When the Default is Not Enough: An Emergency Medicine Clinician's Guide to Novel Amyloid-Related Imaging Abnormalities in Alzheimer's Disease
With the first approvals of amyloid-targeting therapies (ATTs) for patients with early Alzheimer’s disease (AD) neurobiology, the way this illness is viewed and managed is facing a paradigm shift. However, while disease-modifying therapies (DMTs) are a long-awaited breakthrough in the treatment of AD, ATTs have also introduced new, class specific adverse effects, amyloid-related imaging abnormalities (ARIA), with which most clinicians, regardless of specialty, have not yet come into contact, creating a host of novel considerations and potential practice changes. This lack of exposure and limited published guidance may be particularly problematic in emergency department (ED) settings which are likely to encounter the most urgent needs of those affected by ARIA.
This live virtual webinar focuses on emergency medicine clinicians' role in the recognition and acute management of ARIA, including how ARIA may present and what courses of action are needed for different ARIA severities.
The target audience for this activity includes emergency medicine physicians, neurologists, neuroradiologists, nurse practitioners, physician assistants, nursing staff, triage specialists, and other healthcare professionals (HCPs) specializing or consulting in the care of older adults in the ED.
Upon completion of the educational activity, participants should be able to:
- Describe the range of symptoms of ARIA that may prompt a patient to seek emergency care and how to differentiate them from more common conditions to appropriately triage these individuals and determine next steps in their management
- Isolate possible types of ARIA (ARIA-E, ARIA-H) as well as which do and do not require hospital admission/immediate treatment (e.g., corticosteroids) to effectively coordinate variable patient presentations
- Identify key areas of interdisciplinary communication that may impact a care team’s ability to successfully triage, diagnose, and/ or treat ARIA and employ corresponding solutions to maximize workflow efficiency and patient outcomes
- Recognize which medications/treatments that may be administered in the ED are inappropriate or contraindicated in patients prescribed ATTs and strategize management protocols for clinical scenarios in which they would be utilized
The Relevance of ATT and ARIA to the ED
- Overview of amyloid-targeting therapies
- Importance and challenges of accurate medical history in patients with cognitive impairment
- Definitions, prevalence, and risk factors of ARIA-H and ARIA-E
Workflow Discussion and Q&A What changes have to happen in your ED to better recognize these therapies and their potential complications?
ARIA Recognition and Triage
- Range of clinical presentations of ARIA that may be seen in the ED
- Appropriate work-up for patients presenting with symptoms of ARIA and how that deviates from typical ED protocols
- Differential diagnoses and ARIA mimics; what to communicate to the radiologist
Workflow Discussion and Q&A Workflow Example: roles and responsibilities.
Management of Patients on ATT
- Categories of ARIA radiographical severity and their respective management strategies in the ED
- Contraindicated medications and therapies for patients on ATT
- Potential interventions that may be beneficial in certain presentations of ARIA
- Candidates for discharge vs admission and corresponding plans
Workflow Discussion and Q&A Support for patients & caregivers: what to expect after discharge.
Don Melady, MSc(Ed) MD
Associate Professor, Faculty of Medicine
University of Toronto
Schwartz-Reisman Emergency Medicine Institute
Toronto, Ontario Canada
Kevin Biese, MD, MAT
Vice-Chair, Academic Affairs Director
Division Of Geriatric Emergency Medicine Clinical
Associate Professor, Internal Medicine, Division Of Geriatrics
Chapel Hill, NC
Gloria Chiang, MD
Vice Chair, Clinical and Translational Research
Director, Brain Health Imaging Institute
Associate Professor, Neuroradiology
Department of Radiology
Weill Cornell Medicine/NewYork-Presbyterian Hospital
New York, NY
Richard Isaacson, MD
Director, Center for Brain Health,
Schmidt College of Medicine
Florida Atlantic University
Boca Raton, FL
Jennifer Sutherland, PharmD, BCEMP
Emergency Medicine Clinical Pharmacy Specialist
PGY2 Emergency Medicine Pharmacy Residency Program Director
Assistant Adjunct Clinical Professor-Division of Practice Management and Clinical Education
UNC Health | UNC Medical Center | UNC Eshelman School of Pharmacy
Chapel Hill, NC
This activity is jointly provided by Medical Education Resources (MER) and Efficient LLC and was developed in partnership with the Geriatric Emergency Department Collaborative (GEDC).
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by Medical Education Resources (MER) and Efficient LLC. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Disclosure of Relevant Financial Relationships
Medical Education Resources ensures balance, independence, objectivity, and scientific rigor in all our educational activities. In accordance with this policy, MER identifies relevant financial relationships with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Reported relevant financial relationships are mitigated by MER to ensure that all scientific research referred to, reported, or used in an accredited continuing education activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing learners with high-quality accredited continuing education activities that promote improvements or quality in health care and not the business interest of an ineligible company.
Efficient LLC and Medical Education Resources' planners and managers have no financial relationships to disclose.
Dr. Melady has no financial relationships to disclose
Dr. Biese reported the following financial relationships:
- Speakers Bureau: Apogee Health staffing for geriatric providers in the ER/, Third Eye Telehealth for residents in SNFs
Dr. Chiang has no financial relationships to disclose
Dr. Isaacson reported the following financial relationships:
- Consulting Fees: Acadia, Novo Nordisk
Dr. Sutherland has no financial relationships to disclose
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources, Efficient LLC, and/or Lilly. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.
This activity is supported by an educational grant from Lilly.
Method of Participation
There are no fees for participating in and receiving credit for this activity. During the period March 25, 2024 through March 25, 2025, participants must: 1) read the learning objectives and faculty disclosures, 2) complete the pre-and intra-activity assessment questions 3) participate in the live virtual activity, and 4) complete the evaluation form.
A statement of credit will be issued only upon receipt of a completed activity evaluation form.