Despite decades of intense research, treatments for Alzheimer’s disease, the most common form of dementia, are disappointing. The most successful interventions can only treat symptoms and moderately slow progression.
Many of the drugs that have been trialled focus on reducing or removing the misfolded proteins that are the hallmark of Alzheimer’s.
Yet this approach has been broadly ineffective, so researchers have begun casting their nets wider. Psychedelics, with their newfound popularity, are just one port of call.
The current case report focuses on a woman in her 80s who had received a dementia diagnosis 10 years prior. At the beginning of the recent intervention, her condition was quite advanced.
She was incontinent, could only speak in single syllables, and could not dress herself. Walking and eating both required assistance, and she was emotionally unresponsive.
With the consent of her legal guardians, the woman was enrolled in a psilocybin trial in Brazil.
At the first session, she received 5 grams (g) of psilocybin-containing mushrooms. This is not a small dose. When taken recreationally, 1–2 g is enough to experience a strong psychoactive response commonly referred to as a “trip.”
Shortly after receiving the dose, the patient appeared to be overheating. She also entered a prolonged sleep-like state.
Then, as the report authors write, “[a]pproximately 19 [hours] after administration, the patient spontaneously initiated autobiographical conversation lasting several hours.”
In the following weeks, the patient stopped being incontinent — even during the night — could move more easily, and became much better at social interactions. Just days after the psylocibin intervention, she could walk unaided and dress herself.
The benefits of this intervention persisted, so the researchers decided to continue the treatment.
One month after the initial intervention, the woman received a second, slightly smaller dose of “just” 3 g. During this session, she was verbally expressive throughout and “described emotionally positive imagery involving surfing with her son on a peaceful island.”
The authors also note that she used more facial expressions and humor, and demonstrated “emotional reciprocity.” She was also markedly better at walking unaided.
Trialing a psychedelic dose on an older adult with significant health problems seems, on the surface, to pose various ethical problems.
Medical News Today spoke with Dustin Hines, PhD, an associate professor of psychology at the University of Nevada, Las Vegas, who was not involved in this research, about the implications of such an endeavor.
We asked Hines how the researchers were able to get ethical sign-off.
“There is already a substantial safety record for high-dose psilocybin in clinical research,” he explained. “Much of that foundation comes from the seminal work of Roland Griffiths, whose studies in patients with advanced, life-threatening cancer helped launch the modern psychedelic research renaissance.”
“In those trials,” Hines continued, “many participants were nearing the end of life and unlikely to survive their illness, so ethics boards weighed the potential to relieve profound psychological suffering against the relatively low risk of a carefully supervised psilocybin session.”
“That work helped establish the precedent for later studies using similar doses,” he told us.
However, the ethics statement given in the study paper provides little reassurance. “Ethical approval was not required for this single case report conducted in routine private clinical practice, in accordance with local legislation and institutional requirements,” it reads.
This case study reads like a modern-day miracle, but we must temper that excitement for now. There are significant limitations. Firstly, this is just a case study, so there is no guarantee that the same effect would be seen in other patients.
Secondly, the participant’s condition had not been verified by scientists. Although her symptoms and disease course make it highly likely that she was experiencing Alzheimer’s disease, the authors did not confirm the diagnosis with scans.
Thirdly, the symptoms of dementia can ebb and flow, so it is possible that her condition just happened to improve at the very time she took the magic mushrooms.
When we asked Hines whether he was surprised by the results, and he said “yes and no.” According to him:
“The story is remarkable because the patient reportedly had advanced Alzheimer’s with years of severe impairment, then showed transient gains. That is extraordinary. However, as a neuroscientist who studies serotonin 5-HT2A signaling, I am not surprised that a powerful serotonergic psychedelic could acutely reorganize brain network activity and temporarily reveal capacities that seemed lost.”
Finally, he emphasized that: “The key word is ‘temporarily.’ This is a single case report, not proof of Alzheimer’s reversal.”
Recently, there has been a great deal of interest in psychedelic therapy, particularly for the treatment of depression.
Although very little research has been conducted on psilocybin and dementia, specifically, there are theoretical reasons why it might work.
Psilocybin, once consumed, is rapidly converted into psilocin. This molecule works at a type of serotonin receptor called 5-HT2A. Modulating this receptor:
- improves neural plasticity, making the brain more adaptable — studies show that people with Alzheimer’s have reduced numbers of synapses, so improving plasticity might help the brain build new communication pathways
- diminishes inflammation, which is a factor in dementia and other brain conditions
- improves cognitive functions such as creativity and cognitive flexibility.
Also, previous research has shown that 5-HT2A receptors decline in density in people with Alzheimer’s disease.
Hypothesizing on the potential mechanisms at play, Hines told us that: “In Alzheimer’s, some neural circuits may be impaired but not completely destroyed. Psilocybin may transiently increase network flexibility enough for residual circuits involved in memory, emotion, movement, continence, and social behavior to come back online.”
However, he also emphasized that, at this stage, this remains a hypothesis, “not established fact.”
MNT also spoke to Tim Spector, OBE, FMedSci, a professor of epidemiology at King’s College London in the United Kingdom.
Spector was not involved in this study but his own research has increasingly focused on links between gut health and brain health.
He offered up another potential mechanism by which magic mushrooms might, theoretically, improve Alzheimer’s symptoms.
“The ‘trippy’ effects of psilocybin are partly due to its influence on the brain’s default mode network (DMN),” he told us.
This network is “turned on” when our brain is at rest and plays a role in self-focused thinking, autobiographical memory, and mind-wandering.
Specifically, psilocybin reduces connectivity within the DMN and increases connectivity between the DMN and other brain regions. Interestingly, these changes can persist long after the trip has finished.
“Although this is entirely hypothetical, we also know that the DMN is altered in people with Alzheimer’s, so ‘rebooting’ it might, theoretically, play some part in relieving symptoms,” Spector suggested.
At this stage, research into the possibility that magic mushrooms might help treat dementia is in its infancy. There is no definitive research, and the possible mechanisms, while encouraging, are not backed by evidence.
In general, psilocybin treatment, when conducted by experts, appears to be safe and carries few significant adverse events, so there is reason to be hopeful.
However, only time will tell. In the meantime, Hines has a strong message for anyone considering trying this at home:
“Do not try this at home on yourself or a loved one with dementia. This case involved a very high mushroom dose in a medically fragile older adult, with suspected hyperthermia, sweating, autonomic activation, and prolonged altered consciousness.”
“Older adults with dementia,” he continued, “are at higher risk for falls, aspiration, delirium, panic, cardiovascular complications, medication interactions, and inability to consent.”
