MAY 2012
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

The challenges of Alzheimer’s Disease - Part II


“Years ago, when my grandmothers had Alzheimer’s, there was little acceptance of the disease. Thankfully, today there’s much more community support for caregivers,” says Lea Thompson, the famous TV and Movie star. People such as Lea are trying to create awareness in the society about the disease and drum up support for the much-needed research. There was recent front page news about the famous country singer Glen Campbell, who missed his cue on the stage occasionally and now he has admitted that has developed Alzheimer’s.

Are there any good tests for Alzheimer’s? Neurologists can often check the level of your memory with a few simple clinical questionnaire and a good neurological evaluation. Walking speed and hand-grip strength and your general health can correlate with cognitive function and stroke risk in older adults, says one study. One laboratory test that can help is MRI of the brain, which shows some degree of cerebral atrophy or cerebral volume loss in Alzheimer’s.

Unfortunately, there is no effective treatment for the condition; however, there are a few memory boosters such as Aricept (donepezil) that is moderately effective in improving short-term memory in patients with early Alzheimer's. Exelon (rivastigmine) is shown to be slightly more effective than Aricept at slowing the rate of decline in similar patients. Because it blocks two chemical pathways and not just one, it increases the amount of memory chemicals in your brain. Exelon is probably most useful in people who are in the earliest stages of memory loss. Namenda (memantine) is another drug that was just recently approved for use in the United States. It has shown a modest effect in alleviating some of the symptoms for people suffering with the disease and has little side effects. However all these drugs, in my experience, are at best palliative and only marginally improve the memory.

Start thinking of Prevention

So, it is better for all of us to take a few preventive steps since most of the baby boomers are going to live beyond 80 and that is when this disease is likely to hit you most. Here are some suggestions that you could consider now.

  1. Diet: Higher adherence to a Mediterranean-type diet is associated with a trend for reduced risk of developing mild cognitive impairment (MCI) and with reduced risk of MCI conversion to AD. The focus here is on healthy foods such as fruits, vegetables (avocados and olives especially), nuts, whole grains and, of course, fish. Use canola and olive oil for cooking. Only a minimum of lean meats and sweets should be allowed.

  2. Vitamins A, C and E are antioxidants that prevent cell damage and believed by some to slow down the diseases of aging. There are studies that suggest antioxidants might prevent dementia. There is no absolute proof though but they are worth trying.

  3. Fish oil supplements

Dr. Gary Small, director of the UCLA Center on Aging, says aging brains show signs of inflammation, and fish oil has anti-inflammatory properties. Fish itself has been considered a ‘brain food’ by our ancestors.

  1. Indian curry

Dr. Small, who's 57, says that as he gets older, he might also try eating more foods with curry in them. "Some studies from Singapore have shows that those who ate curry once a week had better memory scores," he said. Curcumin, a key ingredient of the spice turmeric and plenty in all Indian curries, is good for the memory. It is a powerful antioxidant and it has been shown to protect nerve cells, making it potentially useful in conditions such as Alzheimer's and Parkinson's. “Since it has both neuroprotective and memory-enhancing properties, it may be unique in treating clinical disorders associated with the loss of nerve cells and cognitive abilities,” say researchers at the U.S. Salk Institute, one of the world's leading research centers. There is evidence that Curcumin binds to plaques, and basic research on animals engineered to produce human amyloid plaques has shown benefits. Dr. Mehemet Oz, the well-known cardiac surgeon and TV personality, eats curry regularly to prevent Alzheimer’s disease.

Please note that some of the other alternative medicines such as Ginko Biloba have not been proven to be of great value although being touted as good for preventing dementia.

Green tea and Ashwagandha may be beneficial too but the evidence so far is not strong. So, continue your Indian food with plenty of curried dishes.

To be continued . . .

Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.


DRY EYE Management: Raised to a SCIENCE!


Have you ever felt burning sensations in your eyes, tired and red eyes, gritty and discomfort, especially when facing the direct blast of the air conditioner in your car or the ceiling fan in your bedroom? Chances are you have dry eyes.

