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Looks like your location is not in our Shipping Matrix. We ship worldwide! Shipping to:. Offers are binding. You will be asked to enter credit card information in a next step. If the seller accepts your offer an order will be placed and your card charged. For more details on how offers work click here. We will forward your request to the seller of this product and will update you with their decision shortly. To access trade prices, please apply to our Trade Program after sending your request. If you wish to sell a personal item to our network of professional vendors, please fill out this form. Thanks for your inquiry, someone from our team will be in touch shortly. Click here for full description Close description. Please examine every order upon delivery. In the event that there are visible signs of damage or missing or incorrect pieces, please indicate the problem on the Delivery Note and contact us within 48 hours of delivery. A signed delivery receipt without notations of missing, damaged, or incorrect item s represents your acceptance of the complete order in perfect condition. He opened his own design office in , and was one of a handful of designers who helped define and popularize the 'Danish Modern' design style. He was driven to create affordable, practical designs, and his preferred material was wood. Notable projects include Spokeback Sofa , and Spanish Chair , as well as a variety of shelving and storage designs. He was honored with the Eckersberg Medal in , the annual prize from the Copenhagen Carpentry Guild in , and the C. Hansen Medal in Danish furniture maker Fredericia Stolefabrik was founded in by N. The company and the town continued to host the fair until The company's early collections in the s reflected the influence of pared-back, English and Central European designs. In , Thonet made an exclusive licensing agreement with Fredericia for the Scandinavian region. To meet the high demand, Fredericia doubled its production staff. However, with the Nazi occupation of Denmark during the Second World War, raw materials were scarce and Fredericia struggled to survive. In the aftermath of the war, Fredericia was faced with bankruptcy. During his years with the FDB, Mogensen had worked with Hans Wegner to develop modern, functionalist, affordable furniture collections. Graversen wanted Mogensen's 'unpretentious, pure, and honest' design ethos to define Fredericia's future. The No. The following year, Fredericia produced a collection of Shaker-inspired dining furniture by Mogensen, alongside a number of designs originally developed during Mogensen's years at the FDB, such as his famous Spindle-Back Sofa and Hunting Chair In , Fredericia introduced Mogensen's iconic Spanish Chair. Mogensen stayed with Fredericia until his untimely death in In , Fredericia acquired the license for a number of Mogensen's designs for P. Over the years following Mogensen's passing, Frederica has continued to cultivate fruitful partnerships with prestigious Danish designers. In , Federica acquired production rights for a range of Wegner furniture previously manufactured by the Johannes Hansen. In the s, Fredericia began working with Nanna Ditzel , a. With a deep respect for tradition, Fredericia Stolefabrik has remained family-owned and changed hands only once throughout hundred-year history. The company has continuously prided itself on excellent Danish craftsmanship. Free Shipping from Germany to:. Choosing vintage and antique furniture reduces your carbon footprint by cutting down on waste and reduces demand for new materials and extends the life of the products we use. Shipping quote request Oh! Information about your order:. Back Send a request. Please sign up or login in order to make an offer. We noticed you are new to Pamono! Please enter your password to continue to the question form Please enter your password to continue to the offer form. Private Customer Design Professional Interior Designers, Architects, and other professionals working on interior design projects. Do you want to sell a personal item? Do you want to edit your offer? Enter Amount Enter Percentage. Almost There! To follow your conversation on the platform, please complete the registration. To proceed with your offer on the platform, please complete the registration. Sign up for updates and special offers. Successful Thanks for your inquiry, someone from our team will be in touch shortly OK If you are a Design Professional, please apply here to get the benefits of the Pamono Trade Program. About This Piece Vintage Design. Spanish Chair for Fredericia Furniture. You may have to pay import duties upon receipt of your order. You will be responsible for further transport beyond that point. We recommend asking a family member or friend for an extra hand; alternatively, you may upgrade to In-Home Delivery see below. A wooden crate may be used for intercontinental shipments for maximum protection. Item will be left in its packaging after delivery. A signature will be required upon delivery. In-Home Delivery: For in-home delivery service, additional fees apply. Please get in touch A skilled driver or a team of two will bring your item s inside your home and place it in the immediate entryway. For unusually large or heavy items, we recommend asking a family member or friend for an extra hand, as we cannot send more than 2 drivers. Mogensen passed away in Denmark in Fredericia Danish furniture maker Fredericia Stolefabrik was founded in by N. Only one available. New Destination. Cancel Confirm. Complimentary In-House Delivery. In-house delivery is not available. Sustainable Choice. More Questions about this item? Get in Touch. Are you a professional? 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Official websites use. Share sensitive information only on official, secure websites. Dementia is a common chronic condition, mainly affecting older adults, characterised by a progressive decline in cognitive and functional abilities. Medical treatments for dementia are limited. Cannabinoids are being investigated for the treatment of dementia. We included all randomised controlled trials RCTs of cannabinoids for the treatment of dementia. We included participants of any age and of either sex with diagnosed dementia of any subtype, or with unspecified dementia of any severity, from any setting. We considered studies of cannabinoids administered by any route, at any dose, for any duration, compared with placebo, no treatment, or any active control intervention. Two review authors independently screened and selected studies for inclusion, extracted data, and assessed the risk of bias in included studies. When necessary, other review authors were involved in reaching consensus decisions. We included four studies participants in this review. Most participants had Alzheimer's disease; a few had vascular dementia or mixed dementia. Three studies had low risk of bias across all domains; one study had unclear risk of bias for the majority of domains. Primary outcomes in this review were changes in global and specific cognitive function, overall behavioural and psychological symptoms of dementia BPSD , and adverse events. All included studies reported data on adverse events. We judged the certainty of evidence for adverse event outcomes to be low or very low due to serious concerns regarding imprecision and indirectness. If there are benefits of cannabinoids for people with dementia, the effects may be too small to be clinically meaningful. Dementia is the name for a range of conditions associated with an ongoing loss of thinking ability, memory, and other mental abilities. Medical treatments for dementia are limited and confer modest benefits. However, there are continuing problems with their lack of efficacy, safety, and feasibility. Accordingly, new, safe, and more effective treatments are needed for dementia and its associated symptoms. The cannabinoids are one potential agent under investigation for the treatment of dementia. The purpose of this systematic review was to investigate whether cannabinoids could help people with dementia, and whether they have any potential harmful effects. We searched databases of scientific studies to find studies that had to randomly decide whether people would be treated with cannabinoids or a comparator. We combined the results of included studies to estimate the effects of cannabinoids. We also assessed how well these studies were conducted and how credible their results were. We searched for relevant studies that had been published up to June We found four trials that met the inclusion criteria for this review. A total of people were included in those four trials. Most participants had Alzheimer's disease, and a few had vascular dementia or mixed dementia. Trials used different types of cannabinoids. Studies reported that cannabinoids have little or no effect on memory and thinking. They reported different results regarding overall behavioural and psychological symptoms of dementia, based on the types of individuals who were reporting data. Family caregivers did not report a beneficial effect of cannabinoids on behaviour and psychological symptoms, but nursing staff reported improvement of symptoms among participants receiving cannabinoids. Harms were reported in all studies, among both participants taking cannabinoids and those taking placebo. However, we could not combine the total number of harmful events due to problems with data reporting. There was no significant difference between participants taking cannabinoids and those given placebo in the total numbers of harmful events belonging to nervous system disorders, psychiatric disorders, and gastrointestinal disorders. Sedation including lethargy was more frequent in participants taking cannabinoids, but these results were uncertain. We have very low confidence in these results because studies included a small number of participants, there were differences between the studies, and their results were uncertain. Based on data from four small trials of short duration, it is uncertain whether cannabinoids have any beneficial or harmful effects on dementia, compared to placebo. Even if the benefit reported in these studies is real, the effect was modest and may not be important to people living with dementia. Furthermore, available studies were very short, with efficacy examined over 3 to 14 weeks, and one study did not report its methods and results completely. Dementia is a common chronic condition mainly affecting older adults and characterised by a progressive decline in cognitive and functional abilities. It has been estimated that 47 million people worldwide were living with dementia in , and the number was projected to increase to more than million in due to population ageing ADI This disabling condition brings with it a significant burden to individuals and their carers, as well as a large financial burden for the health system Standfield , thus driving the need to identify effective therapeutic interventions. Medical treatments for dementia are limited, with an emphasis on managing symptoms. Licensed medications are available only for dementia due to AD and PDD, and these have only modest benefit for cognitive symptoms. At least half of patients with dementia will also experience behavioural and psychological symptoms BPSD such as agitation, aggression, psychosis, and circadian rhythm disturbances. These symptoms lead to significant caregiver stress Rabins , are distressing for the patient, and often precipitate placement in residential or nursing homes Steele Use of these drugs in dementia is associated with serious side effects including increased risk of cerebrovascular adverse events and death FDA ; MHRA ; Schneider Accordingly, new, safe, and more effective treatments for dementia and its associated symptoms. Multiple studies have indicated that patients have positive attitudes towards medical cannabis Banwell ; Gazibara There are three general classes of cannabinoids, including herbal cannabinoids phytocannabinoids that are derived from the cannabis plant Cannabis sativa , endogenous cannabinoids that are produced in bodies of humans and animals, and synthetic cannabinoids that are produced in a laboratory. Cannabis, also known as marijuana, is a preparation of the Cannabis plant. It is one of the most popular recreational drugs; an estimated million users used cannabis globally in , which roughly corresponds to 3. The use of cannabis is illegal in most countries. Although the general public may perceive cannabis as the least harmful illicit drug, there has been a noticeable increase over the past decade in the number of patients seeking treatment for disorders related to cannabis use UNODC Anxiety, drowsiness, euphoria, dry mouth, psychosis, dizziness, and diarrhoea are known adverse effects Whiting Research for medical use of cannabinoids has resulted in development and marketing of the synthetic cannabinoids dronabinol and nabilone. Nabilone is taken orally as a capsule. Daily dosage and route of administration depend on the indication Howard Nabilone and dronabinol are used as interventions for reducing vomiting associated with chemotherapy. A combination of cannabidiol and THC Sativex has been approved in several countries for treating spasticity in multiple sclerosis, and it is being studied for cancer pain. One cannabidiol drug Epidiolex has been studied for use in epilepsy. Many ongoing studies are exploring therapeutic targets for both cannabinoid receptor agonists and antagonists Kaur Cannabinoids exert their effect by acting at two specific cannabinoid receptors, CB1 and CB2, in the endogenous cannabinoid system Howlett ; Matsuda CB1 receptors are found throughout the central nervous system, particularly in the hippocampus, basal ganglia, and cerebellum. In contrast, CB2 receptors are expressed in peripheral tissues, especially on white blood cells, and are much less widespread in the central nervous system see Campbell for a review. Several demonstrated neurobiological effects of cannabinoids could be relevant for the treatment of dementia. The main function of the endogenous cannabinoid system ECS is thought to be regulation of synaptic transmission Baker ; this process can be disordered in many neurological conditions including dementia. The ECS consists of endogenous cannabinoids