Clinical Depression as Risk Factor for Alzheimer’s Disease

Overview

Clinical Depression and Alzheimer's disease have a lot in common and share a complex relationship. Depression -- a mental disorder caused by chemical imbalances in the brain -- can include symptoms that look like Alzheimer's, such as concentration problems, memory impairment, and difficulty making decisions. When depression looks like Alzheimer's disease or another dementia, it's often referred to as pseudodementia. It's treatable, but relapse is a significant concern. Depression and Alzheimer's disease can also occur together, where each disorder requires treatment that doesn't interfere with the treatment of the other condition. This is another complex diagnostic and treatment situation.

Traditional science admits that Depression is one of the multiple symptoms, associated with Alzheimer’s Disease (AD). However, new research data show a different causal relationship between these two disorders. Clinical depression might be a substantial risk factor for AD.

Study from Rush University Medical Center (2008)

Investigators from Rush University Medical Center sought to determine if depressive symptoms actually contribute to the development of dementia (risk factor hypothesis) or are a consequence of the disease (reverse causality hypothesis.) The research emanates from numerous observational studies that show higher levels of depressive symptoms in old age are associated with increased incidence of Alzheimer’s disease and mild cognitive impairment.

Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center, and colleagues examined data from the Rush Religious Orders Study, a cohort of 917 older Catholic clergy without dementia at study onset, to examine the change in depressive symptoms of Alzheimer’s disease before and after the emergence of the cognitive symptoms of the disease.

For up to 13 years, the study participants underwent annual clinical evaluations that included assessment of depressive symptoms, cognitive testing, and clinical classification of mild cognitive impairment (MCI) and Alzheimer’s disease. During the study period, 190 participants developed Alzheimer’s disease.

Consistent with earlier findings in the Rush Religious Orders Study, having more depressive symptoms at baseline was associated with increased incidence of Alzheimer’s disease and MCI.

However, the study found that those who developed Alzheimer’s disease showed no increase in depressive symptoms before clinical diagnosis. Researchers were able to observe patients during a mean of approximately four years before the onset of dementia. Additionally, researchers saw no increase in depression during the three to four years preceding the onset of MCI, which antedates the onset of dementia by several years.

“If depressive symptoms are a consequence of dementia or a reaction to declining function, depressive symptoms would likely increase at some point before dementia is clinically evident,” said Wilson. “We observed no such increase.”

The study also found that even after the diagnosis of Alzheimer’s disease was made there was no general increase in depression, but rather an increase that was confined to individuals with certain personality traits.

“Depressive symptoms may be associated with distinctive changes in the brain that somehow reduce neural reserve, which is the brain’s ability to tolerate the pathology associated with Alzheimer’s disease,” said Wilson.

Study from University of Massachusetts Medical School (2010)

The study, headed by epidemiologist Jane Saczynski of the University of Massachusetts Medical School, used data from the famous Framingham Heart Study to track depression and dementia in 949 people over 17 years.

At the beginning of the study, none of the participants had any dementia symptoms; by the end, 136 had developed Alzheimer's and 28 had other dementias. Of those who had depressive symptoms at the beginning of the study, 21.6 percent later developed dementia, compared with 16.6 percent of non-depressed individuals. After controlling for factors like smoking and genetics, the researchers found that depression raised the risk of later dementia by 50 percent.

The long time frame makes it less likely that the participants already had dementia-related damage at the beginning of the study, Saczynski said. And because the depression showed up so much earlier than the dementia, the study, like Wilson's, supports the notion of depression as a dementia risk factor, not a symptom.

Exactly how a mood disorder like depression can contribute to Alzheimer's disease isn't currently clear, but the effect is probably cumulative.

One theory, Saczynski said, is that depression weakens the body's defenses against dementia by affecting the brain's blood supply. Cardiovascular disease (another risk factor for Alzheimer's) and depression are often clinically linked, Saczynski said, perhaps because of reduced blood flow to the brain. These vascular changes might render the brain more vulnerable to Alzheimer's-related damage. Another possibility is that the chronic stress of depression changes the brain's structure.

Study from Erasmus Medical Center (2008)

Dr. Breteler published her study in the April 2008 issue of Neurology when she worked at the Erasmus Medical Center in the city of Rotterdam in the Netherlands. During the study she followed 503 non-demented persons aged 60-90 over a period of 6 years to chart the association, if any, between depression, the development of Alzheimer’s disease and hippocompal volume. She used three-dimensional MRI scans to quantify the size of each study participant’s hippocampus. Prior to the study 88 participants developed depression before age 60 and 46 participants developed depression after age 60. None of these people showed hippocampal atrophy (i.e. shrinkage of the hippocampus) at the outset of the study.

