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Anti-Amyloid Therapies for Alzheimer’s Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician - 17/01/25

Doi : 10.1016/j.annemergmed.2024.12.002 
Megan A. Rech, PharmD, MS a, , Christopher R. Carpenter, MD, MSc b, Neelum T. Aggarwal, MD c, Ula Hwang, MD, MPH d, e
a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare Edward Hines, Jr. VA Hospital, IL 
b Department of Emergency Medicine, Mayo Clinic School of Medicine, Rochester MN 
c Departments of Neurological Sciences, Rush Alzheimer’s Disease Center, Chicago, IL 
d Departments of Emergency Medicine & Population Health, New York University Grossman School of Medicine, New York, NY 
e Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 17 January 2025

Abstract

Alzheimer’s disease is the neurodegenerative disorder responsible for approximately 60% to 70% of all cases of dementia and is expected to affect 152 million by 2050. Recently, anti-amyloid therapies have been developed and approved by the Food and Drug Administration as disease-modifying treatments given as infusions every 2 to 5 weeks for Alzheimer’s disease. Although this is an important milestone in mitigating Alzheimer’s disease progression, it is critical for emergency medicine clinicians to understand what anti-amyloid therapies are and how they work to recognize, treat, and mitigate their adverse effects. Anti-amyloid therapies may be underrecognized contributors to emergency department visits because they carry the risk of adverse effects, namely amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities are observed as abnormalities on magnetic resonance imaging as computed tomography is not sensitive enough to detect the microvasculature abnormalities causing vasogenic edema (amyloid-related imaging abnormalities-E) microhemorrhages and hemosiderin deposits (amyloid-related imaging abnormalities-H). Patients presenting with amyloid-related imaging abnormalities may have nonspecific neurologic symptoms, including headache, lethargy, confusion, and seizures. Anti-amyloid therapies may increase risk of hemorrhagic conversion of ischemic stroke patients receiving thrombolytics and complicate the initiation of anticoagulation. Given the novelty of anti-amyloid therapies and limited real-world data pertaining to amyloid-related imaging abnormalities, it is important for emergency medicine clinicians to be aware of these agents.

Le texte complet de cet article est disponible en PDF.

Keywords : Alzheimer's, Anti-amyloid therapy, Amyloid-related imaging abnormalities, Dementia


Plan


 Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
 Author contributions: MAR: narrative review idea, writing – original draft. CRC: writing – critical revisions. NTA: writing – critical revisions. UH: writing – critical revisions. All authors contributed substantially to the revision process. MAR takes responsibility for the paper as a whole.
 All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). MAR has a grant from the Emergency Medicine Foundation/AstraZeneca unrelated to this topic. CRC is Associate Editor for the Journal of the American Geriatrics Society, leads the Society for Academic Emergency Medicine Guidelines for Reasonable and Appropriate Care in the Emergency Department committee, serves on the American College of Emergency Physicians Clinical Policy Committee, is Chair of the American College of Emergency Physician’s Geriatric Emergency Department Accreditation Advisory Board, serves on the Clinician-Scientist Transdisciplinary Aging Research Leadership Core, and is an editor for the American College of Emergency Physician’s MyEMCert program. NTA has had several grants in the last 36 months (R01AG062637, R01AG061848, R01AG053798, R01AG066910, R01AG065248, U01AG082350, U24AG082930, R01AG058679, R01AG073627, UH2AG083289, P30AG072975, R01AG077489, R01AG083764, R44AG077737). This study was supported by the National Institute of Aging Geriatric Emergency Care Applied Research Network Award: R33AG058926 (Hwang).


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