Whilst the idea of your geriatric relative hallucinating in their rocking chair may seem ludicrous, researchers are in fact examining a variety of ways psychedelics can be used as a viable treatment for Alzheimer’s disease. At present, there are no disease-modifying treatments for Alzheimer’s or any other subtype in dementia, but thanks to a reignition of interest in psychedelics in Western medical research, scientists and researchers are now investigating the ability of these drugs to enhance mood, behaviour and even memory in those suffering from the debilitating memory-loss disease.

From ketamine-assisted therapy, microdosing psilocybin to help treat eating disorders and depression, using LSD to treat PTSD, there exists a number of studies that cite the role these psychoactive drugs can play in those with psychiatric and neurological conditions. Owing to the drugs’ capacity to stimulate neurogenesis, provoke neuroplasticity, and reduce neuroinflammation, they are a compelling candidate in the battle against dementia.

Globally, more than 55 million people live with dementia, and there are nearly ten million new cases every year. It is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people worldwide. Alzheimer’s is the most common type of dementia, and more than 520,000 people in the UK have dementia with the figure set to rise.

Dementia is a neurodegenerative syndrome – usually of a chronic or progressive nature – that leads to a deterioration in cognitive function. In Alzheimer’s disease, which is progressive, connections between nerve cells are lost as proteins build up and form abnormal structures referred to as “plaques” and “tangles.” Over time, these plaques and tangles damage the cells, the “chemical messengers” in the brain deteriorate, and symptoms worsen.

Across the pond, Dr Albert Garcia-Romeu is an Assistant Professor at Johns Hopkins University, home to the world’s leading psychedelic research unit. Garcia-Romeu is currently conducting a research study to see whether psilocybin can work as a therapeutic agent in treating depression among people with mild cognitive impairment (MCI) or early-onset Alzheimer’s. 

I spoke to Dr Garcia-Romeu about how psilocybin can treat cognitive decline, the current trials’ participants and process, and discussed the likelihood of integrating psychedelics into care for those suffering from the debilitating symptoms of Alzheimer’s disease. 

How do psychedelic drugs help treat cognitive decline and what sort of effect do they have on the brain? 

Currently, there is no data showing psychedelic drugs can treat cognitive decline. Research in animals suggests psychedelics such as psilocybin may facilitate certain learning and memory-related processes like object memory consolidation or enhance aspects of working memory. 

Research in animals has also shown that a single administration of a psychedelic such as psilocybin can lead to increases in brain plasticity, including the growth of new, long-lasting connections between neurons in critical parts of the brain such as the prefrontal cortex. 

This data provides a good rationale for studying psychedelics as potential therapeutics in neurodegenerative conditions such as Alzheimer’s disease characterized by neuronal atrophy and cognitive decline. Additionally, many people with conditions like Alzheimer’s disease also suffer from other symptoms such as apathy and depressed mood that can adversely impact their quality of life. Traditional antidepressant medications are always not effective in helping these individuals. 

Studies in people with major depression have demonstrated rapid antidepressant effects that can last months after a single high dose of psilocybin. Other studies have shown psilocybin can help reduce anxiety and depression and improve the quality of life in people with life-threatening conditions such as cancer diagnoses. These results have encouraged us to study the mood and memory-related effects of moderate and high dose psilocybin in people with early-stage Alzheimer’s Disease and Mild Cognitive Impairment. 

We are now in the process of conducting an initial study to learn more about whether psilocybin can help provide any mood or memory benefits to this population and are excited to learn more about the possibilities in this area.

What current evidence base proves that psychedelics can be effective therapies in controlled medical settings?

Recent studies indicate the promising potential of high dose psilocybin treatments in people with major depression as well as cancer-related distress. Other preliminary studies have shown high dose psilocybin in conjunction with talk therapy can be useful in helping people overcome substance-related conditions like cigarette smoking and alcohol dependence. 

The field is growing rapidly now, but much of this work harkens back to earlier research in the 1950s and 60s showing similar potential of LSD for treating anxiety and substance use disorders, including opioid dependence. 

There are other drugs like MDMA that are also being studied and showing great results for treating post-traumatic stress disorder among other conditions. However, there is still much to learn about how these drugs can exert therapeutic benefits often for long periods after one or a few doses.

Could you tell me more about the trial you are conducting at Johns Hopkins, the process and participants, and what you hope the results will show?

We are conducting a small trial in 20 people with early-stage Alzheimer’s Disease or Mild Cognitive Impairment and depressed mood. This is an initial study to assess how individuals with these conditions respond to a moderate (15mg/70kg) and high (25mg/70kg) dose of psilocybin under supportive conditions. We are assessing their mood, anxiety, quality of life, and memory function before and after each dose and then at several follow-up time points a few months later. 

Consistent with our prior studies, participants are thoroughly screened for medical and mental health issues before enrolling to ensure optimal safety. Once enrolled, people go through a 3-week preparation process that includes a brief life review, discussion about current symptoms and treatment goals, and targeted preparation for the psilocybin dosing sessions. There are two dosing sessions that occur in the study, and after each, we continue to discuss both the experiences people had in these sessions and any impact they feel this may have had on their day-to-day life and overall health condition for several weeks afterward. 

Finally, participants come back for several follow-up visits to examine how they are feeling in the longer term. We hope this study will give us some better evidence about whether psilocybin can help improve mood and memory in people with early-stage Alzheimer’s Disease or Mild Cognitive Impairment, as well as getting more information about what dosage, and wraparound support is optimal in this population. 

If the results are positive, what is the likelihood of psychedelic drugs being integrated into care for those living with dementia?

It’s still too early to say. However, psilocybin is already moving along the path towards the large-scale trials necessary to receive medical approval for use as an antidepressant treatment in the United States and Europe. 

If those studies show safety and efficacy of psilocybin in people with depression, that will likely lead to more widespread clinical implementation in other populations and broader medical accessibility. If our initial data show a signal for benefits in people with early-stage Alzheimer’s Disease or Mild Cognitive Impairment, that will also open the door to larger and more rigorous trials that could lead to psychedelic-based treatments for Alzheimer’s Disease or other dementia-related conditions down the line. 

I’ve also attached some relevant literature here for reference, and feel free to check out this short interview. People can also visit this page to learn more about this work.