The Remarkable Case of the Woman with Alzheimer’s Disease and Psilocybin
Will We Be Adding Mushrooms to Our Advanced Directives?
A flurry of sensationalist articles have crossed my psychedelic news feed in the last few days, drawing from a case study reported in the Frontiers in Neuroscience, of a woman in her eighties with a 10-year history of Alzheimer’s disease, who was given psilocybin.
While my main interest is psychedelics in the service of conscious aging and not palliative care, this story stopped me in my tracks.
The report described how the woman, who was withdrawn, non-communicative and incontinent at the time she was given 5 grams of psilocybin mushrooms, experienced the following:
“Approximately 19 h post-administration, spontaneous autobiographical speech emerged. Over subsequent days and weeks, functional improvements included restoration of urinary continence, improved ambulation, autonomous dressing, increased emotional responsiveness, sustained social interaction, contextual memory retrieval, preserved working memory for social context, and spontaneous conversational engagement.”
I shared these findings with Dr. Mikhael Kogan, a palliative care physician and director of George Washington University’s Integrative Medicine Center, who has a special interest in Alzheimer’s disease. He was skeptical, finding the story too good to be true.
I am a writer, not a clinician, and am in no position to comment on the validity of this study, other than to note that conclusions can’t be drawn from a single case, and that the therapeutic use of psychedelics for the debilitating conditions of older age, while not new, is still poorly investigated.
From the existential dread of a terminal diagnosis, to the depression associated with Parkinson’s disease, the main focus of psilocybin-assisted therapy has been to alleviate suffering, and not as a cure.
This case report points to the possibility of something in between.
A temporary window
The authors of the study suggest that someone with a late-stage neurodegenerative condition could still maintain some residual functional capacity, which could be accessed – at least temporarily – by the administration of psilocybin.
This is an intriguing notion and hopefully the scientific community will pick up the signal and run with it (or, considering the pace of scientific research, crawl with it…).
Don’t do this at home
As someone who follows the real-world use of psychedelics by older adults, I know that there is a lot of informal experimentation already going on out there – including for the ailments of older age. And as sensationalist reports of this miraculous recovery from dementia make the rounds, there will surely be those who find hope in the message.
To be one-thousand percent clear, I am not in any way, shape or form suggesting that people give psilocybin to anyone with dementia, or any other condition for that matter.
There are a host of complicating factors, first and foremost the problem of obtaining informed consent from someone without the cognitive capacity to give it.
But I also know that caregiving for someone with dementia can take a heavy toll. And if there are options that may provide some relief, people will seek them out, even if they are outside of the consensus. Fortunately, compared to many viral DIY health fixes, under the proper conditions, psilocybin is relatively safe, even for most older adults.
A Risk/Benefit Assessment
Back when I was reporting about cannabis in older life, a man wrote to me about how THC gummies helped his elderly father with dementia with the agitation he experienced every evening when no anti-psychotic or other medication helped.
Yes, it was federally illegal and doctors frowned upon it. Furthermore, the father had no say in the matter. But the family made a risk/benefit assessment and decided accordingly.
I suspect that a similar phenomenon is already happening with psilocybin.
A Shift in the Conversation
As the boomer generation enters older age, the conversation about how to approach decline and death is shifting in a new direction. We may have helped our parents through advanced older age and come away with the strong desire to do things differently. Or we may simply find that society’s attitudes about how to approach the physical and cognitive realities of aging to be out of synch with our values.
How we craft an approach to our health in older age that suits our sensibilities – including the option of using psychedelics to enhance how we age and die – is a riveting unfolding story.
Preparing an Advanced Directive is a ritual of older age where we provide guidance to assigned caregivers on the kind of care we would prefer if we can’t make our own decisions. Maybe it’s time to consider writing into the directive the option to administer psilocybin if there is a chance it could make a positive difference.
That would at least take care of the issue of informed consent – and could possibly make a difference in our quality of life toward the end of life.
Plans for the book launch are coming together! Starting 7/7 in Washington, DC, then on to Baltimore, Victoria, BC, Seattle, Portland, Bay Area and more. More info to come! Hope to meet you in person and sign a book!
I would also add that if you want to include something in your advance directive. It should not be specific to one treatment, such as psilocybin. You might include that you would approve of any novel or unconventional treatments that might prove useful in the future. That way family has flexibility. That is, if you trust your family to have good judgment.
As a neurologist who treats dementia, I am going to go out on a limb and say this patient probably had significant coexisting depression which was treated with the psilocybin. I'm not saying the patient wasn't also suffering from dementia, although that is a possibility as well.
I can think of two good examples from my own practice. In one case, a patient had given up his job as a zookeeper because he was unable to perform his work duties. Over the next 6 months he lost the ability to do self-care such as dressing, bathing and was spending much of his time sleeping. His wife was on the verge of putting him in a nursing home. After treatment with SNRIs, he nearly returned to normal cognitive function. In fact, he was able to return to his job duties. He did later develop dementia but it was several years later. The initial decline was almost certainly due to what we would call "pseudo-dementia" which is a dementia appearing condition due to severe depression.
I also had a patient who was hospitalized with inability to care for herself, severe confusion, bowel and bladder incontinence. She also had hallucinations and delusions. She looked like an advanced dementia patient. However, after treatment with SSRIs and an antipsychotic medication. She also returned to normal function. I have continued to follow her 5 years out and she still is functioning at a high level, living at home, enjoying game night with her husband and friends. She has since developed Parkinson's disease and may in fact have lewy body dementia in its early stages. However, her initial decline was also clearly psychiatric in origin.
In both cases, medications resulted in improvement in their cognitive function. In addition to their mood issues.
I believe the psilocybin provided the same benefit for the patient in the article. Psilocybin is a medication like any other.