During the course of the study 33 people developed Alzheimer’s disease. Statistical analysis showed that people with a history of early onset depression (before age 60) had a 3.76 times greater chance of developing Alzheimer’s than non-depressed participants, whereas people with late onset depression (after age 60) had an increased risk of 2.34 over non-depressed participants. People who developed depression during the study showed no increased risk of developing Alzheimer’s.

Dr. Breteler concluded that depression is clearly a predictor of Alzheimer’s disease but not necessarily a cause and it’s possible there is a single as-yet-unknown mechanism in the brain which causes both problems. Dr. Breteler said that if Dr. Wilson’s theory that depression shrinks the hippocampus before onset of Alzheimer’s was correct she would have expected to find decreased hippocampal volume in the depressed patients at the study outset, but she didn’t find this, since the study participants all had hippocampal volume within normal range. She also said that if depression causes Alzheimer’s the people who first experienced depression during the study should have higher rates of Alzheimer’s than the normal population. 

Conclusion

So, who is right: Dr. Wilson and Dr. Saczynski, claiming that depression constitutes a big risk for the AD development later in life, or Dr. Breteler, who did not find this causal relationship? It is probably subject for additional research and multiple longitude studies. However, one thing is obvious. If you have depression – do not let it be. Seek for medical assistance promptly and fight with it by all available means. Not only you make your life miserable, but you also may step forward towards the greater risk of developing AD.

Sources and Additional Information:

http://alzheimers.about.com/od/whatisalzheimer1/f/depriskfactor.htm

http://psychcentral.com/news/2008/04/08/depression-as-risk-factor-of-alzheimers/2130.html

http://www.livescience.com/9977-depression-increase-chances-alzheimer.html

http://lawyerswellbeing.com/blog/?p=380

Self-Administered Screening Tool for Alzheimer’s

Alzheimer's Disease (AD) is a disease that affects many people over the age of 50. Characterized by memory loss, loss in reasoning and decision-making ability; it affects not only the victim, but also friends and relatives.

The TYM (Test Your Memory)test is a new cognitive test comprising of 10 tasks presented on 2 sides of a single sheet of soft card. Most people take about 5 minutes to complete the TYM. The test can be completed under supervision from a health professional. The maximum score is 50/50.

This test is very easy to do but it is worthwhile noting that this test is not a concrete Alzheimer’s test. You will still have to seek medical advice for an accurate diagnosis. However, this self-administered test could represent a very efficient way for early diagnosis of Alzheimer’s disease. The 10-task test appears to be even more sensitive in picking out the early disease symptoms, comparing with standard Alzheimer’s test, according to results of the new scientific research.

Summary

Early diagnosis of Alzheimer’s disease is important and the mini-mental state examination (MMSE) is the standard way of detecting the condition. But a new study from Cambridge, UK, suggests that there might be a better way, with a simpler test. The study compares the self-administered cognitive screening test (TYM, or ‘test your memory’) with the MMSE and finds it performs better.

Introduction

The main symptom of Alzheimer’s disease is decline in memory, although other cognitive deficits are also important. Although there is no cure for Alzheimer’s disease, as yet, there are treatments and interventions that may delay the progress of the condition. That is why earlier and more accurate diagnosis is so important.

What was done?

Researchers at Addenbrooke’s Hospital, Cambridge, UK, devised and evaluated a new test called TYM (Test Your Memory). It is a series of ten tasks including the ability to copy a sentence, knowledge of words and their meaning, calculation, verbal fluency and recall ability. The ability to carry out the test is also noted. Each of the tasks has a score and the total for the TYM test is 50 points. The researchers had a group of 540 healthy individuals aged 18 to 95 years carry out the test. They also tested 139 patients with either Alzheimer’s disease or mild cognitive impairment. The test was compared to the MMSE and another standard test called the Addenbrooke’s cognitive examination.

What was found?

The healthy controls completed the test in an average time of five minutes. Their average score was 47 out of 50. Those with Alzheimer’s had a lower average score of 33. Those with mild cognitive impairment scored an average of 45. Average performance was constant between ages 18 and 70, with a small decline after this age. Scores did not vary between men and women or with geographical location, suggesting the socioeconomic factors might have only minor impact on the results. The TYM could detect 93% of those with Alzheimer’s disease while the MMSE detects only 52% of those with the condition.

