Dronabinol for Agitation in Dementia Crossover Trial

The goal of this clinical trial is to study the effects of dronabinol in US Veterans with agitation related to moderate to severe dementia. The main goals of the study are:To evaluate the efficacy of dronabinol for the treatment of agitation in moderate to severe dementia compared to placeboTo evaluate the safety of dronabinol in the treatment of agitation in moderate to severe dementia compared to placeboFifty (50) subjects will be given either dronabinol or placebo for 8 weeks. All subjects will then undergo a "washout" phase for 3 weeks, followed by the crossover intervention (i.e. subjects who received placebo during the first phase will receive dronabinol during the second phase, and vice versa). Thus, all participants will be taking dronabinol at some point during the study. During the study, subjects will undergo evaluations for:AgitationCognitive changesPhysical changes (i.e. labs, ekg, physical exam)

Inclusion Criteria:US Veteran who is not pregnant or unable to become pregnantDiagnosis of Major Neurocognitive Disorder (aka dementia) of any typeFunctional Assessment Staging Test (FAST) score of 5 or higherPresence of clinically significant agitation and/or irritability with an NPI subscale score greater than or equal to 4If treated with cholinesterase inhibitors or memantine, dosage must be stable for 3 months, or if discontinued they may enroll after 1 monthMust be able to swallow capsulesMust meet International Psychogeriatric Association's provisional definition of agitation in dementia.Must have decisional capacity to sign informed consent or have a legally authorized representative available to provide consentMust have an available study partner who spends at least 10 hours per week with the subject.Exclusion Criteria:Psychotropic medication changes (i.e. concomitant antidepressants, antipsychotics) less than 1 month prior to study randomizationContraindications to dronabinol (hypersensitivity or allergy to any cannabinoid or sesame oil)Use of cannabinoids (including over the counter products such as "CBD" or medical cannabis) or other illicit drugs in the past 3 monthsHistory of psychotic symptoms due to another psychiatric illness other than dementia int he past 2 years.Unstable current psychiatric disorder or neurologic condition (i.e. unstable depression, bipolar disorder, epilepsy, etc.) other than agitation or psychosis due to dementia.Suicidal ideations in the past 3 months or attempts in the past yearClinically significant delusions and/or hallucinations which are considered by the PI's to be a contraindication for dronabinol useTaking 1 or more medications which in the judgement of the PI's can be contraindicated with the use of dronabinolUnstable or uncontrolled medical conditions including cardiovascular system issues (i.e. angina, cardiac arrhythmias, recurrent syncope, hypertension, etc) as judged by the PI's.