Quote · The Peter Attia Drive
#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.
Where this was said
Exceptional treatment responses
At 1:14:34 · chapter starts 1:12:20
Two patient stories anchor the episode's most hopeful moments. First: a woman in her seventies who sought out Gayatri Devi after seeing her on television, was confirmed to have Alzheimer's via spinal tap, started on lecanemab, cleared her amyloid — and then showed no tau on a subsequent tau PET scan [1] — Gayatri Devi "One patient cleared her brain amyloid and then subsequently showed no tau on a tau PET scan — a response Gayatri Devi describes as so remar…" 1:12:20 . Gayatri Devi describes her disbelief: she 'refuses to believe' the pathology is truly gone and is waiting for a confirmatory spinal tap. Second: an identical twin whose sibling is in a care facility; Gayatri Devi's patient, who also had rheumatological heart disease requiring a mechanical valve and Coumadin therapy, was started on monoclonal antibody therapy with intensive monitoring, never developed side effects, and cleared her amyloid — dramatically outperforming her genetically identical twin. Both cases illustrate that individual immune biology may be as important as the drug itself.
One patient cleared her brain amyloid and then subsequently showed no tau on a tau PET scan — a response Gayatri Devi describes as so remarkable she 'refuses to believe' the pathology is gone. Another patient, an identical twin of a facility-dwelling Alzheimer's patient, did so well on monoclonal therapy despite having a mechanical heart valve and being on Coumadin.
Before monoclonal antibodies, Gayatri Devi was already deploying a complex toolkit: cholinesterase inhibitors, memantine, valacyclovir, WATCHMAN procedures to get patients off blood thinners, and transcranial magnetic stimulation since 2008. Today these tools remain core elements of her multimodal approach alongside anti-amyloid therapies.