What this study means?

The TYM is faster to administer than MMSE and does not need highly qualified people to do so. It is also more accurate and tests a wider range of cognitive abilities. The Addenbrooke’s test is also more sensitive than MMSE, but takes longer to administer. Therefore, the TYM looks very promising, but it now needs to be validated in a wider range of clinical settings.

The TYM Features

The average TYM score for normal individuals is 47/50 up until the age of 70 years and then there is a small decline.

The TYM test has several features which should help the diagnosis and management of patients with memory problems:

1. The patient fills in the test themselves. This saves time.
2. The TYM test is a permanent self-written record of a patient’s achievement on a certain date and can be referred back to.
3. The TYM tests 10 different cognitive domains including anterograde memory, semantic knowledge and visuospatial skills which are typically affected early in Alzheimer’s disease.
4. There is a very clear distinction between the scores of normal controls (average 47/50) and patients with mild AD (average 33/50). A cut off of 42 has a sensitivity of 93% and specificity of 86% in the diagnosis of AD in our study.
5. It is powerful in detecting mild Alzheimer's disease detecting 93% of cases in our study.

The TYM Details

You can pass the Alzheimer’s Test by downloading the following files from the BMJ:

Alzheimer's Test Part 1 (PDF File)
Alzheimer's Test Part 2 (PDF File)

Disclaimer

Please note that it’s not a clinical diagnosis of Alzheimer's disease. It is only a screening tool for patients who may have Alzheimer’s disease. There are many reasons why patient will score poorly on the TYM for example poor concentration. A poor TYM score does not mean a patient has Alzheimer’s but a reason for the poor score needs to be sought. If you are concerned about your memory, it is recommended seeking medical advice. Note that the test can be applied only for English speaking individuals. It has been already translated on about 20 languages, and it is in the process of validation internationally. Non-English versions of TYM will be posted as soon as validation is completed.

 

Also, the text for the test was created in England and should be adapted to the area where you live, such as take out "Who is the Prime Minister" and put, for example, in "Who is the President of the United States. Also something more common, like "Most people wear jeans for casual wear" instead of "Good citizens always wear stout shoes".

Sources and Additional Information:

http://www.tymtest.com/index.html

http://www.healthandage.com/diy-alzheimer%E2%80%99s-test-is-fast-and-accurate

http://www.alzheimersreadingroom.com/2009/06/test-your-memory-tym-for-alzheimers-or.html

http://alzheimers.infopop.cc/eve/forums/a/tpc/f/762104261/m/541100051

Greater purpose in life as weapon against Alzheimer’s Disease

The United States is currently experiencing the early stages of what is expected to be an epidemic of Alzheimer's Dementia. It is predicted that the current number of cases of Alzheimer's Dementia will double by 2020, and double again by 2040. Some unfortunate individuals are born with genes that strongly predispose them to developing Alzheimer's Dementia. However, this is true for only a minority of people. The familial, early onset form of Alzheimer's Dementia, which is so strongly linked to genetic abnormalities, is responsible for about five percent of cases of this illness. There is compelling evidence that the rest of us can escape, or at least postpone or diminish the severity of Alzheimer's, by improving our diets, maintaining our health and generally living healthier lifestyles. In most cases, it appears Alzheimer's Dementia can be avoided.

An underappreciated but scientifically substantiated fact is that getting a good education, challenging your mind, maintaining friendships and staying socially active can also help reduce the risk of developing Alzheimer's Dementia in later life. A new report in the American Medical Association journal, Archives of General Psychiatry, now compliments those findings in showing that simply having a sense of purpose in life can help to reduce this risk.

People who say their lives have a purpose are less likely to develop Alzheimer's disease or its precursor, mild cognitive impairment, a new study suggests. Purpose -- which the researchers define as a "psychological tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness that guides behavior" -- has long been thought to protect against adverse health outcomes. For example, it was recently reported to be associated with longevity, they noted. But there was little information on the association of purpose with Alzheimer's disease.

As the population ages and dementia becomes a more frequent diagnosis, there's increasing impetus to determine the causes of the disease, associated risk factors and how to prevent it, explained study co-author Dr. Aron S. Buchman, an associate professor in the department of neurological sciences at Rush University Medical Center in Chicago.

"There has been a lot of interest in psychosocial factors and their association with cognitive decline and dementia in later life," he said.

