S12 EP49: I love the buffet

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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.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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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 or discovered. Basically that there are now so many different ways that we can treat dementias.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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Names are inorganic bites of information. Our brain is trained to remember things organically. A name is really a neologism. It's a made up thing. It doesn't have very much meaning.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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The ability to recall common nouns, to remember to call something a chair, to say that's a book — if you're beginning to have trouble coming up with words for that, finding words as opposed to trouble finding names, that becomes more of a problem.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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Women often will present with depression. They present with withdrawal. They often have more language difficulty problems than men do. And I've actually had patients in my practice who've been misdiagnosed with Alzheimer's disease and other dementias who really only turned out to have menopause related cognitive impairment.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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The other thing, Peter, I always ask myself anytime a new drug comes out is, would I want this drug? If I had Alzheimer's now, knowing everything I know about this drug, would I want to be on this drug? And I felt that with aducanumab, my answer was yes. So that's why I started giving it to my patients.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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I never thought that patients with Alzheimer's could get better. And even before we had the monoclonals, I had patients who got better with treatment, which just didn't make sense. And I used to think, maybe I made a misdiagnosis. Because the teaching is that every person with Alzheimer's inexorably declines.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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There is no more heterogeneous disease I can think of than Alzheimer's disease. Because each person with Alzheimer's disease has their own private version of Alzheimer's disease that is different from everyone else who has the disease because that person has their own individual brain.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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We don't have a cure yet, but we can give each person a cocktail of medications just like they do with patients with HIV. And in this particular patient, he was on IVIG. And therefore, you can keep the person functional, not just alive, but actually functional.

Gayatri Devi

#399 ‒ The evolution of Alzheimer's dis…

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