endocannabinoids , cannabinoid receptors, and enzymes responsible for synthesis and degradation of endocannabinoids Lu Endocannabinoids exert their actions mainly by acting on cannabinoid receptors CB1 and CB2 Gowran ; other receptors such as peroxisome proliferator activated receptors PPARs and transient receptor potential TRP channels also mediate certain endocannabinoid actions, especially of the acylethanolamides. CB1 receptors are found mainly in the central and peripheral nervous system, where they usually mediate inhibition of ongoing release of different neurotransmitters Szabo Activation of CB1 affects cognition and memory, alters control of motor function, and induces signs of analgesia Pertwee CB1 receptors regulate processes such as excessive glutamate production and subsequent oxidative stress, which can damage neurons and lead to neurodegeneration Grundy They are also found in peripheral tissues where they have a role in energy balance and metabolism Silvestri Some evidence suggests that CB2 receptors may be involved in neuroprotection by reducing neuroinflammation Ehrhart Neurodegeneration is a feature common to the various types of dementia; therefore the neuroprotective effects of cannabinoids may be beneficial in slowing progression of these diseases. Some trial authors have reported a significant reduction in CB1 levels in cortical areas and neurons distant from senile plaques Solas ; others have indicated that there are changes in the expression, distribution, and availability of CB1 in AD Ahmad ; Mulder According to Solas and colleagues, CB2 levels are significantly increased in the brains of people with AD, mainly on the microglia around the senile plaques Solas Cannabinoids may have more specific effects in Alzheimer's disease pathology, as they can reduce excitotoxicity, mitochondrial dysfunction, oxidative stress, neuroinflammation, and the formation of amyloid plaques and neurofibrillary tangles Ahmed ; Aso These studies suggest that cannabinoids could interrupt the disease process as well as treat symptoms in AD. However, cannabinoids also have known symptomatic effects, which may be of benefit in dementia. The most common neuropsychiatric symptoms NPSs in dementia, including depression, anxiety, agitation, aggression, wandering, pacing, sleep disorders, psychosis, and eating disorders, are associated with more rapid dementia progression and higher healthcare costs Beeri ; Tschanz A recent review indicated that findings from six studies show significant benefit from synthetic cannabinoids dronabinol or nabilone for agitation and aggression; however conclusions were limited by small sample size, short trial duration, and lack of placebo control in some studies Liu In another randomised controlled trial van den Elsen , oral THC 4. A recent retrospective systematic chart review suggested that administration of dronabinol improved sleep duration, food consumption, and agitation Woodward With increased life expectancy and increased numbers of people aged 60 years and older, the number of new cases of dementia is projected to rise. The need to offer effective and safe interventions to people with dementia is growing. We included participants of any age and of either sex with diagnosed dementia of any subtype or with unspecified dementia of any severity from any setting. Studies that included only a subset of relevant participants were included only if data for the population of interest were reported separately. Experimental interventions: cannabinoids administered by any route, at any dose, for any duration. Changes in global and specific cognitive functions, measured by any validated cognitive scale covering multiple cognitive domains or single cognitive domains e. Overall behavioural and psychological symptoms of dementia BPSD , measured with any validated instrument e. Changes in functional outcomes, such as activities of daily living ADLs , measured by validated tools such as:. Quantitative observational tools for measuring frequency of occurrence of wandering, agitation, and general restlessness. ALOIS is maintained by the Information Specialists of the Cochrane Dementia and Cognitive Improvement Group and contains studies in the areas of dementia prevention, dementia treatment, and cognitive enhancement in healthy individuals. Studies are identified from:. The search strategies used can be seen in Appendix 1. In addition, we contacted the first authors of two relevant trials to request details of any unpublished or current studies that might meet inclusion criteria for this review. We also examined the reference lists of retrieved articles to look for additional trials for inclusion. Two review authors independently screened titles and abstracts from all bibliographic records retrieved via the literature search to identify eligible studies. If it appeared from title and abstract that a study might be eligible, we obtained a full text of the report to make a decision. If available, we also obtained all errata and supplementary data for all full texts of studies eligible for inclusion. If necessary, we planned to translate full texts of reports that were not published in English, by employing a translation service. However, we did not find such studies. When we found multiple reports of the same study, we linked them together. Two review authors independently evaluated the full texts of relevant articles according to eligibility criteria. The review authors were not blinded to study data. We resolved possible disagreements via discussion and, if necessary, through involvement of a third review author. We listed justifications for exclusion of articles that were retrieved in full text. Two review authors independently extracted relevant data from the included studies. We resolved potential discrepancies via discussion and involvement of a third review author if necessary. In case of language ambiguity, we contacted researchers in the field familiar with the language in question. We used an electronic data extraction form, including source, eligibility, methods, participants, interventions, comparators, outcomes, results, and miscellaneous notes, according to the Cochrane Handbook for Systematic Reviews of Interventions Chapter 7. We also collected information on details of funding sources, declarations of interest of primary investigators, and methods used to control possible conflicts of interest. Two review authors independently piloted the form using two studies. The data extraction form was adapted thereafter, if necessary. For dichotomous outcomes from the same study, we extracted the number of events and the total number of participants for each outcome group at each time point. If we did not find the necessary data, we tried to complete them with the help of the primary study authors see the section Dealing with missing data. One review author entered the data into Review Manager 5 RevMan , and another review author checked the data for accuracy. When we found published protocols of eligible studies, we extracted data from ongoing studies, including study name, methods, participants, interventions, outcomes, starting date, contact information, and notes. However, during