The study looked at the positive aspects of life and their possible effect on keeping dementia at bay, "looking at happiness, purposefulness in life, well-being and whether those kind of concepts are associated with a decreased risk of dementia," Buchman explained.

For the study, published in the March issue of the Archives of General Psychiatry, Buchman and his colleagues collected data on 951 older people without dementia who participated in the Rush Memory and Aging Project. The participants were asked to respond to statements such as: "I feel good when I think of what I have done in the past and what I hope to do in the future," and "I have a sense of direction and purpose in life."

After an average four years of follow-up, 16.3% of the people in the study developed Alzheimer's disease. Taking into account other factors that could account for Alzheimer's, the researchers found that people who responded most positively to statements about their lives were the least likely to develop the condition. Also, people who said they had more purposeful lives were less likely to develop mild cognitive impairment and had a slower rate of cognitive decline.

People who scored 4.2 out of 5 on the purpose-in-life measure were about 2.4 times less likely to develop Alzheimer's disease, compared with people who scored 3.0, the study found.

It's not known whether there is a biological reason for this finding, the researchers noted.

"One possibility is that, truly, somebody with high purpose in life might have a lower risk of developing dementia because of what's involved in purpose in life," Buchman said.

"The importance of the study," he added, "is this doesn't prove anything, but it points researchers in the direction of a link between purpose in life and cognition in late life. And now we have to find out what the biological basis is."

Still, the researchers think these findings could have implications for public health. "In particular, these findings may provide a new treatment target for interventions aimed at enhancing health and well-being in older adults. Purpose in life is a potentially modifiable factor that may be increased via specific behavioral strategies that help older persons identify personally meaningful activities and engage in goal-directed behaviors," the authors continue. "Even small behavioral modifications ultimately may translate into an increased sense of intentionality, usefulness and relevance."

"More social activity, more physical activity, higher cognitive activities, high purpose in life -- all these psychosocial factors seem to be linked with longer life, decreased mortality, decreased disability and provide important clues to a public health approach to try to increase independence in older people in later life," Buchman said.

Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System, wondered if the study is really measuring depression, not a purposeful life.

"I am unclear about how low scores on the purpose-in-life measures can be separated from mild depression," Cole said. "Depression has been repeatedly associated with increased Alzheimer's disease risk. So psychiatrists can make a distinction, but they seem likely closely related."

"One wonders whether this is a treatable psychiatric condition contributing to risk or an early symptom of decline," he added.

William H. Thies, chief medical and scientific officer at the Alzheimer's Association, said the new study "contributes to the literature that says there is a linkage between behavior and disease."

The study begs the question whether there is more Alzheimer's disease because more people have a lower sense of purpose, or is a lower sense of purpose an early, subtle, sign of dementia, he said.

"As we get better and better at having biological measures of the disease, we will shed a lot of light on these kinds of studies and whether these behaviors are simply a symptom or they are a place where you can intervene," Thies said.

Previous researches have shown that people that have long histories of Major Depression are twice as likely to develop Alzheimer's Dementia than those that do not. Reduction of stress further decreases the likelihood of dementia. Indeed, studies have shown that people who describe themselves as calm, relaxed, and self-satisfied can reduce their risk of Alzheimer's by one half. The East Boston study showed that every year of education after high school reduces the risk of Alzheimer's by 17 percent. A study at Duke University showed that having intellectually challenging work in adult life can reduce the risk of dementia even further beyond what a good education alone can do. In the Honolulu-Asia Aging Study it was found that maintaining friendships in later life significantly improves the likelihood of avoiding dementia. Another interesting study found that people already diagnosed with Alzheimer's Dementia who have large social networks of family and friends can maintain better cognitive function, even with higher levels of amyloid plaque damage in their brains, than can those without such social support. Scientific studies have also shown that people with deeply held religious beliefs and dedication to religious practices, regardless of the type, have a slower rate of cognitive decline when Alzheimer's dementia is already diagnosed. The current study now adds to this list of things we can do and ways we can approach life that can reduce our risk of dementia. Having a sense of purpose in life can reduce this risk.

Sources and Additional Information:

http://www.medicinenet.com/script/main/art.asp?articlekey=113908

http://www.huffingtonpost.com/scott-mendelson-md/a-sense-of-purpose-in-lif_b_488528.html

http://www.sciencedaily.com/releases/2010/03/100301165619.htm

http://abcnews.go.com/Health/AlzheimersNews/purpose-life-stave-off-alzheimers/story?id=9986018

Sage as Alternative Treatment to Alzheimer's

A popular Chinese sage herb has been shown to contain similar active ingredients to compounds used in Western medicine to treat Alzheimer's disease.

