What ED Physicians Need to Know About New Amyloid Targeting Treatments: Side Effects and Treatment Cautions Part 2

with Richard Isaacson and Kevin Biese

In 2024, dementia care costs are projected at 360 billion dollars, anticipated to rise to 1 trillion by 2050. Currently, 7 million people in the US have Alzheimer’s Disease (AD). AD not only affects individuals but also their families, with 11 million unpaid family caregivers providing essential support for those living with AD. New Amyloid Targeting Treatments (ATTs) have the potential to offer some therapeutic benefits for AD. However, there are some side effects and risks associated with them, particularly the use of one of the more controversial drugs in Emergency Medicine, tPA.

In Part 2 of this series, Dr. Christina Shenvi, Dr. Richard Isaacson, and Dr. Kevin Biese continue their conversation on ATTs using case scenarios to illustrate the decision-making challenges faced by Emergency Department (ED) care providers. This episode highlights the nuanced and rapidly evolving landscape of treating Alzheimer’s patients with these new medications and what EDs need to consider as they prepare to care for these patients.

Key Points

  • Emergency department physicians face significant challenges managing patients on ATTs who present with stroke-like symptoms. The uncertainty is compounded by the lack of extensive data on the interaction between thrombolytics, such as tPA, and these treatments.
  • Shared-decision making is essential in ED settings to balance the risks and benefits of using thrombolytics, ideally involving the interdisciplinary team and the patient’s family.
    • Consider the patient’s vascular risk factors, duration of treatment with ATTs, and access to MRI.
    • Patients on ATTs may face a higher risk of intracranial hemorrhage when treated with tPA for stroke.
  • There is a need for proactive planning and a standardized approach to managing patients on ATTs.
  • There is a need for conversations between neurologists, social workers, and patients about conveying which patients are on ATTs to emergency medical providers.
  • ED physicians should stay updated with evolving guidelines and evidence to ensure they are making informed decisions.

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