the conduct of the review, we did not encounter data that had to be extracted from figures. Two review authors independently assessed the risk of bias for each study, using the Cochrane 'Risk of bias' tool, according to the Cochrane Handbook for Systematic Reviews of Interventions Chapter 8. For all included studies, we described the risk of bias both in tables and narratively in text. We also provided an overall judgement about included studies in the 'Risk of bias' tables and the 'Risk of bias' charts. We analysed whether there was any information addressing the appropriateness of methods used to prevent undue industry influence during the clinical trial process. We considered ordinal outcomes only if we could justifiably treat them as a continuous variable, or if they could be sensibly dichotomised by combining adjacent categories. Given that there are no definitive guidelines for handling these measurements, we reported on our decision, which was reached in a discussion that involved at least two review authors. We did not identify any trial with multiple treatment arms. If data from a study were missing and could not be calculated using available data and statistics, we tried to contact the trial authors to complete the data. To contact study authors, we made at least two contact attempts via email or other potential means of contact over six weeks, checking for alternate contact information if the first attempt failed. In the case we were unable to retrieve the complete data, we reported this in the 'Risk of bias' assessment and addressed missing outcomes and summary data as a source of bias in data analysis. Whenever we had two or more studies in analysis, we measured and described heterogeneity of the treatment effect between trials using the I 2 statistic and the P value from the corresponding Chi 2 test. To minimise reporting bias, we planned in the protocol to include both published and unpublished trials. For detecting possible reporting bias, we planned to use a funnel plot and Egger's test for asymmetry, if enough more than 10 studies were available Egger However, due to insufficient numbers of trials identified, we did not make this assessment for possible reporting bias. When applicable, we compared conference abstracts and available trial protocols of included studies with published data. For data synthesis, we considered all listed primary and secondary outcomes. If types of participants, interventions, comparisons, and outcome measures used were very different between studies, we used only narrative interpretative synthesis of data for individual studies separately. We were planning to perform tests for heterogeneity using the Chi 2 test and the I 2 statistics within each of these groups. However, due to insufficient data, we were unable to perform these subgroup analyses. In the review protocol, we planned to conduct sensitivity analyses to explore the robustness of analyses. We also planned to use imputation methods in the sensitivity analysis to check for possible bias from missing data. We used the Grading of Recommendations Assessment, Development and Evaluation GRADE approach to assess the quality of evidence behind each of our effect estimates high, moderate, low, or very low quality Guyatt This rating indicates our confidence that the effect estimate is close to the true effect size, taking account of risk of bias, inconsistency between studies, imprecision in the effect estimate, indirectness with respect to our outcome of interest, and publication bias. Our searches, conducted by the Cochrane Dementia and Cognitive Improvement Group information specialists, yielded a total of records. From this, we identified 55 references for which we sought further information. We excluded 28 studies. See Figure 1 for the study flow diagram and Appendix 1 for additional details of the searches we performed. The characteristics of the four studies included in this review are summarised in the Characteristics of included studies table. All studies compared cannabinoids with placebo. The oldest study was conducted in the USA Volicer It enrolled 15 participants hospitalised in the Dementia Study Unit. Participants were diagnosed with AD, with duration of illness varying from 2 to 16 years, and, in most cases, with severe dementia. It enrolled 22 participants, but recruitment details were not provided. Within each block, Namisol 0. Among participants, 18 had AD, 1 had vascular dementia, and 1 had mixed dementia. A total of 24 participants were allocated in the Namisol group and 26 in the placebo group. Participants received Namisol 1. Among participants, 34 had AD, 7 had vascular dementia, and 9 had mixed dementia. Herrmann was conducted in Canada. It enrolled 39 participants with moderate to severe AD. Therapeutic dose was 1 to 2 mg per day. We excluded 28 studies as described in the Characteristics of excluded studies table. One study was excluded because randomisation was not reported, and results for the cannabinoid group were not reported separately from those for another intervention group Mahlberg We summarised the 'Risk of bias' results in Figure 2 and Figure 3 and Figure 3. For detailed assessment, please see the Characteristics of included studies table. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Random sequence generation: all studies were described as randomised; three studies reported adequate methods of randomisation and were judged to have low risk of bias Herrmann ; van den Elsen NCT ; van den Elsen NCT ; one study did not report a method of randomisation and thus was judged to have unclear risk of bias Volicer Allocation concealment: three studies used an adequate allocation concealment method and were judged to have low risk of bias Herrmann ; van den Elsen NCT ; van den Elsen NCT ; the remaining study did not report method of allocation concealment and thus was judged to have unclear risk of bias for this domain Volicer For three studies, we obtained detailed information about which groups of individuals were blinded Herrmann ; van den Elsen NCT ; van den Elsen NCT ; thus we judged these studies as having low risk of bias. In one study Volicer , of 15 patients enrolled, 11 patients completed both study periods. One patient who died of a heart attack two weeks before the end of the study while on placebo was also included in the analysis. It is not reported when participants who dropped out due to intercurrent infection terminated the study. We judged this study to have unclear risk of bias for this domain. Three studies had reported that the study protocol was published; we did not find differences between outcomes planned in those study protocols and outcomes reported in manuscripts Herrmann ; van den Elsen NCT ; van den Elsen NCT ; thus we judged them to have low risk of bias for selective reporting. Volicer did not report information about availability of the study protocol; thus we were unable to check whether there was selective reporting; we judged this study to have unclear risk of bias for selective reporting. We did not find other potential sources of bias. Thus, all studies were judged as having low risk of other bias. Two studies reported changes in