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ARIA Care Pathways: Voices from the Frontline | Episode 1: Designing SDM Pathways

General Practice

Old age psychiatry

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Description

This program is supported by an independent education grant from Lilly. This online education program has been designed for healthcare professionals globally excluding the UK.

This is Episode 1 of a four-part podcast series.

Join internationally recognized Alzheimer’s disease expert Anton Porsteinsson, MD, for this podcast series exploring the latest evidence in identifying, mitigating, and managing ARIA in clinical practice.

Throughout four expert-led episodes, we navigate the complexities of anti-amyloid therapies, from mastering shared decision-making to establishing multidisciplinary protocols for urgent ARIA response.

Accreditation:

AffinityCE designates this activity for 0.25 AMA PRA Category 1 Credit™
This activity is accredited by the EBAC® for 15 minutes of effective education time.

Session Highlights

Defining Realistic Goals: Learn how to frame the benefits of anti-amyloid therapies by managing expectations of "slowing decline" versus "cognitive improvement" for patients with very mild dementia.
Personalized Risk Stratification: Discover how APOE genotyping quantifiably changes the conversation regarding symptomatic ARIA risk.
The Lifestyle Commitment: Discuss the "lifestyle cost" of therapy, including the mandatory schedule for safety MRIs and the essential role of the care partner.

Who Should Watch

This program is designed for healthcare professionals involved in Alzheimer’s disease diagnosis, imaging, treatment, and acute evaluation, including:

Neurologists
Radiologists and Neuroradiologists
Emergency Medicine Physicians
Psychiatrists and Geriatric Psychiatrists
Primary Care Physicians (MD/DO)
Nurse Practitioners and Physician Assistants
Infusion Center Staff
Nursing Staff
Triage Specialists
Frontline Clinical Support Teams

Presented by

Anton P. Porsteinsson, MD - a Professor of Psychiatry, Neurology, Neuroscience, and Medicine at the University of Rochester School of Medicine and Dentistry. As the Director of the Alzheimer’s Disease Care, Research, and Education Program (AD-CARE), he is a world-renowned investigator in the diagnosis and treatment of Alzheimer's disease and related dementias.

With over 240 publications and decades of clinical experience, Dr. Porsteinsson is a leading voice in developing safety protocols and risk mitigation strategies for emerging anti-amyloid therapies.

Rev. Dr. Cynthia Huling Hummel is a Patient Advocate who was diagnosed with Alzheimer's disease in early 2016.

Program Schedule

ARIA Care Pathways: Voices from the Frontline

In discussion with Anton P. Porsteinsson, MD

15 min - Episode 1: Designing SDM Pathways (Current Episode)

Design individualized treatment plans for early AD that balance patient/caregiver goals with ARIA risk-mitigation strategies.

15 min - Episode 2: Detecting Early ARIA with Confidence

Accurately detect and classify early ARIA (ARIA-E and ARIA-H) on MRI or by symptom recognition.

Please click here to access Episode 2.

15 min - Episode 3: Applying Risk Mitigation Strategies

Integrate dose-modification tactics and MRI scheduling protocols into treatment plans for patients on anti-amyloid therapies.

Please click here to access Episode 3.

15 min - Episode 4: Coordinating Multidisciplinary ARIA Response

Implement multidisciplinary ARIA response protocols, including urgent radiology communication, EMR alerts, and cross-specialty coordination.

Please click here to access Episode 4.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Lilly.

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures

Anton P. Porsteinsson, MD, has disclosed financial relationships within the past 24 months with the following ineligible companies: Eisai and Lilly. These relationships include receiving research grants to his institution from both, and serving as a DMC member for Lilly.

These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr. Porsteinsson intends to discuss non-FDA uses of drug products and/or devices and their unlabeled indications. He will disclose to the audience when this discussion takes place.

