CANNABINOIDS AND NEUROPROTECTION IN THE ELDERLY: THERAPEUTIC EVIDENCE, CLINICAL PERSPECTIVES, AND LEGAL REGULATORY CHALLENGES
DOI:
https://doi.org/10.56238/arev8n2-055Keywords:
Cannabinoids, Neuroprotection, Aging, Right to Health, Health RegulationAbstract
The increase in life expectancy has intensified, within the scientific and legal-health arenas, the search for strategies aimed at preserving cerebral function during aging, particularly in light of the growing prevalence of neurodegenerative diseases such as Alzheimer’s and Parkinson’s. In this context, cannabinoids—bioactive compounds derived from Cannabis sativa—have become part of the therapeutic debate due to their potential neuroprotective effects, with particular emphasis on cannabidiol (CBD). This study presents a critical analysis of the clinical and experimental evidence supporting the therapeutic use of cannabinoids in older adults, examining their mechanisms of action, pharmacological safety profile, and applicability in neuropsychiatric disorders associated with aging. Beyond the biomedical dimension, the paper also addresses the normative and jurisprudential framework governing the medicinal use of cannabis in Brazil, considering the regulatory role of ANVISA and the evolving case law of the courts regarding the realization of the fundamental right to health and therapeutic autonomy. A qualitative methodology is adopted, based on an integrative review of the scientific literature published over the past ten years in the PubMed, Scopus, SciELO, and LILACS databases. The findings indicate significant clinical potential for CBD in geriatric contexts, while also highlighting regulatory gaps and the need for integrated, safe, and evidence-based clinical and legal guidelines, thereby strengthening interdisciplinary dialogue among neuroscience, geriatrics, health law, and public policy.
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AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA (Brasil). Resolução RDC n. 17, de 6 de maio de 2015. Define critérios e procedimentos para a importação de medicamentos à base de canabidiol em associação com outros canabinóides por pessoa física, para uso próprio, mediante prescrição de profissional legalmente habilitado. Diário Oficial da União: seção 1, Brasília, DF, n. 86, p. 59, 8 maio 2015. Disponível em: https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-17-de-6-de-maio-de-2015-10344384. Acesso em: 13 jul. 2025.
AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA (Brasil). Resolução RDC n. 327, de 9 de dezembro de 2019. Dispõe sobre os procedimentos para a concessão da autorização sanitária para a fabricação e importação, prescrição, comercialização, dispensação, e monitoramento de produtos de cannabis para fins medicinais, no âmbito do Sistema Nacional de Vigilância Sanitária. Diário Oficial da União: seção 1, Brasília, DF, n. 238, p. 70, 11 dez. 2019. Disponível em: https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-327-de-9-de-dezembro-de-2019-232669373. Acesso em: 13 jul. 2025.
ARAUJO, Ana Sofia; GONÇALVES, Maria Beatriz; FERNANDES, Luísa Carolina; RIBEIRO, Pedro Henrique. Cannabidiol use in older adults with dementia: symptomatic relief and pharmacovigilance considerations. Revista Brasileira de Geriatria e Gerontologia, Rio de Janeiro, v. 27, n. 1, p. 1-14, 2024.
AUBRY, Régis; BELMIN, Joël; TRIVALLE, Christophe. Soins palliatifs et maladie d’Alzheimer: l’importance de la communication dans les stades avancés. Revue Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, Paris, v. 18, n. 3, p. 355–362, set. 2020.
BALLARD, Clive; GITTINS, Malcolm. Antipsychotic use in dementia: an analysis of mortality risk in end-of-life care. The Journal of Palliative Medicine, v. 24, n. 8, p. 1234–1240, ago. 2021.