Sage Clinical Effects

Clinical, animal and laboratory studies have shown that sage can help both the symptoms of Alzheimer's disease and contain the pathological mechanisms underlying this neurodegenerative condition.

Old memories
Sage contains cholinesterase inhibitor compounds that give it the ability to act in a similar way to drugs currently used to alleviate some of the effects of Alzheimer's disease. Cholinesterase inhibitors slow the breakdown of the neurotransmitter, acetylcholine, thereby improving interconnectivity between different parts of the brain. By so doing they enhance cognition and memory – functions that deteriorate in Alzheimer's patients.

Two helpful acids
More importantly, compounds in sage such as carnosic acid and rosmarinic acid both help to combat the pathological processes that underlie Alzheimer's disease. Both of these compounds are strong antioxidants; carnosic acid is particularly useful as it crosses the blood-brain barrier to counteract free radical damage to the brain.

Carnosic acid
Sage also enhances the production of glutathione, one of the most important of the body's own antioxidants. Furthermore, it helps to improve circulation to the brain by dilating the middle cerebral arteries. This is a very important function as a declining blood supply to the brain exacerbates the impaired neurological function caused by other pathological processes associated with neurodegenerative diseases.

Beats beta-amyloid
Sage also counters the damaging effects of beta-amyloid, the protein that clogs up the neural pathways in the brain and is the root cause of Alzheimer's disease.

Medicinal Plant Research Centre Research

It has taken 400 years but scientists have finally demonstrated what herbalists have long believed: sage is a tonic for the brain. Oil derived from the herb improved the memory of healthy young adults given a list of words to recall.

The Medicinal Plant Research Centre at Newcastle and Northumbria universities (both in UK) tested a group of 44 adults aged between 18 and 37. Some were given capsules containing sage oil while others received a placebo capsule of sunflower oil.

Those who took the sage oil performed consistently better, remembering more words than those who had the placebo.

Herbalists have been recommending sage since the 16th century. In 1597 John Gerard wrote: 'It is singularly good for the head and brain and quickeneth the nerves and memory.' Part of a 1652 description of sage by Nicholas Culpepper reads: 'It also heals the memory, warming and quickening the senses.' 

Other Applications for Sage

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Cognitive improvement (Grade: A)
Sage has long been suggested to improve memory. Several trials provide evidence for the use of sage. Additional study is needed to confirm these findings and determine the best dose.

Mood enhancement (Grade: A)
Sage has long been suggested to improve mood. Several trials provide evidence for the use of sage. Additional study is needed to confirm these findings and determine the best dose.

Acute pharyngitis (Grade: B)
Sage mouthwashes and gargles have been approved for use against sore throat in Germany by the German Commission E for many years. Additional study is needed comparing sage to standard therapies.

Herpes (Grade: B)
Early evidence suggests that sage extracts may be useful in the treatment of herpes skin manifestations.

Menopausal symptoms (Grade: B)
Sage has been tested against menopausal symptoms with promising results.

Lung cancer prevention (Grade: C)
Sage used daily as a spice in foods has been associated with a lower risk of lung cancer in the Mediterranean diet.

Dosing

Adults (over 18 years old)

Doses of 25-50 microliters of the essential oil have been taken by mouth one to three times daily. Single daily doses of 60 drops of an ethanolic extract of S.officinalis were used in a clinical study with benefit. 120 milligrams of sage extract and 60 milligrams of alfalfa extract (Medicago sativa) have been used daily for up to three months to alleviate symptoms of menopause. Dried sage leaf, 300 or 600 milligrams, in single daily doses have been used. A 15% spray containing 140 microliters of S. officinalis extract per dose has been applied to the skin six to nine times daily for three days.

Children (under 18 years old)

There is no proven effective dose for sage in children. However, secondary sources note that children have safely eaten sage as a spice in foods for many centuries.

Safety

Allergies

Avoid in individuals with a known allergy or hypersensitivity to sage species, their constituents, or to members of the Lamiaceae family. Systemic allergic reactions relating to cross sensitivity have been noted.

Dust from sage plants may contain airborne microorganisms that may induce allergic reactions in farm workers and herb processors.

Sage powder should not be used for asthma. Although some formulations of sage have been reported to be useful in asthma, sage powder is not appropriate for use in asthmatic patients since it can cause bronchial reactions.

