Course Title: Session A: Looking Behind the Smokescreen: Cannabis, Cognition and Multiple Sclerosis

Credit Hours: 1.0

Instructor(s) Anthony Feinstein, MPhil, PhD, FRCP

Looking Behind the Smokescreen: Cannabis, Cognition and Multiple Sclerosis

Abstract & Learning Objectives

Multiple sclerosis may impair cognition in 40-70% of patients depending on the disease course.  The deficits are typically those of information processing speed, working memory and executive function. An estimated 14-18% of MS patients smoke or ingest cannabis for help with pain, spasticity and insomnia. Given concerns that cannabis may impair cognition in healthy subjects the use in patients with MS begs the question of whether it may further compromise cognition. There are a paucity of data that address this, but findings from three studies will be presented suggesting that regular cannabis smoking is associated with greater cognitive impairment in MS patients. fMRI and structural MRI data from one these studies that underpin the cognitive findings will also be presented. As with any medication, it is important for those who use it or prescribe it that the benefits and risks be weighed. This is starting to take place with cannabis and MS but more data are needed to inform the discussion.

Anthony Feinstein, MPhil, PhD, FRCPC

Anthony Feinstein, MPhil, PhD, FRCPC

Professor, Department of Psychiatry
University of Toronto

1.    To appreciate the prevalence and implications of cognitive dysfunction in MS.
2.    To gain an understanding of how cannabis may further influence the cognitive changes seen in MS.
3.     To understand how functional and structural brain changes may account for cognitive changes linked to cannabis use.

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Speaker Biography

Dr. Feinstein received his medical degree in South Africa at the University of the Witwatersrand. Thereafter he completed his training in Psychiatry at the Royal Free Hospital in London, England, before training as a neuropsychiatrist at the Institute of Neurology, Queen Square in London. His Master of Philosophy and Ph.D. Degree were obtained through the University of London, England. He is currently a Professor of Psychiatry at the University of Toronto.

His neuropsychiatry research focuses on the search for cerebral correlates of behavioral disorders associated with multiple sclerosis, traumatic brain injury, and hysteria (Conversion Disorders). He is currently Chair of the Medical Advisory Committee of the MS Society of Canada.

Dr. Feinstein is also involved in a series of studies of relevance to current issues within our society. The questions being addressed are: How are journalists affected emotionally by their work in zones of conflict and what motivates them to pursue such dangerous occupations?

In 2000-2001 he was awarded a Guggenheim Fellowship to study mental health issues in post-apartheid Namibia. This led to the development of that country’s first rating scale for mental illness. Subsequent work in Botswana produced that country’s first rating scale for mental illness as well.

Dr. Feinstein is the author of Dangerous Lives: War and the Men and Women Who Report It (Thomas Allen, Toronto 2003), In Conflict (New Namibia Books, 1998), The Clinical Neuropsychiatry of Multiple Sclerosis (Cambridge University Press 1999, with a second edition in 2007), Michael Rabin, America’s Virtuoso Violinist (Amadeus Press, 2005, with a second edition in 2011) and Journalists Under Fire: the Psychological Hazards of Covering War (John Hopkins University Press). His most recent book is Battle Scarred (Tafelberg Press, 2011). He has published widely in peer-reviewed journals and has authored many book chapters.

In 2012, a documentary, “Under Fire” produced by Dr. Feinstein and based on his research of journalists in war zones was shortlisted for an Academy Award. The documentary received a 2012 Peabody Award.