BARCHEL, Daphna; STOLAR, Orit; DE-HAAN, Tomer; ZIV-BARAN, Tomer; SABAN, Natasha; FUCHS, Doina; BERKOVITCH, Menachem. Oral cannabidiol use in children with autism spectrum disorder to treat related symptoms and co-morbidities. Frontiers in Pharmacology, Lausanne, v. 9, p. 152, 2019. Disponível em: https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2018.01521/full. Acesso em: 10 jul. 2025. (em inglês) DOI: https://doi.org/10.3389/fphar.2018.01521
BEEDHAM, William; SBAI, Magda; ALLISON, Isabel; COARY, Roisin; SHIPWAY, David. Cannabinoids in the Older Person: A Literature Review. Geriatrics (Basel), v. 5, n. 1, art. 2, 13 jan. 2020. DOI: https://doi.org/10.3390/geriatrics5010002
BENEDETTI, Fernanda Aparecida; OLIVEIRA, Karla Maria dos Santos; FARIA, Raquel de. Cuidados paliativos: comunicação eficaz como ferramenta no cuidado ao paciente e sua família. Revista de Enfermagem UFPE On Line, Recife, v. 15, n. 1, p. e247901, jan. 2021.
BOMFIM, Thiago Silva; CARVALHO, Juliana Mendes; FONSECA, André Luís; MEIRELES, Letícia Ribeiro. Uso medicinal da cannabis em idosos com dor crônica: análise de coorte retrospectiva. Revista Brasileira de Geriatria e Gerontologia, Rio de Janeiro, v. 26, n. 3, p. 1-12, 2023.
BONNET, Marie-Claire; HOHMANN, Andrea G.; WALLACE, Mark S. Cannabinoid-based treatment for chronic pain in the elderly: mechanisms, efficacy and safety. European Journal of Pain, Oxford, v. 25, n. 4, p. 734-745, 2021.
BRASIL. Superior Tribunal de Justiça. Recurso Especial n. 1.657.075/SP. Relator: Ministro Herman Benjamin. Brasília, DF, 27 jun. 2017. Disponível em: https://www.stj.jus.br. Acesso em: 13 jul. 2025.
BRUCKI, Sonia Maria Dozzi; TAVARES, Paula de Castro; BERTOLOUCCI, Paulo Henrique Ferreira. Cannabis e envelhecimento cerebral: aspectos clínicos e terapêuticos. Revista Brasileira de Neurologia, São Paulo, v. 51, n. 2, p. 104-112, 2015.
CAMPOS, Alline Cristina; FOGAÇA, Manoela Verônica; SCARANTE, Fernando Fortes; GUIMARÃES, Francisco Silveira. Cannabidiol for the treatment of anxiety disorders: exploring mechanisms and clinical perspectives. Neuroscience & Biobehavioral Reviews, Oxford, v. 143, p. 104938, 2022.
CASSANO, Tiziana; VILLANI, Roberto; PACE, Luciana; CARBONE, Alessia; BUKKE, Shetty Harish; ORKISZ, Sylwia; TROTTA, Pamela; TOMASETTI, Carmine. Cannabidiol: a promising strategy to treat and prevent movement disorders? Frontiers in Pharmacology, Lausanne, v. 11, p. 1240, 2020. DOI: https://doi.org/10.3389/fphar.2020.00124
CASTILLO, Pablo E.; YOUNTS, Thomas J.; CHÁVEZ, Andrés E.; HASHIMOTODANI, Yuki. Endocannabinoid signaling and synaptic function. Neuron, Cambridge, v. 102, n. 1, p. 48-67, 2019.
CONSELHO FEDERAL DE MEDICINA (Brasil). Resolução CFM n. 2.324, de 11 de outubro de 2022. Define critérios para a prescrição de canabidiol como uso terapêutico e dispõe sobre a atuação médica. Diário Oficial da União: seção 1, Brasília, DF, n. 196, p. 211, 17 out. 2022. Disponível em: https://www.in.gov.br/en/web/dou/-/resolucao-cfm-n-2.324-de-11-de-outubro-de-2022-438675948. Acesso em: 13 jul. 2025.
CRUZ, Renata Maria da Silva; NUNES, Mariana Dias; PEREIRA, Bruna Ferreira; LOPES, Andreia Silva. Dor crônica no idoso: implicações clínicas e desafios terapêuticos. Revista Dor, São Paulo, v. 22, n. 2, p. 120-126, 2021.
DI MARZO, Vincenzo; BIFULCO, Maurizio. The endocannabinoid system and its therapeutic exploitation. Nature Reviews Drug Discovery, London, v. 20, n. 2, p. 105-106, 2021.