Side Effects and Warnings

Sage (Salvia officinalis) is uncontrolled in the United States. This means all parts of the plant and its extracts are legal to cultivate, buy, possess, and distribute (sell, trade, or give) without a license or prescription. If sold as a supplement, sales must conform to U.S. supplement laws. If sold for consumption as a food or drug, the U.S. Food and Drug Administration (FDA) regulate sales. Sage is approved for food use as a spice or seasoning in the United States and appears on the FDA's list of substances Generally Recognized as Safe (GRAS).

Skin rash may occur in some patients who are exposed to the leaves.

Sage is likely safe when included in the preparation of foods as a spice for upset stomach, due to a long history of use around the world. Sage is also likely safe when used in moderate amounts as a cream applied to the skin for herpes infections.

Certain medicinal preparations or high doses of sage have been documented to induce seizures. Large amounts or prolonged use of sage leaf or ingestion of sage oil may cause restlessness, vomiting, dizziness, rapid heart beats, tremors, seizures, and kidney damage.

Some patients may exhibit increases in blood pressure during sage essential oil therapy.

When using a 15% spray containing sage extract for three days, minor dry pharynx or mild burning of the throat have been reported in some patients. Other side effects may include: cheilitis (cracking and drying of the lips), stomatitis (mouth sores), dry mouth, and local irritation.

A plant preparation that is not sterile and not free of particles should not be used in the eye since these preparations may damage the cornea.

Sage powder should not be used for asthma, since sage powder can cause asthmatic attacks.

Pregnancy & Breastfeeding

Due to a lack of available scientific evidence, women should avoid sage supplementation during pregnancy and breastfeeding. Hormonal effects are possible and could be dangerous.

Interactions

Interactions with Drugs

Sage essential oil and tinctures may increase the effects of drugs used in the treatment of Alzheimer's disease.

Sage extracts may have antimicrobial effects.

Sage may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Sage may have anti-inflammatory activity. Use cautiously with anti-inflammatory medications, due to possible additive effects.

Sage may have antioxidant activity.

Use cautiously with benzodiazepines or drugs broken down by the liver. Sage may increase sedation.

Sage essential oil and tinctures can induce seizures and may enhance the ability of some drugs to induce seizures.

Sage essential oil may have estrogenic activity. Extracts of the leaves of sage may abolish hot flashes and night sweating in some menopausal women.

Use cautiously with thyroid hormones, due to possible additive effects.

Interactions with Herbs & Dietary Supplements

Sage may increase the effects of alfalfa (Medicago sativa) on the reduction of menopausal symptoms, including hot flashes, insomnia, nocturnal sweating, dizziness, headaches, and palpitations.

Sage essential oil and tinctures may increase the anticholinergic effects of drugs used in the treatment of Alzheimer's disease.

Sage extracts may have antimicrobial effects.

Some species of sage may cause convulsions. Theoretically, this might interfere with anticonvulsant drug therapy.

Sage may have anti-inflammatory activity. Caution is advised when taking other anti-inflammatory herbs or supplements, due to possible additive effects.

Based on laboratory studies, sage may have antioxidant activity.

Sage may interact with therapies that are broken down by the liver.

Sage may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Sage essential oil may have estrogenic activity. In addition, extracts of the leaves of sage may abolish hot flashes and night sweating in some menopausal women. Caution is advised in patients taking phytoestrogens.

Sage may increase the amount of drowsiness caused by some herbs or supplements.

Sage may induce a significant increase in thyroid stimulating hormone and interact with other herbs and supplements that affect the thyroid.

Sources and Additional Information:

http://www.medicinal-herbs-and-spices.com/sage-benefits.html

http://www.medicalnewstoday.com/articles/4212.php

http://www.nutraingredients.com/Research/Sage-alternative-treatment-to-Alzheimer-s-drug

http://www.wellness.com/reference/food/sage-salvia-officinalis-salvia-lavandulaefolia-salvia-lavandulifolia/

http://www.aromamd.net/edu_alzheimers_dementia.pdf

17 Myths and Facts about Alzheimer's Disease

According to the Alzheimer's Association, about 5 million Americans are living with Alzheimer's disease today -- a figure that's expected to increase as the baby boom generation ages. The disorder causes neurons, or cells in the brain, to malfunction and die. The onset of Alzheimer's usually happens after the age of 60, but early-onset Alzheimer's can affect younger people. Though scientists have learned much about the illness in the last decade, many questions remain about the causes, stages, and treatment of Alzheimer's. It's not surprising, then, that patients' and caregivers' understanding of the disease is often off-target. Myths and half-truths only add to fear of the disease, which can prevent people from getting help that could improve their quality of life.