global or specific cognitive functions Herrmann ; van den Elsen NCT This study found a mean difference MD between groups of 1. A minimum clinically important difference MCID of 1. However, the difference of 1. We judged the certainty of evidence to be very low due to indirectness and imprecision. We judged the certainty of evidence to be low due to imprecision and inconsistency. We conducted a subgroup analysis considering Herrmann as a separate subgroup because of differences in participants, interventions, and outcome measures Analysis 1. However, given the very small number of studies and the range of differences between them, it is not possible to draw conclusions about the origin of the heterogeneity. Again, this MCID is estimated in a single study and should not be taken as firmly established, but it is likely that neither the effect in the pooled analysis nor effects in either subgroup are clinically important. There were 45 adverse events with Namisol and 45 adverse events with placebo during Period B second period of six weeks. Herrmann did not report adverse events as 'mild to moderate. This study was terminated for 3 patients: 1 developed a grand mal seizure after the first dronabinol dose, and 2 developed a serious intercurrent infection. Study authors reported the exact P value of McNemar's test as 0. The frequency distribution of SAEs per individual and period that corresponds to this P value indicates that 1 person experienced an SAE during both nabilone and placebo periods. As such observation contradicts the definition of SAE participation in the study should be stopped after experiencing it , we decided we would not report this effect size. We considered the evidence to be of low certainty downgraded by two levels for imprecision: one small trial, and confidence interval crosses the line of no effect. Therefore we are uncertain of the effects of Namisol on nervous system event disorders as adverse events odds ratio OR 0. Evidence from van den Elsen NCT was considered to be of low certainty downgraded by two levels for imprecision: one small trial and confidence interval crosses the line of no effect. Therefore we are uncertain of the effect of Namisol on the rate of somnolence OR 0. We judged the certainty of the evidence as low downgraded by two levels for imprecision: one small trial and confidence interval crosses the line of no effect ; thus, we are uncertain of this result. We judged the certainty of evidence as low downgraded by two levels for imprecision: one small trial and confidence interval crosses the line of no effect ; thus, we are uncertain of this result. This study demonstrated on average little to no effect of Namisol on improving functional outcomes MD 0. We are uncertain about the effects of cannabinoids on functional outcomes low certainty; downgradeded by two levels due to imprecision because of one small study and confidence interval crossing the line of no effect. Comparison 1: Comparison: cannabinoids versus placebo, Outcome Changes in functional outcomes, Barthel Index. Pooled results OR 1. Thus, we are uncertain about the extent of the effect of cannabinoids on overall dementia severity. Comparison 1: Comparison: cannabinoids versus placebo, Outcome Minimal to marked improvement on dementia severity, assessed on the CGI Change scale. Overall, small to no difference in weight was found with cannabinoids compared to placebo MD 0. The observed difference was within the range that excluded any clinically important effect on weight. We are uncertain about the effects of cannabinoids on appetite low certainty; downgraded by two levels due to imprecision because of small studies and confidence interval crossing the line of no effect. This study demonstrated an increase in nutritional status MD 0. We considered that this was not a clinically important effect. Cannabinoids likely result in little to no difference regarding nutritional status. We considered the results to be of low certainty due to imprecision downgraded by two levels for imprecision because of one small study and confidence interval crossing the line of no effect. However, the only study that did not apply the ITT principle in analysis was largely underpowered to confidently detect or exclude a small or large clinically important effect, or no effect. We considered the results of low certainty due to imprecision downgraded by two levels for imprecision because of one small study and a large confidence interval crossing the line of no effect. Thus, we are uncertain about the extent of the effects of cannabinoids on agitated or aggressive behaviours. However, on this measurement scale, one could not exclude that cannabinoids may have little clinically important effect or no effect. We judged the certainty of evidence as moderate downgraded by one level for imprecision due to small studies. Cannabinoids likely result in little to no difference in this outcome. Except for one study that used the Lawton Observed Affect Scale to evaluate mood in patients after receiving dronabinol or placebo Volicer , no other study assessed this domain. However, data were not adequately reported so that variability of scores could be estimated, and data were not used for quantitative analysis. Carer ratings of patient sleep using sleep diaries or validated observer scales. We considered the results of low certainty downgraded by two levels for imprecision because of one small study and confidence interval crossing the line of no effect. Any other symptoms associated with dementia e. Two studies analysed the effects of administering cannabinoid agents to dementia patients on caregiver burden using different measurement scales. Thus, we calculated the standardised mean difference. The other two studies were substantially underpowered for this outcome. This resulted in a largely uncertain pooled estimate OR 1. Because these studies were substantially underpowered for mortality, the resulting pooled estimate was uncertain OR 0. We considered the results of low certainty downgraded by two levels for imprecision because of one small study and wide confidence interval crossing the line of no effect. Based on our summary data, it is uncertain whether cannabinoids can have beneficial or harmful effects for people with dementia, compared to placebo. For few outcomes suggesting a positive effect of cannabinoids, the effect possibly ranged from a small effect that is not clinically meaningful to a large, clinically important one. Included studies were underpowered, heterogeneity among them was considerable, and their results were inconsistent. The summary effect sizes reported were often smaller than what is considered the minimum clinically important difference for the relevant scale. Because the included studies used different types of cannabinoids, different dosage and frequency, and different duration of administration of cannabinoids, and because they did not report data for relevant subgroups e. For example, only one study reported data on patients' quality of life, and two studies reported data on caregiver burden. Reporting data for adverse events was inconsistent, and we could not always use them in summary analyses. Thus, the