This site is intended for healthcare professionals

ARIA Care Pathways: Voices from the Frontline | Episode 4: Coordinating Multidisciplinary ARIA Response

General Practice

Old age psychiatry

Share

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 4 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

Avoiding the Stroke Mimic Trap: Learn why it is catastrophic to administer standard stroke protocols like tPA (thrombolytics) to ARIA patients and how to implement emergency protocols for urgent MRI.
Closed-Loop Communication: Establish best practices for urgent radiology-to-neurology handoffs, including the necessity of verbal communication and EMR flags for new or worsening ARIA.
Acute Management Pillars: Review the critical steps for managing severe symptomatic ARIA in an ICU setting, including blood pressure control for malignant hypertension and seizure management.

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

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 (Current Episode)

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

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:

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

Similar communities

Similar events and on demand videos

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 META. MEA 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 and early Alzheimer's disease. Over 4 episodes, we're cover practical cases addressing real world challenges in ARIA detection and management. Welcome to the final episode where we are stepping out of the memory clinic and into the emergency department. When Aria presents acutely, how does the system respond? I'm joined by our expert, Doctor Anton Porstensson, a leading expert in Alzheimer's disease care. Welcome. Doctor Porstenson, we have a potentially dangerous scenario described in the literature. A patient on anti-amyloid therapy presents to the ER with sudden confusion, headache, and perhaps some focal deficit. To an ER doctor, this looks like a stroke. Why is it critical that they know this patient is on an anti-amyloid therapy before they initiate standard stroke protocols, specifically regarding TPA thrombolytics? Um, this is always highly concerning, and we take special precautions to mitigate this risk. So let me start with that because I think that number one, you have to tell the patient and their care partner. Uh, about, uh, this possibility right at the start and tell them, if you ever end up in the emergency room with, uh, uh, these symptoms, um, uh, you need to tell people that you're on, uh, a treatment with a humanized monoclonal antibody targeting beta amyloid. We also give them a card, uh, to carry. Uh, and show to their providers. Furthermore, in our electronic medical record, we flag them. Um, but you know, as they're traveling, uh, and that hospital doesn't have access to our medical record, we want them to be informed. Why are we so concerned about this? Uh, when you have, um, RA. And if, especially if the radiographic severity is, is significant, um, I remember one instance where the um Radiologist instead of calling us, the, uh, uh, uh, treatment team, uh, called the primary care doc. And the primary care doc said, oh my God, straight to the emergency room. Uh, that person thankfully didn't, uh, present with stroke symptoms. If you have stroke symptoms, every minute matters. Um, and the, uh, emergency room, uh, providers are, are very sensitive to that and appropriately so. So what do they do? They get most often just a CT scan. Um, they may get a, a, a, a shorter protocol MRI scan. And if they don't know that there is the potential for Aria here, they won't use the right type of scan, and they won't include the right type of sequences. Let's say that, um, uh, this person, uh, isn't having a stroke. Remember, we talked about the clinical symptoms of, um, uh, aria and so they come in with a headache, they come in with vague neurological symptoms. Um, um, yep, that mimics a stroke for sure. And then what is RAE? It is basically an angitis. The the vessels are, are more leaky. They're more brittle. And if you throw an antithrombolytic agent into this, you can be in severe trouble that, you know, we have a few cases where this has happened. And there was basically severe bleeds in, in multiple regions of the, of the brain, and this could have been avoided. This person should have had a different type of treatment, that is, uh, symptomatic treatment for the symptoms that they have. And if there was a further intervention, it probably should have been a steroid. Let's ask our patient advocate, Cynthia, does your care team provide you with a wallet card or a specific letter to carry to the emergency room? How empowered do you feel to tell an ER doctor, I am on an Alzheimer's infusion, please call my neurologist. Oh, absolutely. Um, I think it's so important to have some sort of, um, card or letter. So that if you're in a place where you're feeling especially anxious or you can't articulate what's going on or somebody else is driving you to an urgent care or emergency center to say um we need to get this, this is so important because the, the treatment um uh how, how they move forward depends on the knowledge of what you're already Um, on and, and you know that it's important that they all communicate with each other so I'm good with that, um, and I encourage everybody, um, if your study doesn't have, um, you know, that treatment information, um, to get that to your, your Patients, your research participants so that they can share that. Um, I have no problem whenever I go for a visit to a doctor I don't know, I always tell them I'm living with, with amnestic mild cognitive impairment due to Alzheimer's disease, so I want you to write things down. Um, the more we can share and be honest about the current situation as opposed to, well, it's not really important that you, um, no, it really is important and you want everyone to be safe. And you want to have the best outcome, you know, and we can only do that if we communicate. Doctor Portenson, the radiologist is often the first to see the problem. In your institution, what is the protocol for urgent radiology communication? If a radiologist sees new RAE on a scan, is an EMR note enough, or do you require a verbal handoff? When we started commercial treatments with the humanized monoclonal antibodies, we basically decided that we were going to use one radiology, neuroradiology group, uh, yes, within our system. But we built with them a template and basically it is clear that any MRI done as part of this monitoring sequence highlights what it is for, because a radiologist has to kind of understand, you know, what is being asked of him or her. Um, we also have basically an agreement that they call us, that we're the ones that are requesting the MRI and that if they see something they say something, and that is that they call us. We don't want to read about it, you know, whenever we. Open up our inbox and the electronic medical records or lo and behold, we get, uh, you know, a paper either faxed to us or sent to us, that's not good enough. So there needs to be a verbal handoff. Let's look at the worst case scenario. We have a case study of a 60 six-year-old male who developed severe headache, confusion, and inability to read. He arrived at the hospital with a BP of 206, 116. This patient required ICU admission. What are the key pillars of managing this severe symptomatic ARA event in an acute setting? So first of all, this is a medical emergency. This is a very rare occurrence. This is a highly symptomatic RAE presentation. And we're we're assuming that that's it. There can be other reasons, and that's why actually it is really important basically that that they do the right imaging in the, in the hospital. But let's just assume they found an R E. So again, Symptomatic management. Uh, this patient is, uh, hypertensive. Uh, uh, we have to address this kind of malignant, uh, hypertension with appropriate treatment. Um, if there are, uh, you know, if there's a serious headache, uh, we need to treat that. But you cannot treat it with, uh, uh, I would advise against treating it with NSAIDs or aspirin or anything that changes the, uh, the, the bleeding parameters here, uh, confusion. So the right environment, the right support. Uh, there's a visual disturbance here, so, uh, uh, we need to understand this something happening, uh, uh, to the, uh, to the eye, or, uh, or, or is this just.