FERRÉ, Sergi; BASOLI, Francesco; LECCA, Serena; SOLINAS, Marcello. The endocannabinoid system in neurodegenerative diseases: a review of current status and perspectives. Journal of Neural Transmission, Vienna, v. 130, p. 1153-1170, 2023.
GELDORF, Karen Elizabeth; HOFFMAN, Julia Rose; WINTERS, James Lee. Cannabinoids and mental health in aging: a review of current evidence and perspectives for clinical application. International Psychogeriatrics, Cambridge, v. 33, n. 8, p. 743-756, 2021. DOI: https://doi.org/10.1017/S1041610220003282
HICKEY, J. P.; COLLINS, A. E.; NELSON, M. L.; CHEN, H.; KALISCH, B. E. Modulação do estresse oxidativo e neuroinflamação por cannabidiol (CBD): alvos promissores para o tratamento da doença de Alzheimer. Current Issues in Molecular Biology, Guelph, v. 46, n. 5, p. 4379–4402, 6 maio 2024. DOI: https://doi.org/10.3390/cimb46050266
HILLEN, Jennifer B.; SOULSBY, Nicola; ALDERMAN, Clive; CAUGHEY, Graham E. Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia: systematic review. Therapeutic Advances in Drug Safety, v. 10, p. 2042098619846993, 15 maio 2019. DOI: https://doi.org/10.1177/2042098619846993
HUANG, Weimin; LI, Ying; CHEN, Xiaojun; ZHANG, Liang; WANG, Qian; XU, Feng; ZHOU, Mei. Cannabidiol: agonist‑like modulation of PPAR‑γ, TRPV1, CB₁ e CB₂ e implicações para a neuroproteção. Frontiers in Pharmacology, Lausanne, v. 11, p. 595 635, 10 jul. 2020.
JUÁREZ, Rocío Araceli; MEZA, Beatriz Elena; CARRILLO, Juan Pablo; MORENO, Valeria Fabiola. Cannabinoid receptor 2 in neuroinflammation: a therapeutic perspective. Journal of Neuroimmunology, Amsterdam, v. 362, p. 577782, 2022.
KLEYNHANS, Jürgen; LOPES, Ana Maria; SOUSA, Jorge; KARLING, Jonas; MUÑOZ, Carla; BOGGIANI, Denise; GONÇALVES, Patrícia; RIBEIRO, Samuel. Polypharmacological potential of cannabidiol: interactions with CB₁/CB₂, TRPV1, 5‑HT₁A e PPAR‑γ. Molecules, Basel, v. 28, n. 7, art. 3271, 22 mar. 2023. DOI: https://doi.org/10.3390/molecules28073271
KOMOROWSKI, Mateusz; RUIZ, Sofia; MEADOWS, Jessica; NOWICKI, Michal. Endocannabinoid modulation of neurogenesis and synaptic plasticity in aging brains: implications for cognitive resilience. Frontiers in Aging Neuroscience, Lausanne, v. 15, p. 1197389, 2023.
LU, Hsiao-Chun; MACKIE, Ken. An introduction to the endogenous cannabinoid system. Biological Psychiatry, New York, v. 87, n. 1, p. 85-93, 2020.
ManganelliL. A. G., FonsecaY. S., VieiraW. H., SouzaL. G., MaiaM. C., SáM. G. T. L. de, CorreiaA. P., ReisA. S. L. da S., RamosM. S., & LimaK. de O. (2024). Uso de canabinoides no tratamento de distúrbios neurológicos em idosos. Revista Eletrônica Acervo Saúde, 24(12), e18084. https://doi.org/10.25248/reas.e18084.2024 DOI: https://doi.org/10.25248/reas.e18084.2024
MARTÍN-MORENO, Ana María; REY, Pedro; MARTÍNEZ-ORDÁS, Luisa; GARCÍA-GARCÍA, Laura; GASPAR, Jose Manuel; RIVERA, Pablo. Cannabidiol and other cannabinoids reduce microglial activation in vitro and in vivo: relevance to Alzheimer’s disease. Molecular Pharmacology, Rockville, v. 81, n. 4, p. 387-398, 2012.