Here are 17 common myths about Alzheimer's -- busted.

Myth: If you're forgetful, you're getting Alzheimer's disease.

Reality: Memory loss is a key symptom of Alzheimer's, but forgetfulness doesn't mean you have the disease. Even if your forgetfulness is due to more than simple aging, there are still many causes for dementia that lead to a decrease in cognitive function; physicians will make an Alzheimer's diagnosis only after other conditions have been ruled out.

Myth: Memory loss is a natural part of aging.

Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness. Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.

Myth: Most people with Alzheimer’s are oblivious to their symptoms.

Reality: Typically someone in the early stage of Alzheimer’s disease does realize, at least part of the time, that something’s wrong. (Whether they recognize it as Alzheimer’s is another matter.) Most people with the disorder are aware that they’re experiencing memory lapses, for example, or that they’re starting to have trouble doing certain familiar tasks (following a favorite card game, cooking a particular recipe). Insight varies by individual, and the degree of awareness can shift from day to day.

Depending on their level of awareness and attitude toward correction, people with Alzheimer’s may appreciate being gently told when they make a mistake due to memory loss, disorientation, or another disease symptom. On the other hand, self-awareness of symptoms can make someone frustrated, angry, scared, or socially withdrawn. As the disease progresses and symptoms worsen, awareness of the situation is likely to decline.

Myth: An x-ray of the brain can diagnose Alzheimer's disease.

Reality: Unfortunately, the brain changes that cause Alzheimer's can not be seen with an x-ray. However, promising new tests using MRI and other imaging techniques are in development. Physical examination is important to rule out other conditions; the disease is then most often diagnosed by a series of tests of mental status.

Myth: If you have a family member with Alzheimer's, you'll get it, too.

Reality: In rare cases, early-onset Alzheimer's is inherited through genes. This familial form of Alzheimer's causes just 7% of all Alzheimer's cases. Genetics plays a small role for those people who don't have this form of Alzheimer's but who do get the disease later in life. If you have a parent, brother or sister with the disease, you have a slightly higher risk of getting it.

Myth: Aluminum in products we use causes Alzheimer's.

Reality: Most of us use products every day that contain aluminum. Food prepared in aluminum pots and pans carries trace amounts of the metal. Many underarm antiperspirants also contain aluminum. There is no scientific evidence that aluminum exposure causes Alzheimer's. Although the disease's exact cause is unknown, most research suggests that several factors, such as age, genetic susceptibility and overall quality of health, ultimately contribute to whether or not someone develops the disease.

Myth: Aspartame causes memory loss.

Reality: This artificial sweetener, marketed under such brand names as Nutrasweet and Equal, was approved by the U.S. Food and Drug Administration (FDA) for use in all foods and beverages in 1996. Since approval, concerns about aspartame's health effects have been raised.  According to the FDA, as of May 2006, the agency had not been presented with any scientific evidence that would lead to change its conclusions on the safety of aspartame for most people. The agency says its conclusions are based on more than 100 laboratory and clinical studies.

Myth: Flu shots increase risk of Alzheimer’s disease

Reality: A theory linking flu shots to a greatly increased risk of Alzheimer’s disease has been proposed by a U.S. doctor whose license was suspended by the South Carolina Board of Medical Examiners. Several mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer's disease and overall better health. 

• A Nov. 27, 2001, Canadian Medical Journal report suggests older adults who were vaccinated against diphtheria or tetanus, polio, and influenza seemed to have a lower risk of developing Alzheimer’s disease than those not receiving these vaccinations.
• A report in the Nov. 3, 2004, JAMA found that annual flu shots for older adults were associated with a reduced risk of death from all causes.

Myth: Silver dental fillings increase risk of Alzheimer's disease.

Reality: According to the best available scientific evidence, there is no relationship between silver dental fillings and Alzheimer's. The concern that there could be a link arose because "silver" fillings are made of an amalgam (mixture) that typically contains about 50 percent mercury, 35 percent silver and 15 percent tin. Mercury is a heavy metal that, in certain forms, is known to be toxic to the brain and other organs.

Many scientists consider the studies below compelling evidence that dental amalgam is not a major risk factor for Alzheimer's. Public health agencies, including the FDA, the U.S. Public Health Service and the World Health Organization, endorse the continued use of amalgam as safe, strong, inexpensive material for dental restorations.

