Cognitive dysfunction affects 50% of patients with MS and affects daily activities in 5% to 10%. Several studies have shown that patients with MS who smoke cannabis have more severe cognitive difficulties than those who do not, in particular affecting working memory, information processing speed, and executive dysfunction. A new study published in Neurology May 27, 2014, consisted of 20 subjects, smoking cannabis daily or 4 to 5 times. They were trying to treat pain, spasticity, insomnia, anxiety. Several smoked for recreation. There were no structural differences on MRI from a matched group who did not smoke. There were, however, significant differences in cerebral activation in the smokers on functional MRI. No subject was intoxicated at the time of the evaluations. Patients with MS show increased activity on functional MRI as cognitive tasks become more complex. These compensatory efforts can fail. This seems to be the reason that smoking cannabis affects cognitive function. It is not known if this activation pattern would improve or how long it would take if patients stopped smoking.

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Dr. Jack Florin

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