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. View show notes here: https://peterattiamd.com/gayatridevi/ Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ 0:00:00 - Intro 0:00:11 - Gayatri’s training and clinical focus, why dementia is a spectrum disease, and how personalized treatment is changing Alzheimer's care 0:03:55 - How Alzheimer's disease fits within the broader spectrum of dementia: diagnosis, biomarkers, and early pathophysiology 0:10:45 - The emerging role of neuroinflammation and viral infections in Alzheimer's disease; 0:15:18 - Gayatri’s comprehensive approach to evaluating cognitive decline in high-functioning patients 0:27:30 - Why forgetting names is usually normal and when word-finding problems become concerning 0:32:26 - Why women are at higher risk for Alzheimer's disease and how menopause influences cognition 0:39:20 - The promise and limitations of blood-based biomarkers for diagnosing Alzheimer's disease 0:44:22 - When preclinical Alzheimer's screening is appropriate and how to interpret positive biomarker results 0:46:51 - Case study: early Alzheimer's prevention in a highly-functional woman in her 50s with two copies of APOE4 0:51:32 - Anti-amyloid therapies: balancing clinical benefit with ARIA risk using slow titration 1:00:17 - The aducanumab controversy, why it was discontinued, and why Gayatri would still choose it 1:03:51 - How anti-amyloid therapies cause ARIA, strategies for detecting and managing these complications, and how future therapies may improve safety and accessibility 1:13:20 - Two patient examples of exceptional responses to anti-amyloid therapy 1:15:52 - A multimodal approach to Alzheimer's treatment: combination therapy, MRI-guided TMS, GLP-1 receptor agonists, and more 1:22:30 - Vascular dementia, Lewy body dementia, and the overlap with Alzheimer's disease 1:28:31 - Lewy body dementia and Parkinson's disease: distinguishing two alpha-synuclein disorders 1:38:33 - Risk factors for Lewy body dementia and what remains unknown 1:41:11 - Treating menopause-related cognitive impairment: hormone therapy, brain rehabilitation, and balancing breast cancer risk 1:50:01 - How biomarkers changed Gayatri's perspective on the potential for Alzheimer's patients to improve 1:52:28 - The future of Alzheimer's care: AI, precision medicine, and personalized treatment -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/