Rev. Dr. Cynthia Huling Hummel has no relevant financial relationships with ineligible companies to disclose.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

EBAC® CME Information:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the European Board for Accreditation of Continuing Education for Health Professionals (EBAC)

MedAll is an EBAC accredited provider since 2025. The European Board for Accreditation of Continuing Education for Health Professionals (EBAC) accredits Continuing Education (CE) programmes for the international medical community.

This program is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 15 minutes of effective education time.

In compliance with EBAC guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CE activities.

EBAC® holds an agreement on mutual recognition of substantive equivalency with the US Accreditation Council for CME (ACCME) and the Royal College of Physicians and Surgeons of Canada, respectively.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) and the American Medical Association, physicians may convert EBAC® External CME credits to AMA PRA Category 1 Credits. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of participation in an activity eligible for conversion of credit to AMA PRA Category 1 Credit.

The Accreditation Council for Continuing Medical Education (ACCME) and the Royal College of Physicians and Surgeons of Canada hold an agreement on substantial equivalency of accreditation systems with EBAC.

EBAC® is a member of the International Academy for CPD Accreditation (IACPDA) and a partner member of the International Association of Medical Regulatory Authorities (IAMRA).

How to Obtain Your EBAC® Certificate:

Participants must complete the full activity, the post-test, and the evaluation form before the stated expiration date. There are no prerequisites, and there is no fee to participate or certificate. A Certificate of Completion will be issued upon successful completion of all required components.

A minimum passing score of 70% on the post-test is required. Participants should consult their own professional licensing authority regarding eligibility to claim credit for this educational activity.

EBAC® only awards CE certificates in increments of 1.0 credit.

Participation Costs

There is no cost to participate in this program.

This continuing education activity will expire on December 31st 2026.

Estimated time to complete this activity: 15 minutes.

Content is accurate as of the date of release.

Learning objectives

Upon completion of this activity, participants should be better able to:

Design individualized treatment plans for early AD that balance patient/caregiver goals with ARIA risk-mitigation strategies.

