# What ED Physicians Need to Know About New Amyloid Targeting Treatments: Side Effects and Treatment Cautions Part 1 About This Podcast 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 this series, Dr. Shenvi is joined by two guests: Dr. Richard Isaacson, a neurologist and Director of Research at the Institute for Neurodegenerative Diseases in Florida, and Dr. Kevin Biese, an associate professor at UNC Chapel Hill and director of the Geriatric ED Collaborative and Geriatric ED accreditation programs. In part 1, they delve into how ATTs work, which patients are good candidates for them, complications that may arise, and the financial implications of these new drugs. They tie these insights back to what this all means for ED physicians, focusing on how these patients present, what ED physicians need to know, and the actions they need to take to provide the appropriate care. Play the Episode https://youtu.be/RLeDAdwz3pE For more on this topic, continue to Part 2. Play Next Episode Key Points Alzheimer’s disease begins silently in the brain decades before memory loss symptoms appear. It starts with the buildup of amyloid protein that may be associated with or trigger tau tangles and through either neuroinflammation or a combination of amyloid and tau, results in neurodegeneration. Amyloid Targeting Treatments (ATTs) target beta-amyloid in the brain to slow neurodegenerative disease progression. Patients in the early stages of AD or with mild cognitive impairment are ideal candidates for ATTs. In ED settings, we need a shift in perspective to recognize which patients might be on ATTs. About 30% of individuals taking ATTs will develop amyloid-related imaging abnormalities (ARIA) but only about 6% of cases are symptomatic. The two main patterns of imaging abnormalities are ARIA-H (microhemorrhages) and ARIA-E (edema). Symptoms may be nonspecific (headache, confusion, vomiting, visual disturbance, and weakness) but can also mimic a stroke. Patients with the APOE4 gene, especially those with two copies, are at increased risk of both Alzheimer’s disease and side effects from ATTs. The high cost of ATTs, which can exceed $20,000 annually, and their evolving insurance coverage present significant financial challenges. Related Resources TOOLKIT | March 28, 2024 Preparing your Emergency Department for Patients on Amyloid-Targeting Therapy A toolkit capturing key information of amyloid-targeting therapy and offers practical guidance you can easily integrate into your everyday clinical practice. Explore Toolkit WEBINAR | March 25, 2024 A Guide to Amyloid-Related Imaging Abnormalities in Alzheimer’s Disease This webinar focuses on emergency medicine clinicians’ role in the recognition and acute management of ARIA, including how ARIA may present and what courses of action are needed for different ARIA severities. Watch Webinar References https://pubs.rsna.org/doi/10.1148/rg.230009 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629981/ https://www.mdpi.com/2077-0383/13/5/1245 Next, listen to Why Hospital-at-Home May be the Best Option for Your Next Patient with Dr. Mike Craig. Play Episode View All Dementia Resources >