399 - The evolution of Alzheimer's disease and dementia care | Gayatri Devi, M.D.

Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. >> [music]

>> Gaya, so great to be with you today. Um, very excited to talk about this. Um, it's a topic that um, we've discussed a number of times on the podcast. Um, but unfortunately, there's always a lot to talk about here. Um, and I think your um, a physician that of course is is near and dear to our heart in the practice.

We co-manage a number of of um, high-risk patients. Um, and um, you know, I've just always been impressed by the way that you um, have have taken a very personalized approach to managing this condition, but I just want to let folks get to know you a little bit better. So, you're both a neurologist um,

and a psychiatrist, is that correct? I'm imported in multiple specialties, neurology, psychiatry, um, brain injury medicine, pain medicine, and um, behavioral neurology, but my subspecialty is really memory disorders, primarily from a neurological perspective. But all these other areas

allow me to better handle people with cognitive impairment. >> I'm just kind of curious as you think about the evolution of your career, um, when you started, which is obviously not that many years ago, you're still quite young, to where you are today, what has been kind of the biggest shift

in your understanding of the dementing conditions that we're going to talk about today? >> I think two things, Peter. One, that over the years of my practice, I've come to realize that pretty much all dementing conditions, and particularly Alzheimer's disease, can present variably depending on the

person who has the condition. And also depending on comorbidities. So, there really is a spectrum aspect to Alzheimer's and dementias, which people don't recognize. They think of it as an all or nothing disease, and that's not true. Much like autism, it really can span the spectrum from very mild

impairment that doesn't get worse to severe impairment that kind of deteriorates rapidly. That's number one, that dementias are really a spectrum disorder.

And number two, that what's really exciting to me is I feel like I'm in the field now almost as if I was an infectious disease doctor who is practicing medicine before and after penicillin was invented.

You know, or discovered, sorry. So, basically that there are now so many different ways that we can treat um dementias. We can personalize our treatment. Uh we can give each person the right um cocktail, if you will, of medications that would best benefit them.

And we now have uh drugs that can alter the course of the disease, which is absolutely, to my mind, fantastic. We still have a ways to go, but I feel like we're on the threshold of something um really grand.

>> Well, that's probably the thing I want to talk most about today, but I I I think there's some groundwork I'd love to to lay to bring the listeners along with us before we get into both the treatments, but also the way in which you personally kind of manage some of the risks. So, we're going to talk