#399 ‒ The evolution of Alzheimer's disease and dementia care: how early detection, personalized treatment, new therapies, and a multimodal approach are changing the landscape | Gayatri Devi, M.D.

Description

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Gayatri Devi is a nationally recognized neurologist specializing in memory disorders, including Alzheimer's disease and related dementias. In this episode, Gayatri explains how to think about dementia as a spectrum—including Alzheimer's disease, vascular dementia, Lewy body dementia, and mixed presentations—while exploring the evolving biology of amyloid, tau, and neuroinflammation and why brain pathology does not always correlate with symptoms. She discusses her approach to detecting subtle cognitive decline in high-functioning individuals, the role of biomarkers and APOE4 testing in asymptomatic patients, the benefits and risks of anti-amyloid therapies such as lecanemab and donanemab, and strategies for minimizing treatment-related complications. Gayatri also examines why some patients may stabilize or even improve with individualized care, the overlap among different dementia syndromes, and the relationship between menopause, estrogen, and cognition—including her concept of menopause-related cognitive impairment. Finally, she discusses how advances in early detection, AI-assisted monitoring, targeted therapies, and precision medicine are reshaping the future of dementia care. We discuss: Gayatri's training and clinical focus, why dementia is a spectrum disease, and how personalized treatment is changing Alzheimer's care [3:45]; How Alzheimer's disease fits within the broader spectrum of dementia: diagnosis, biomarkers, and early pathophysiology [7:15]; The emerging role of neuroinflammation and viral infections in Alzheimer's disease [13:30]; Gayatri's comprehensive approach to evaluating cognitive decline in high-functioning patients [17:45]; Why forgetting names is usually normal and when word-finding problems become concerning [29:00]; Why women are at higher risk for Alzheimer's disease and how menopause influences cognition [33:45]; The promise and limitations of blood-based