• March 1991, the Dental Devices Panel of the FDA concluded there was no current evidence that amalgam poses any danger.
• National Institutes of Health (NIH) in 1991 funded a study at the University of Kentucky to investigate the relationship between amalgam fillings and Alzheimer's. Analysis by University statisticians revealed no significant association between silver fillings and Alzheimer's. 
• October 30, 2003, a New England Journal of Medicine article concluded that current evidence shows no connection between mercury-containing dental fillings and Alzheimer's or other neurological diseases. 

Myth: All old people have Alzheimer's disease.

Reality: Even though age is an important risk factor for Alzheimer's, the majority of old people do not have the disease. It's important to note that normal aging doesn't necessarily include dementia or Alzheimer's.

Myth: Alzheimer’s disease affects only old people.

Reality: Though the majority of patients with AD are above 65 years old, there are also cases, when the disorder affects people in their 50^th or even 40^th. That is why it is important to understand that the symptoms of AD, such as memory problems, are not part of normal aging. The earlier the disorder is detected – the more effective management of it could be.

Myth: Men are at higher risk of developing Alzheimer's than women.

Reality: Alzheimer's disease affects both men and women that is true but it is believed to be more common in women. The reason for this claim is based on the unrelated fact that women live longer than their opposite sex so are more likely to develop the disease at some stage of their life.

Myth: Alzheimer's disease is preventable.

Reality: There is no treatment that can prevent Alzheimer’s disease. There is, however, a growing amount of evidence that lifestyle choices that keep mind and body fit may help reduce the risk. These choices include being physically active; eating healthy foods including fresh fruits, vegetables and fish; keeping your brain challenged; reducing stress, keeping an eye on your blood pressure, blood sugar and cholesterol levels; avoiding traumatic brain injury; and keeping socially active.

Myth: Alzheimer’s disease can be cured with pills, herbs, or supplements.

Reality: Currently there is no cure for Alzheimer’s disease. Modern pharmaceutical options can only slow down the progression of the disorder. The effect of herbs, such as ginkgo biloba, vitamins E, B and C, as well as folic acid and selenium, on patients with Alzheimer’s disease is also not yet fully understood, and the history of their use for AD treatment contains many controversies and vagueness. There are some evidences of beneficial effect of the said remedies, but it is definitely too early to claim that they are able of curing Alzheimer’s disease.

Myth: Alzheimer’s disease makes people hostile, violent, and aggressive.

Reality: As a matter of fact, Alzheimer’s disease affects different people in different ways. Some patients develop certain changes in their behavioral patterns, like becoming violent or aggressive, and some do not. It is important to understand that the symptoms of AD may be frightening and scary first of all for a patient himself; that is why it is important to educate yourself, as well as a patient, about the disorder, and what to expect from it in order to prevent aggressive responses from a patient. Try to improve his usual surroundings in accordance with his specific demands, do not expose him to stressful events, and make him feel comfortable even with his gradually decreased abilities.

Myth: People with Alzheimer's disease cannot understand what is going on around them.

Reality: Some people with Alzheimer's disease understand what is going on around them; others have difficulty. The disease does affect a person's ability to communicate and make sense of the world around them, although it affects each person differently. When we assume someone does not understand, feelings can be hurt unintentionally. The fact is a person with Alzheimer's disease is still the same person as before and needs to be treated with dignity and respect.

Myth: Life with Alzheimer's disease isn't worth living.

Reality: There is no single course for Alzheimer's disease, which typically can be a part of a person's life for many years. Memory loss and communication problems can cause frustration and anger. With help, though, a person with Alzheimer's can have a meaningful and productive life. According to the National Institute of Neurological Disorders, several medications have been approved for early- and middle-stage Alzheimer's, including Aricept(donepezil), Exelon (rivastigimine),  Namenda (memantine), and Razadyne (galantamine; formerly Reminyl). A number of other medications can be used to control anxiety, depression, sleeplessness, and agitation, any or all of which may accompany the disease.

Sources and Additional Information:

http://alzheimers.about.com/lw/Health-Medicine/Conditions-and-diseases/Myths-and-Realities-of-Alzheimers-Disease.htm

http://www.pillwatch.com/info/alzheimers-disease-myths-and-realities.html

http://www.alz.org/alzheimers_disease_myths_about_alzheimers.asp

http://www.memorystudy.org/alzheimers_myths.htm

http://www.poststat.net/rightathome/pub.59/issue.1059/article.4339/