data identified from the four included trials cannot be considered complete for relevant outcomes. Most of the included participants had Alzheimer's disease AD. Thus, the results of this review are not necessarily applicable to individuals living with other types of dementia. Although some of the included participants had mild dementia and were recruited from a community setting, most participants had moderate to severe dementia, which often requires institutionalisation. Thus, study findings may not apply to all individuals living with dementia. Thus, the evidence may not apply to other settings. Dementia care is different across international settings, and some of the treatments used routinely in the included studies are not recommended or are not available in all healthcare systems. The fourth study, Volicer , did not report enrolment dates but was published more than 20 years ago. Best practice in dementia care is changing over time, and the generalisability of studies that are decades old is questionable. All interventions in the included studies were oral cannabinoid medicines; thus, results of this review may not apply to other routes of cannabinoid administration. Thus, we have a lot of uncertainty about their results. Using GRADE methods, we judged the certainty of evidence for primary outcomes to be low or very low due to risk of bias, inconsistency, indirectness, and imprecision of results. We adhered to the recommended Cochrane search and review methods; thus we consider that we have identified all data of interest to the review question. In , Walther and Halpern published a review of clinical and preclinical data on cannabinoid use in different neurodegenerative diseases, including AD. Despite the possible therapeutical potential of cannabinoids in the in vitro studies, review authors found scarce clinical data for the use of cannabinoids in AD. A review of Liu et al. Review authors included letters, case studies, and controlled trials from four electronic databases. Out of these six studies, five were excluded from our review: three were not RCTs Passmore ; Walther ; Woodward , one was a prematurely finished RCT with 2 participants Walther , and for one, randomisation was not reported and results were not reported separately for the dronabinol group Mahlberg Current and novel treatments for pharmacological management of agitation and aggression in AD included cannabinoids as one group of those promising novel treatments reviewed by Liu et al. Out of the six studies mentioned in the review, we excluded four Passmore ; Walther ; Walther ; Woodward The review highlighted that although no large RCTs had tested cannabinoids for treating agitation in AD, the results of available individual case reports and small studies suggested that cannabinoids may be a potentially useful intervention, acting on an alternative pathway in which to target symptoms, such as agitation and aggression, associated with AD Liu In , Lim et al. This review included four RCTs investigating cannabinoids dronabinol, Namisol in dementia, one of which we excluded as prematurely terminated Walther They urged that new trials in this field are needed, so that cannabinoids can be seriously considered as an alternative to current pharmacotherapies for treating symptoms of dementia Weier et Hall A review of the effect of cannabinoids on neuropsychiatric symptoms, pain, and weight loss in dementia was published in by Sherman et al. This review included seven studies and one case report. Of these, four were excluded, as they were not RCTs Mahlberg ; Passmore ; Walther ; Woodward , and one was prematurely finished Walther Review authors found that the included studies had small sample sizes and included various clinical populations. They concluded that their findings suggest that cannabinoids may be well tolerated and effective for the treatment of neuropsychiatric symptoms such as agitation, as well as weight and pain management, for patients with dementia. However, the review authors also concluded that additional studies are needed to elucidate further the relative risks and benefits of cannabinoids for dementia Sherman Their findings indicate that THC for the treatment of agitation has been consistently negative; results with synthetic cannabinoids were inconclusive due to substantial heterogeneity. Review authors warned that the safety of cannabinoids should be closely monitored, as they are associated with increased sedation Ruthirakuhan Of these six studies, two were excluded from our review: one was a prematurely finished trial with two participants Walther , and the other did not report randomisation Mahlberg In the systematic review assessing the safety and effectiveness of cannabinoids for treating neuropsychiatric symptoms in dementia, Hillen et al. Of the six included studies, we excluded one as a prematurely ended trial Walther , and three were published manuscripts from a single RCT van den Elsen NCT Hillen et al. Although the only RCT with low risk of bias did not show better efficacy of cannabinoids compared to placebo van den Elsen NCT , review authors report that some of the observational studies had promising results. Taking into account the use of low doses of oral cannabinoids and the favourable safety profile with only mild adverse events reported in the included studies, review authors suggested that higher doses of cannabinoids and different drug formulations should be used in future trials Hillen Peprah and McCormack conducted a review of clinical effectiveness and guidelines on medical cannabis for dementia in , including results from one previous systematic review Hillen , as well as from one prospective observational pilot study Broers In , Bahji et al. Of the six included RCTs, we excluded one as prematurely finished Walther , along with one that reported no randomisation methods, without separate results for dronabinol and melatonin groups Mahlberg The overall quality of included studies was judged as low. Review authors concluded that there is preliminary evidence for the efficacy and tolerability of cannabinoids as interventions for NPS. In , Charenbron et al. Review authors recommended that more studies are needed to clarify further and to better assess the benefits of cannabinoids for dementia. The review concluded that it may be too early to postulate that cannabinoids have any effect on dementia symptoms or on their progression Charenbron Based on this review, we can offer some guidance for future RCTs on cannabinoids for dementia. Future studies should:. We would like to acknowledge the work of the authors of the previous version of this review, Sarada Krishnan, Ruth Cairns, and Robert Howard. We are very grateful to Prof. We would like to thank peer reviewers Joanne Ryan and Sebastian Walther and consumer reviewer Cathie Hofstetter for their comments and feedback. We are particularly grateful to Ms. Thanks to Ms. Candida Fenton and Ms. Livia Puljak is forever very grateful to Ms. Camillia Mamic and Mr. Branko Mamic for their support during her training. Availability of an informal or formal caregiver, who is in touch with the patient at least twice a week. Change in dosage of