Cannabis Use Can Exacerbate Cognitive Declines in Patients With Multiple Sclerosis

The use of cannabis among patients with multiple sclerosis (MS) has become increasingly common, especially with the growing legalization of cannabis products. However, recent research suggests that caution is necessary when it comes to frequent cannabis use in this population. In a session at the Consortium of Multiple Sclerosis Centers 2024 Annual Meeting, Dr. Anthony Feinstein emphasized the need for informed conversations between clinicians and patients regarding cannabis use.

A Canadian study by Banwell et al. found that patients with MS use cannabis for a variety of reasons. These include managing sleep, pain, anxiety, spasticity, depression, and even recreational purposes. The wide range of concerns highlights the complexity of patient motivations for cannabis use. However, despite its popularity, questions remain about the impact of cannabis on cognitive function in individuals with MS.

The Impact on Cognition

Dr. Feinstein pointed out that cannabis use does indeed affect cognition in patients with MS, exacerbating existing challenges associated with the disease. While there is ongoing research on the effects of cannabis, it is essential to recognize that cannabis dependence exists and can be challenging. Symptoms of cannabis dependence include an inability to reduce use, spending significant time procuring cannabis, disruptions in social or occupational activities, and withdrawal symptoms such as reduced concentration, irritability, loss of appetite, depression, and insomnia.

THC and Cognitive Decline

Most research focuses on delta-9-tetrahydrocannabinol (THC), one of the primary cannabinoids in cannabis. THC’s metabolites, 11-hydroxy-THC and 11-Nor-9-carboxy-THC, play a crucial role in its effects. Contrary to common belief, cannabis dependence can lead to cognitive decline, even among healthy subjects. Short-term residual effects may persist for hours or several days after use, impacting cognitive function.

The Importance of Informed Conversations

Given the complexity of cannabis use and its potential impact on cognition, clinicians should engage in open discussions with patients. Understanding both the benefits and risks is crucial for informed decision-making. While cannabis may offer relief for some symptoms, it is essential to weigh these benefits against potential cognitive impairments. As the landscape of cannabis use continues to evolve, healthcare professionals must stay informed and guide patients toward responsible choices.

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