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ARIA Care Pathways: Voices from the Frontline | Episode 2: Detecting Early ARIA with Confidence

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 2 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

Distinguishing Pathology: Understand the clinical differences between ARIA-E, which typically resolves, and ARIA-H, which represents persistent microhemorrhages or superficial siderosis.
Identifying Asymptomatic Cases: Gain insights into why over 75% of ARIA cases are asymptomatic and how to radiologically grade Moderate ARIA-E based on multifocal FLAIR hyperintensity.
Imaging Nuances: Learn why using more sensitive sequences like Susceptibility Weighted Imaging (SWI) is critical for accurately reclassifying ARIA severity and determining patient eligibility.

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

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

Please click here to access Episode 1.

15 min - Episode 2: Detecting Early ARIA with Confidence (Current Episode)

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

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:

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

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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 Metall. 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 back 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 2. In this episode, we are moving from the consultation room to the reading room. We will focus on the radiologic and clinical detection of AA. I'm joined by our expert, Dr. Anton Porstensson, a leading expert in Alzheimer's disease care. Welcome, Dr. Porstenson. Let's clarify exactly what we are looking for. We use the terms ARA E and ARA H a lot in this program. Can you briefly distinguish the two in terms of what is physically happening in the brain and specifically if they resolve and or persist? So it is important to understand, um, that RAE and RAH, um, are specific occurrences, and they're, they're not just kind of uh imaging related abnormalities. Um, they can be symptomatic. In rare situations, but mostly they're, they're asymptomatic. That's why we do the MRI monitoring. Uh, Most of them we find just on scheduled imaging. So REA, like I said, stands for amyloid-related imaging abnormality. The E stands for edema. And then, uh, we used to call it the vasogenic edema, uh, previously, and that tells you that it has something to do with the vasculature and some swelling. The other one is RA H and the H stands for hemorrhage. And, um, that can be microhemorrhage. Kind of a pinhead sized bleeds that happen in the, um, uh, brain because of uh fragility of uh the uh small vasculature. Uh, it can be a superficial cirrhosis, which is like a, a, a microhemorrhage, but on the surface, so, uh, of the brain, so it kind of, uh, looks more like a smudge. Um, in rare instances, uh, it can be a, a macro hemorrhage, so a larger bleed, and those obviously we're highly concerned about because of the possibility for negative outcomes or bad outcomes. So, How did this happen? Um, in Alzheimer's disease, uh, amyloid, fibrillary beta amyloid tends to infiltrate the vessel walls, particularly in the very small artery, arteries, uh, the deep penetrance, uh, particularly. And they make the, the wall more brittle. They make the vasculature overall more brittle, and actually spontaneous microhemorrhages are not that uncommon in people that don't get, uh, you know, any anti-amyloid treatments at all. So, uh, RAE is, in my opinion, the big ticket here. And, and what happens? You've got this fibrillary beta amyloid in the vessel walls of these arteries. You give an antibody that binds to fibrillary beta amyloid, uh, kind of, uh, you know, um, oxidizes it and you bring in inflammatory cells. The first amyloid, uh, uh, fibrillary beta amyloid that the antibody meets is basically the one in the, uh, in the vessel walls. And that is removed quite quickly, varies by individuals, but can be a very quick process. In the long run, that ought to be good. But if there's an imbalance between the amyloid being removed and we have some, uh, maybe angitis, uh, from the, uh, inflammatory cells moving in, and the healing of the vessel walls, they can temporarily become leaky. Again, it's an early event. Most, um, REAE is seen in the 1st 3 months, and, um, um, uh, the vast majority of this within the 1st 6 months of, uh, of treatment. Um, RAE, um, um, can be a small area. It can be seen in multiple areas. It can be quite large. So there, there's radiographic definition of, uh, basically the, uh, the severity. But, um, um, AA resolves, RAE resolves. Um, it usually resolves somewhere between, uh, you know, 4 to 12 weeks, the vast majority between 4 and 8 weeks. So, um, it settles down. Uh, are you age, on the other hand, um, you know, once you have a bleed, uh, even if the blood is, um, uh, absorbed. It, it leaves a stain, a hemoglobin stain, and remember that the hemoglobin is an iron-carrying protein. And an MRI at the right sequences is very sensitive in finding these, and they tend not to resolve because of the stain left behind. The microbleed may resolve, but the stain left behind allows us to detect it for a much longer time on, on, on the imaging. Uh, and that's why we kind of maintain account how many microhemorrhages were present at the, uh, baseline, how many have been added, maybe at different time points. And, uh, and, and we really look at the kind of, uh, you know, uh, if, if there is an addition, um, how, how many are they and the kind of, uh, what, uh, what is a new finding, uh, and, and what was something that maybe happened at, uh, you know, before an earlier infusion. So we keep a close eye on that. But that's, uh, basically how these two events, uh, come about. Let's look at a specific scenario. A patient is on therapy and comes in for their scheduled safety MRI before their 4th infusion. They tell the nurse they feel fine, no headaches, no issues. You look at the scan and see two separate areas of flare hyperintensity, one in the frontal lobe, one in the occipital lobe. First, does the lack of symptoms change how you grade this? And second, how would you classify that specific finding? So about 75% of AA E. Is silent, no symptoms whatsoever. About the 20, 25% is um uh symptomatic, and most of those symptoms are very mild, pretty nebulous. Um, then, uh, you have rare instances of, um, uh, kind of highly uh symptomatic RAE and that's in basically the single digit percentages. Um, so this is a very typical, uh, picture. Uh, someone, uh, comes in, uh, this is before the next infusion. An MRI has been done by schedule, and the read suggests that there is RAE present. And then um we have a specific categories. So there is a radiographic uh uh severity that has been basically proposed by the American College of Radilogy that lists R E. Uh, as mild, moderate, and severe. This is just the radiographic severity. It doesn't include symptomatic. Um, and RA H also, uh, is rated as mild, uh, moderate, and, uh, severe. Um, so, uh, mild RAE is just a, uh, kind of a, a small single smaller region. Um, so, uh, basically less than 5 centimeters, uh, uh, across it's, um, biggest, uh, width. Uh, if you have 2. Uh, different locations or a location that is a single location that is 5 to to 10 centimeters. Now we have moderate severity and anything above that falls into the severe radiographic severity for microhemorrhages, uh, basically, um,