antipsychotics, benzodiazepines, or cholinesterase inhibitors within 2 weeks before intervention. Adverse events, blood pressure, heart rate, weight, body composition using a scale to measure lean body mass, bone mass, and fat mass. Acceptability: to investigate acceptability of the randomisation procedure and delivery of the intervention CBD or placebo in capsule form to AD patients and carers recruitment rates. To investigate acceptability of the questionnaires used to measure key outcome domains percentage of completion rates. Qualitative interviews: to explore participants' experiences of taking part in the trial including what encouraged them to take part, their views on the intervention, and how they are finding the trial in general. To explore rates of recruitment and retention in the target population, including determining facilitators and barriers. To investigate acceptability of an oral mucosal method of administration for this indication in terms of compliance and for care home staff in terms of adherence to the titration schedule. To explore actigraphy data for sleep, physical activity, and linked to NPS assessments exploratory analyses. Scores range from 0 to points, with higher score indicating worse outcome. The original protocol for this review was published in , and the first version of the review was published in Krishnan The following changes to the review methods compared to the original protocol were made to bring them in line with current Cochrane recommendations:. The protocol now specifies updated references for diagnostic criteria that will be used for dementia. The new version of the protocol updated primary and secondary outcomes, specifying that validated measures for primary outcomes will be analysed, and that biomarker outcomes will not be included. All references will be managed using EndNote software. A process for screening studies and resolving disagreements has been now described in detail. This section was rewritten extensively. This section was added. Use of the Cochrane RoB tool was described. When only a small number of studies are available, such estimation is often inaccurate and results in biased effect estimates and too narrow confidence intervals. Given that the statistician AJ joined our team after submission of protocol, the effect model was introduced into analysis at the level of the full review. All authors contributed to searching the relevant literature, providing intellectual content, and writing the updated version of the protocol. All authors approved the final version of the protocol. LP coordinated the review process, arbitrated screening and data extraction decisions, performed GRADE analysis, and contributed to writing of the review. As a library, NLM provides access to scientific literature. Cochrane Database Syst Rev. Find articles by Dina Bosnjak Kuharic. Find articles by Domagoj Markovic. Find articles by Tonci Brkovic. Find articles by Milka Jeric Kegalj. Find articles by Zana Rubic. Find articles by Ana Vuica Vukasovic. Find articles by Ana Jeroncic. Find articles by Livia Puljak. Collection date This article is an update of ' Cannabinoids for the treatment of dementia ' in volume , CD High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. Open in a new tab. Source Search strategy Hits retrieved 1. Outcome or subgroup title No. In Week 1, participants received 0. During the last 4 days of Week 6, doses were tapered down to reduce the risk of potential withdrawal. On Days 6 and 7 of Week 6, participants received 0. The placebo phase followed the same dosing structure as was described for the nabilone arm. Quote: 'patients, family members, nurses, clinicians, outcome assessors, and investigators were blinded to treatment allocation and block size' Based on communication with the principal investigator, the following additional information was obtained, indicating that an adequate method of allocation concealment was used sequentially numbered, opaque, sealed envelopes. No emergency unblinding was done. Allocation code was only released from the Pharmacy once all other data entry was completed and verified, and the database was locked. Quote: 'study staff were unblinded only when the final patient completed all study assessments and the database was locked. Unblinding during the study was permitted only in exceptional clinical circumstances i. Quote: 'patients, family members, nurses, clinicians, outcome assessors, and investigators were blinded to treatment allocation and block size. Nurses, clinicians, outcome assessors, and investigators were blinded to treatment allocation. Therefore, 38 participants were included in the statistical analyses. Out of 38 participants, two died before study completion, and nine were terminated early due to serious adverse events five during the nabilone phase and four during placebo phase. Selective reporting reporting bias Unclear risk The study protocol was registered at www. All outcomes mentioned in the study protocol were reported. Other bias Low risk Other sources of bias were not found. In the manuscript Ahmed, , the total number of participants analysed was 10, mean age Baseline characteristics : Patients with dementia and clinically relevant NPS. Each group consisted of 11 patients. Supervision : Primary caregiver, investigator. Adherence : High; The other authors have no disclosures to report. Trial registration : ClinicalTrials. Treatment allocation was done on basis of eligibility of the subject and subject numbers were assigned at that moment. In other words, after screening each eligible subject received a subject number in consecutive order, starting with the lowest number available. Allocation was only present at this pharmacist, who was only contacted again after closing of the trial master file en the data acquisition and registration in Castor and after the analyses plan was agreed on. Other bias Low risk Other sources of bias not found. We consider the washout period to have been adequate for the avoidance of carry over effects. For the purposes of safety assessment and compliance, several phone calls were performed by researchers during the intervention period Days 2, 7, and All were assessed at baseline and at Day The Investigation Medical Product was provided by Echo Pharmaceuticals, Weesp, The Netherlands, which did not provide financial support for the study and had no role in study design, collection, analysis or interpretation of data, or writing the report' Declaration of interest : G. Ahmed, R. Verkes, and C. Kramers report no disclosures relevant to the manuscript. Feuth was supported by a grant from the European Regional Development Fund for the conduct of the study. Rosenberg reports no disclosures relevant to the manuscript. Olde Rikkert reports no disclosures relevant to the manuscript Trial registration Number of protocol at ClinicalTrials. In other words, after screening, each eligible subject received a subject number in consecutive order, starting with the lowest number available. Allocation was present only through this pharmacist, who was contacted again only after closing of the trial master file on the data acquisition and registration in Castor and after the analyses plan