Like millions of people all over the world, you are suffering from this relentless disorder that in many cases is taken lightly and treated generically even though it can have a significant impact on your lifestyle as well as vision.

There is a plethora of over-the-counter relief eye drops and remedies for dry eyes but it is essential that you have a thorough exam with an expert to have a treatment strategy best tailored for your condition. This is also vital to rule out any local causes (eye-related) i.e. lasik surgery in the past or associated systemic disease of which this could be the first indicator i.e. Sjogren's syndrome, certain arthritis, thyroid disorders, drug side effects, etc.

In my instruction courses on dry eye management for eye surgeons globally, I suggest an in-depth diagnostic evaluation, including tear film analysis along with a full spectrum of customized care from medical/pharmaceutical to advanced surgical applications, including amniotic membrane surgeries for patients with this condition.

Dry eye should be approached as a specific entity with a specific cause, which warrants a specific treatment.

Our tear film is actually about 7 microns thick and is made up of three layers:

  1. The Innermost, Mucin Layer (produced by the Conjunctival Goblet cells on the surface of the eye) and this layer makes the tear film “stick” to the eyeball.
  2. The Middle, Aqueous Layer (produced by the Lacrimal glands located on the upper and outer side of your eye socket). This is the real tear film if you may and contains all the chemicals and nutrients needed for ocular health and safety.
  3. The Outermost, Lipid layer (produced by the Meibomian glands, which are arranged along the eyelid margins vertically in rows like “toothpaste tubes” with their “mouths” opening at the lid margin close to the eye lashes). This layer actually provides surface tension to the tear film and hence maintains its vertical distribution on the eye despite gravity and also decreases evaporation of your tear film.

Despite a detailed analytical system for dry eye diagnosis and management (Gulani Matrix), essentially dry eyes are of two basic kinds:

I. Quantitative (Decreased quantity) 1. Decreased production 2. Increased loss

II. Qualitative (Decreased quality/altered chemical content of either one or all three layers despite good quantity) I like to breakdown the treatment protocol into three levels:

  1. Local
    a. Medical (Specific artificial tears/ medicated eye drops) b. Procedures (Lacrimal Plugs/ Meibomian Gland probing)
  1. Systemic (oral medications/diet/environment modification)
  2. Accessories (Moisture chamber goggles/sleep masks)

Additionally, one must rule out any systemic condition (disease) in the body that may have caused or be associated with dry eyes.

Treatment modalities:

Anatomically, the tear film leaves the eye via tear ducts (in each lid) and goes into the nose on a normal basis (remember how some eye drops taste nasty?).

So, let’s say someone has a decreased production but good quality of tears, they can have punctual plugs inserted into their tear ducts and thereby “retain” whatever little tears they produce (a plumbing issue : Block the drain since the tap is producing less water so the water remains in the sink for a longer time). This can further be augmented by tear-producing eye drops such as Restasis.

If the quantity is good but the quality of tears is bad due to deficient oil layer from Meibomian gland blockage; a simple and brief, in-office procedure using a special probe can unblock these glands to release the oils.

Of course, do treat the underlying disease i.e. hypothyroidism, etc., if present. In certain cases based on seriousness, “no-stitch” human placenta surgery, transplants can be performed and, of course, combination therapy is quite possible in serious cases.

Future technologies: Tear film analyzers and specific treatment delivery systems are gaining ground in this much- neglected field of eye care.

Can dry eye patients have laser vision surgery or cataract surgery? Yes, of course. Dry eye patients today can avail of surgery to get rid of their glasses. Dry eyes can be successfully managed first followed by laser vision surgery or advanced cataract surgery modified for these particular patients.

In summary, dry eye is a rampant condition, especially given today's professions and lifestyle where we are continuously exposed to bright screens of the computers and smart phones, all of which aggravate and accelerate dry eyes and their manifestations.

With technology, most dry eye patients can live a normal life and even enjoy their right to see without glasses.

Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at or visit

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