meli R, Infante MT, et al. Long-term assessment of the cognitive effects of nabiximols in patients with multiple sclerosis: A pilot study. Clin Neurol Neurosurg. 2020;196:105990.
  3. Aragona M, Onesti E, Tomassini V, et al. Psychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study. Clin Neuropharmacol. 2009;32:41–47.
  4. Benedict RH, Cookfair D, Gavett R, et al. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc. 2006;12:549–58.
  5. Benedict RH, Amato MP, DeLuca J, et al. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol. 2020;19:860–71.
  6. Broyd SJ, van Hell HH, Beale C, et al. Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016;79:557–67.
  7. Corey-Bloom J, Wolfson T, Gamst A, et al. smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ. 2012;184:1143–50.
  8. Englund A, Morrison PD, Nottage J, et al. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. Psychopharmacol. 2013;27:19–27.
  9. Englund A, Atakan Z, Kralj A, et al. The effect of five day dosing with THCV on THC-induced cognitive, psychological and physiological effects in healthy male human volunteers: A placebo-controlled, double-blind, crossover pilot trial. J Psychopharmacol. 2016;30:140–51.
  10. Filbey F, Hauser C, Rajasekaran K. Rolled into one? Weeding out evidence on cognitive impact of marijuana from that of THC. Neurology Rev. 2020; June supplement.
  11. Glanz BI, Holland CM, Gauthier SA, et al. Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler. 2007;13:1004–10. Hindocha C, Freeman TP, Schafer G, et al.
  12. Hindocha C, Freeman TP, Schafer G, et al. Acute effects of delta-9-tetrahydrocannabinol, cannabidiol and their combination on facial emotion recognition: a randomised, double-blind, placebo-controlled study in cannabis users. Eur Neuropsychopharmacol. 2015;25:325–34.
  13. Honarmand K, Tierney MC, O'Connor P, et al. Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology. 2011;76:1153–60.
  14. Hunault CC, Mensinga TT, Böcker KB, et al. Cognitive and psychomotor effects in males after smoking a combination of tobacco and cannabis containing up to 69 mg delta-9-tetrahydrocannabinol (THC). Psychopharmacology (Berl). 2009;204:85–94.
  15. Morgan CJA, Freeman TP, Hindocha C, et al. Individual and combined effects of acute delta-9-tetrahydrocannabinol and cannabidiol on psychotomimetic symptoms and memory function. Transl Psychiatry. 2018;8:181.
  16. Pavisian B, MacIntosh BJ, Szilagyi G, et al. Effects of cannabis on cognition in patients with MS: a psychometric and MRI study. Neurology. 2014;82:1879–87.
  17. Rog DJ, Nurmikko TJ, Friede T, et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis / Neurology. 2005;65:812–9; 3.
  18. Schoedel KA, Chen N, Hilliard A, et al. A randomized, double-blind, placebo-controlled, crossover study to evaluate the subjective abuse potential and cognitive effects of nabiximols oromucosal spray in subjects with a history of recreational cannabis use. Hum Psychopharmacol. 2011;26:224–36.
  19. Theunissen EL, Heckman P, de Sousa Fernandes Perna EB, et al. Rivastigmine but not vardenafil reverses cannabis-induced impairment of verbal memory in healthy humans. Psychopharmacology (Berl). 2015;232:343–53.
  20. Vachová M, Novotna A, Mares J, et al. A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis. J Mult Scler. 2014;1:122.
  21. Vaney C, Heinzel-Gutenbrunner M, Jobin P, et al. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler. 2004;10:417–24.
  22. Volkow ND, Baler RD, Compton WM, et al. Adverse health effects of marijuana use. N Engl J Med. 2014;370:2219–27.
  23. Wade DT, Makela P, Robson P, et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler. 2004;10:434–41.
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