MAZZETTI, Camila Marques; MOREIRA, Amanda Lopes; AZEVEDO, Fernanda de Souza; SOUZA, Luciano da Silva. Cannabidiol and the prevention of delirium in the elderly: a translational approach. Aging & Mental Health, London, v. 27, n. 3, p. 502-510, 2023.
MEEK, Paula; JONES, Bridget; ANDERSON, Maria; TAYLOR, Justin; KLEIN, Laura. Cannabis use in older adults: clinical considerations and recommendations. The Journal of the American Geriatrics Society, New York, v. 70, n. 2, p. 345-353, 2022.
MORAIS, Cláudia Maria; LIMA, Jéssica Andrade; NASCIMENTO, Ricardo Tavares; OLIVEIRA, Vanessa Beatriz. Impacto dos benzodiazepínicos em idosos: riscos associados e alternativas terapêuticas. Revista de Medicina da USP, São Paulo, v. 99, n. 4, p. 301-308, 2020.
PACHECO-SILVA, Maria Teresa; RIBEIRO, Carolina Andrade; SANTOS, Luciana Batista; SOUZA, Felipe Antônio. Cannabidiol modulates hippocampal neurogenesis and microglial activation in a murine model of Alzheimer’s disease. Neuroscience Research, Tokyo, v. 179, p. 38-47, 2022.
PERES, Fernanda Fernandes; TAVARES, Vanessa Cristina; COSTA, Maurício Rangel; MORAES, Marcelo Felipe. Cannabidiol as a promising therapeutic option for neurodegenerative diseases: mechanisms and clinical evidence. Pharmacological Research, Amsterdam, v. 174, p. 105848, 2021.
PESQUERA, Laura; GARCÍA-BLANCO, Anahí; MORENO, Ernesto; FERNÁNDEZ-RUIZ, Javier. Cannabinoids in neurodegenerative diseases: therapeutic potential and molecular mechanisms. Pharmacology & Therapeutics, Oxford, v. 229, p. 107944, 2021.
QUERFURTH, Henry W.; LAFERLA, Frank M. Alzheimer’s disease. The New England Journal of Medicine, Boston, v. 362, n. 4, p. 329-344, 2010. DOI: https://doi.org/10.1056/NEJMra0909142
RIO DE JANEIRO. Tribunal de Justiça. Processo n. 0030425-84.2018.8.19.0001. Relatora: Des. Katya Maria Monnerat. Julgado em: 27 ago. 2019. Tribunal de Justiça do Estado do Rio de Janeiro. Disponível em: https://www3.tjrj.jus.br. Acesso em: 13 jul. 2025.
SÃO PAULO. Tribunal de Justiça. Processo n. 1011335-78.2019.8.26.0564. Relator: Des. Reinaldo Miluzzi. Julgado em: 18 ago. 2020. Tribunal de Justiça do Estado de São Paulo. Disponível em: https://esaj.tjsp.jus.br. Acesso em: 13 jul. 2025.
SCHIER, Alexandre Rezende de Mello; RIBEIRO, Natália Paula Iribarren; SILVA, Adriana Cristina Santana; HALLAK, Jaime Eduardo Cecilio; CRIPPA, José Alexandre Souza; NARDI, Antonio Egídio. Cannabidiol in anxiety and sleep: a large case series. The Permanente Journal, Oakland, v. 23, p. 18-41, 2019.
TSAI, Joyce; BOOTHBY, Justine; BERGER, Ann M. Use of cannabidiol in older adults: a perspective and scoping review of clinical trials. Journal of the American Medical Directors Association, Amsterdam, v. 21, n. 10, p. 1381-1390, 2020.
VELAYUDHAN, Latha; MCGOOHAN, Katie; BHATTACHARYYA, Sagnik; et al. Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: a systematic review and meta-analysis. PLoS Medicine, v. 18, n. 3, p. e1003524, 29 mar. 2021. DOI: https://doi.org/10.1371/journal.pmed.1003524
WORLD HEALTH ORGANIZATION. Dementia. Geneva, 2023. Disponível em: https://www.who.int/news-room/fact-sheets/detail/dementia. Acesso em: 11 ju