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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Welcome to the Quick Consult podcast brought to you by Metal. Before starting this podcast, please review the faculty information, disclosure statements, and learning objectives using the link in the episode description. To claim your CME credit, complete the evaluation using the link in the episode description. This podcast is a continuing education activity managed and accredited by Affinity CE in collaboration with Medall. Medall is a European board for accreditation of continuing education for health professionals accredited provider. This activity is supported by an independent medical education grant from Lily. Welcome to AA Care Pathways, Voices from the Frontline, a podcast series dedicated to navigating the use of anti-amyloid therapies in early Alzheimer's disease. Over 4 episodes, we'll cover practical cases addressing real world challenges in ARIA detection and management. Welcome to episode 1. In this episode, we will focus on designing individualized treatment plans for early AD that balance patient and caregiver goals with AIA risk mitigation strategies. I'm joined by our expert, Doctor Anton Porstensson, a leading expert in Alzheimer's disease care. Welcome. Mr. Porstenson, let's start with the initial consultation. We know from the data that defining the benefit is just as important as defining the risk. Let's look at a typical profile. A 76 year old woman, independent, perhaps a retired administrator, presenting with mild memory issues. With a QDRS score of roughly 5/30. When you sit down with a patient like this, who is functionally independent but worried, how do you frame the goal of treatment with anti-amyloid therapies? Specifically, how do you manage the expectation of improvement versus slowing decline before you even bring up the safety risks? What is incredibly important is to, um, uh, apply a personalized medicine approach. And that is that the benefit and the risks for the disease modifying treatments, that is the, uh, anti-amyloid antibodies that currently are approved in multiple countries, uh, you, you, you've got to personalize it. So here we have a pretty typical, um, presentation. Someone who's noted that cognitive difficulties is functionally still pretty independent, and the quick dementia rating scale score suggests that they are kind of in the late mild cognitive impairment stage. Um, if this person has, um, uh, Alzheimer's disease, and that would be one of the next steps of, uh, treatment, uh, a disease modifying, uh, therapy, uh, would be an appropriate consideration. So what do I tell people? I tell people that for the average person, they can expect a slowing of decline that the treatment, even if it is able to fully clear out all beta amyloid plaques, it doesn't cure the disease because Alzheimer's disease is more than just an amyloid dysregulation. So, the average person can expect that somewhere between 25 to 35% uh slowing of a decline compared to someone who doesn't get the treatment. So was on a placebo, for example, in the clinical trials. But, um, that percentage slowing varies. And what we do know is that someone who is earlier in their disease and maybe has less. Uh, amyloid, uh, plaque burden or less tau tangle burden can do better. So I emphasize the importance of getting started early, that if this is of interest, this type of treatment, that it's not a good idea to kind of push it out. Let me see when I start to worsen. So there is a range of improvement, but most of all, It doesn't cure the disease. Very, very few people experience any type of improvement in their symptoms. This buys you time. You stay much longer in the milder stage of illness, and particularly for this person who is functionally intact. They can remain that way. They retain their function longer, and that's one of the most important aspect of uh of benefit, uh, to my patients at least. I'd like to bring in our patient advocate Cynthia here to give us the other side of that conversation. When you or your loved one were first considering these treatments, how was the risk of side effects explained to you? Did the doctor use medical terms like edema, or did they explain what that actually meant for your daily life? Well, thank you for the opportunity to share that experience. It wasn't until very recently that we even had treatments that were approved in the United States, and so, um, right from the get-go, people would say to me, have, are you starting a treatment, you know, um, I read this in the paper, are you going to be taking this drug? And I've done so much research on my own, um, that I realized Uh, right from the very beginning that I could not, uh, take the, the drugs that, that were first, um, available because I am homozygous AOE4 and everything I read told me about some of the, um, side effects including RA and edema. So I've done a lot of reading, um, about, um, the side effects and I realized because I live alone. Um, I could not take those drugs. It would just be too risky. And so only recently, it looks like there's a, um, a medication, a drug that I can take, and I'll be starting the rantinumab study, um, God willing, um, my, um, intake visit is in February and I'm scheduled for my first infusion, um, in April. So, um, I'm well aware the doctors, you know, of course, have gone over the side effects with me and I, I was aware of the terminology even before we, we met, but many patients need to have that information. Um, so they can determine whether or not they wanna participate. So I really encourage the, the doctors who are thinking about, um, having a treatment for their patients to explain in, in, in, in a very basic way what those definitions mean. I think it's sometimes people who are professional and they, they use the terms in their everyday work, but those of us Who are just, um, you know, not in the medical field need more explanation. What does edema mean? What, what does, you know, how can that be put in a, a simple way about brain swelling or brain bleeding or when we talk about aria, you know, so you need to make sure that the patient understands. Um, you might have to explain it two or three times in, in different ways based on their education and based on their knowledge because they need to have that information to make a decision on whether or not to go into the treatment. Doctor Porstensson, let's talk about quantifying that risk. Returning to our 76 year old patient, let's say her biomarker testing confirms AD and you order genotyping. She comes back as APOEE3 E3. How does an E3 E3 status change your conversation compared to an E4 carrier? Can you give us the specific risk numbers you would quote to this patient regarding symptomatic ARA? So First of all, um, this person was biomarker verified, uh, and then now we know that, uh, they are an 8.3 homocyte. They've got two copies of, uh, the 8.3 gene, which is the most common genotype, um, uh, uh, among the public. So basically what that means is that they have just the same potential for benefiting from treatment, that is in terms of slowing of the decline, and it does change their overall risk profile. So with someone like her, I would point out that if they were picking and one of the anti-amyloid antibodies, be that leanimab or denanimab, for leanimab, I would say the average person participating in the studies had a risk. of about 12.5%. For donanimab with the standard dose titration, it was about 24%, but maybe lower, down to 14% for someone who goes on a slower titration. Um, I would highlight to them what I'm talking about, that I'm talking about AA E and AA H, and that sounds very benign. So amyloid-related, uh, imaging abnormalities, uh, and E stands for edema, and, um, uh, H stands, uh, for hemorrhage. Um, the main concern is RAE.