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ARIA Care Pathways: Voices from the Frontline | Episode 3: Applying Risk Mitigation Strategies

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 3 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

The Decision Matrix: Review Appropriate Use Recommendations to determine when to continue, suspend, or permanently discontinue dosing based on ARIA-E and ARIA-H severity.
Active Monitoring during Suspension: Learn why monitoring must continue with monthly MRIs even after a drug is paused, as ARIA can continue to evolve or worsen without further dosing.
Managing Severe Cases: Understand the specific, non-prophylactic role of high-dose corticosteroids (e.g., methylprednisolone) in managing serious or severe symptomatic ARIA events.

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

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 (Current Episode)

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

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:

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

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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 MTA. 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 3. We've detected an abnormality on the MRI. Now, the clinician faces a decision, continue, suspend, or discontinue. I'm joined by our expert, Doctor Anton Porstensson, a leading expert in Alzheimer's disease care. Welcome, Doctor Porstenson. Let's return to the case from the previous episode. The patient with asymptomatic moderate REAE multifocal edema. According to the appropriate use recommendations, what is the required action here? Can we just lower the dose or do we have to stop the infusions entirely? It's just uh to refresh everyone's memory, the uh, um, uh. The previous case had two localizations of RAE which made it moderate radiographic severity but asymptomatic. So if it had been symptomatic, we would pause treatment. This was asymptomatic. It wasn't mild, which would have allowed us to consider continuing treatment. It was moderate. So here we would pause. We would not give another infusion. We would keep in contact with the patient to make sure that symptoms didn't emerge later. And then we have a plan for something like this, and that is basically that you schedule an MRI about a month later to see if the radiographic evidence of RA E has cleared and also often as the RA E is clearing, um. RH, particularly microhemorrhages, might appear as the kind of cloud lifts. So we have suspended the treatment. The patient is at home, not receiving the drug. Does the MRI schedule stop because the drug stopped? What is the protocol for monitoring a patient who is currently suspended? So, um, um, yeah, uh, good question. And, uh, basically, uh, you, um, uh, do, uh, another MRI, uh, 4 weeks later. You look at the, the, um, uh, results. Quite often, um, um, if it is, uh, very, you know, low, uh, radiographic severity, so kind of the lower end of moderate. Um, the evidence of RE might disappear in 4 weeks, but often it has decreased but not fully resolved. You would then do another MRI 4 weeks later, so 8 weeks from the initial MRI. Um, uh, you look at that, is the resolution of the REA E. What happened in terms of RA H if there isn't resolution, um, uh, or, you know, maybe you see more, uh, uh, REA H, you may have to go to, um, uh, an MRI 4 weeks later, so at week 12. Um, obviously treatment is paused until we have full resolution of RA E and stability of RA H, and there are very good. Um tables that kind of define the recommendations both in the FDA label for leanimate as well as danimate as well as the appropriate use recommendations that have been been published, so You know, You can continue treatment in some situations. You will suspend treatment in some situations, and in the worst situations where you might have someone who's highly symptomatic. Um, high radiographic severity or you maybe now have a high number of microhemorrhages or more than one superficial cirrhosis or a macro hemorrhage or something like that, you might have to Discontinue treatment permanently. Uh, so there are guidelines, uh, that are available, uh, to follow in those situations. Turning to our patient advocate Cynthia, if your doctor told you treatment had to be paused because of a spot on an MRI, even if you felt fine, how would that impact your trust in the therapy? Would you be anxious to restart or hesitant? First of all, because of the trust level I have with my doctor, if um he said, we found this spot, we need to pause. That gives me great confidence that he's looking out for me, um, and I trust that judgment. So that's why it's so important to build that trust, um, and I I'd be anxious to restart if he thought it was, was safe for me, you know, again, if he had any doubt, then that gives me doubt, and I appreciate that because um he's depending on me to um always be honest about what I'm feeling and experiencing so that he can make a better determination like we saw the spot, but doesn't seem to be doing this, and so now, maybe we can restart. You know, but I, they've, you've got to have that um symbiotic, um, communication, you know, where you're going back and forth. Doctor Portenson, sadly, not every patient can resume. What are the hard stops? At what point do we say, it is no longer safe to ever administer this drug to this patient? So, number one, Every patient is different, so. I think it is important that even if you have a, you know, a milder picture or a moderate picture to make sure that the patient and their family is comfortable with continuing. Um, I've had the, uh, circumstances where, uh, you know, uh, symptoms or radiographic severity that was below the absolute cutoff criteria, um, uh. Had, you know, rattled the patient or the family enough that they were very hesitant about continuing, but there are also very much absolute stopping criteria. Our particular concern is a macro hemorrhage. Really any size, but absolutely, if it is greater than, uh, um, uh, than, uh, uh, 10 millimeters, um, I, I, I basically, any macrohemorrhage would be very concerning to me. Um, uh, new superficial cirrhosis, so more than one. Um, would be, uh, stopping criteria, more than 10 new microhemorrhages. So, for someone that, for example, had 2 at baseline, that would be a total of 12. For someone that had none, that, you know, would be, uh, uh, you know, more than 10, so 11, um. And then um uh other things would be highly symptomatic aria, um, as well as recurrence. So, I've had it happen a few times that someone had an RA E very early, and then that resolved. We started treatment again and Aria returned. Um, uh, the same person actually then had a 3rd occurrence, and on the 3rd occurrence, you know, I think that both myself and the patient and family were like, OK, this doesn't look too good, even if all of them were asymptomatic, all of them were low radiographic severity. So, um, um, uh, basically recurrence, um, requires a conversation. Do we, uh, do we keep going or, or