was agreed on. Attrition was small in both groups. Data from all subjects were used without imputation. Selective reporting reporting bias Low risk The study protocol was registered at www. All outcomes mentioned in the study protocol NCT were reported. The extent of disturbed behaviour exhibited by each patient was determined each week by interview with primary caregivers who were familiar with patients' behaviour and with rating scales Adherence : nurses gave the therapy on a daily basis to every patient. Declaration of interest : not reported Trial registration : not reported Risk of bias Bias Authors' judgement Support for judgement Random sequence generation selection bias Unclear risk It is indicated that participants were randomised, but the method of randomisation was not reported. Allocation concealment selection bias Unclear risk Not reported. It is not reported when participants who dropped out due to intercurrent infections terminated the study. Selective reporting reporting bias Unclear risk Information regarding the study protocol was not reported. We could classify this as a pair of case reports. Each Avidekel oil drop is approximately 0. Full study report is not yet available; thus the study cannont be assessed presently. During the second treatment cycle, those who took medicinal cannabis oil Arm 2 in the first treatment cycle will take placebo Arm 1 during the second treatment cycle and vice versa. The mode of administration will be an oral spray. The dose will be increased from 2. The dose will be increased approximately every 3 days, and on the days the dose has been increased, the resident will record the presence of any adverse events 1 hour after the dose has been administered. Latha Velayudhan; latha. In case of side effects, current dosage will be reduced to the previous one. Primary caregiver must be sufficiently proficient in English to complete required study assessments, as per investigator judgement Exclusion criteria: change in psychotropic medications less than 1 week before study randomisation e. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Comparison: cannabinoids compared to placebo for the treatment of dementia. Sept 47 Jul 22 Jul 14 11 June 21 8 July Sept Jul 40 Jul 49 11 June 50 8 July Sept Jul Jul 11 June 8 July Sept Jul 12 Jul 9 11 June 8 8 July Sept 40 Jul 11 Jul 14 11 June 8 8 July Sept Jul 27 Jul 31 11 June 45 8 July Sept 0 Jul 0 Jul 0 11 June 0 8 July 1. Sept 40 Jul 13 Jul 8 11 June 8 8 July Sept Jul 9 Jul 14 11 June 0 8 July 8. Sept Jul 0 Jul 4 11 June 6 8 July Quote: 'a block randomization code was independently computer generated by the institutional Pharmacy Department. Study authors reported that allocation was concealed, but they did not report the exact method of allocation concealment in the text of the published manuscript. Assessment was performed by trained study staff. Out of 39 enrolled participants, one discontinued the study during the first week placebo due to clinically significant delusions. The study protocol was registered at www. Other sources of bias were not found. Funding : Funding was provided by the European Regional Development Fund ERDF and the Province of Gelderland, which both had no role in study design, collection, analysis, interpretation of data, nor writing the report. Quote: 'The randomization codes were generated by an independent pharmacist, using a computer algorithm for random numbers. In the published article, the authors reported that allocation was concealed, but they did not report exact method of allocation concealment. Quote: 'The causality was assessed by a research physician, blinded to treatment allocation. Quote: 'All participants completed the study as scheduled. The study protocol was registered on www. Other sources of bias not found. Location : Netherlands Participants were recruited from 9 participating institutes throughout the southeast of The Netherlands. Allocation concealment was not mentioned in published reports about the trial. Not reported in the published reports. Upon contact with investigators, we received the following information: 'all outcome assessors were strictly blinded for the treatment allocation, as none was in contact with the pharmacy on the allocation'. This administration schedule was a modification of that recommended for AIDS patients because DAT patients usually eat most of their daily food during breakfast and lunch. Declaration of interest : not reported Trial registration : not reported. It is indicated that participants were randomised, but the method of randomisation was not reported. Four participants dropped out; at 10 weeks: one participant in the placebo group who died before the end of the study; in the dronabinol group, one who developed a grand mal seizure after the first dronabinol dose and two who developed serious intercurrent infections. Information regarding the study protocol was not reported. Amanullah Aragona Assogna Boxer Broers Caldentey Chagas Consroe Curtis Euctr Ghaffar Not an RCT; not a dementia patient sample consecutive study with patients with multiple sclerosis. Kahraman Libro Mahlberg Randomisation not reported; data not reported separately for melatonin and dronabinol groups. NCT Noonan Passmore Scotter Not an RCT review of endocannabinoid system in neurodegenerative diseases. Shelef Solowij Stone Walther This is a failed trial that trial authors discovered they were unable to recruit to. The manuscript describes data for 2 participants only. Wilhelm Woodward Intervention: 'Avidekel' cannabis oil Comparator: placebo Intervention delivery: cannabis oil will be made out of extract from the Avidekel strain and olive oil. Location : University of Notre Dame, Australia Geographical area : Australis Age : 65 years and older Sex : all Inclusion criteria : living within a residential aged care facility; aged 65 years or older; diagnosis of dementia; ability to speak English; known compliance to taking medication; not bedridden Exclusion criteria : to minimise the likelihood of an adverse event, people with certain health conditions or on some medications will be excluded from the study. Taking medications that may interact with cannabis metabolism such as primidone, phenobarbital, carbamazepine, rifampicin, rifabutin, troglitazone, Hypericum perforatum , valproic acid. Primary outcome objective and measures Change in total NPI Neuropsychiatric Inventory between the 2 consecutive scores per treatment block score placebo minus score on THC Secondary outcome objectives To evaluate efficacy on secondary characteristics e. Intervention: cannabidiol, capsule, concentration range to mg Comparator: placebo, capsule. King's College London; Dr. King's College London; Chris Albertyn; chris. Intervention: dronabinol Marinol Comparator : placebo Intervention delivery: capsules of dronabinol will contain 2. Residing in a nursing home. Participants n the placebo group will receive oral placebo gelcaps that are identical in appearance to CBD oil gelcaps, with identical dosing as in the CBD oil gelcaps group. Number of protocol on ClinicalTrials. Pariticpants in the placebo arm will receive placebo capsules.

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