PeerView Neuroscience & Psychiatry CME/CNE/CPE Audio Podcast
Sep 18, 2026 · 39 min · 13 segments
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups. For the full…
Tammie L.S. BenzingerGuestModule one is going to be, would you recognize ARIA in your reading room? Many of us are well aware now that there are new infusion therapies available for Alzheimer's disease, and these are now becoming available globally.
In most regions of the world, all of them that are approved so far, there are specific warnings that come with it, however.
And this is an example of a black box warning that the U.S. FDA has applied talking about amyloid-related imaging abnormalities.
And this is a specific finding that radiologists are responsible for recognizing.
So what is ARIA? Basically, what we're looking for is vasogenic edema and small hemorrhages, either microhemorrhages or siderosis, that we see on MRI.
This is related to the actual clearance and targeting of beta amyloid, which in the setting of Alzheimer's disease is accumulating both in the brain parenchyma, but also in the blood vessels.
We're very familiar with this in radiology as cerebral amyloid angiopathy or CAA.
So for patients who are not on therapy, when we saw these findings, we would be talking about CAA.
If you see something that looks like CAA for a therapy patient, then we need to flag it as ARIA.
What are the risk factors for ARIA? What's been very well established is the patient's age, the older they are, the higher the ARIA risk.
So patients who are homozygous for ApoE4 are most likely to have symptomatic or severe ARIA.
And in many places, patients who have homozygosity for this are not allowed to go on to therapy.
So for example, in the United States, while it's allowed according to the FDA, many of our patients Specialist practice guidelines advise against it at the VA.
And in other parts of the world, such as Brazil, patients with homozygosity for APOE4 are not candidates for therapy because of this ARIA risk.
The other thing that we know happens is that it's associated with the increasing dose, and that means timing during dose escalation.
So most of these therapies, they have an increasing dose over the first few months of treatment, and that's where the ARIA risk is greatest.
Other things that have come out and were reported in a presentation from the U.S. FDA at the Alzheimer's Conference in 2026 include the baseline number of microhemorrhages and siderosis, again, something we can see on imaging, as well as there are numerous reports coming out about a patient's baseline hypertension, even before therapy.
So it's important for these patients to be well-controlled for their hypertension.
What are the mitigation strategies for ARIA risk? Well, obviously, noticing if they have hypertension, the dose escalation.
And for us in radiology, it's very, very important when we're looking at these baseline scans to use a protocol and reporting structure that will consistently identify even just one microhemorrhage, unfortunately, because for all of us, we know that's really tough and may not necessarily be what we're used to in practice.
We also need to recognize that ARIA is in the differential diagnosis for these patients, particularly if they show up in our ER as a code stroke patient later.
Module one is going to be, would you recognize ARIA in your reading room? Many of us are well aware now that there are new infusion therapies available for Alzheimer's disease, and these are now becoming available globally.
In most regions of the world, all of them that are approved so far, there are specific warnings that come with it, however.
And this is an example of a black box warning that the U.S. FDA has applied talking about amyloid-related imaging abnormalities.
And this is a specific finding that radiologists are responsible for recognizing.
So what is ARIA? Basically, what we're looking for is vasogenic edema and small hemorrhages, either microhemorrhages or siderosis, that we see on MRI.
This is related to the actual clearance and targeting of beta amyloid, which in the setting of Alzheimer's disease is accumulating both in the brain parenchyma, but also in the blood vessels.
We're very familiar with this in radiology as cerebral amyloid angiopathy or CAA.
So for patients who are not on therapy, when we saw these findings, we would be talking about CAA.
If you see something that looks like CAA for a therapy patient, then we need to flag it as ARIA.
What are the risk factors for ARIA? What's been very well established is the patient's age, the older they are, the higher the ARIA risk.
So patients who are homozygous for ApoE4 are most likely to have symptomatic or severe ARIA.
And in many places, patients who have homozygosity for this are not allowed to go on to therapy.
So for example, in the United States, while it's allowed according to the FDA, many of our patients Specialist practice guidelines advise against it at the VA.
And in other parts of the world, such as Brazil, patients with homozygosity for APOE4 are not candidates for therapy because of this ARIA risk.
The other thing that we know happens is that it's associated with the increasing dose, and that means timing during dose escalation.
So most of these therapies, they have an increasing dose over the first few months of treatment, and that's where the ARIA risk is greatest.
Other things that have come out and were reported in a presentation from the U.S. FDA at the Alzheimer's Conference in 2026 include the baseline number of microhemorrhages and siderosis, again, something we can see on imaging, as well as there are numerous reports coming out about a patient's baseline hypertension, even before therapy.
So it's important for these patients to be well-controlled for their hypertension.
What are the mitigation strategies for ARIA risk? Well, obviously, noticing if they have hypertension, the dose escalation.
And for us in radiology, it's very, very important when we're looking at these baseline scans to use a protocol and reporting structure that will consistently identify even just one microhemorrhage, unfortunately, because for all of us, we know that's really tough and may not necessarily be what we're used to in practice.
We also need to recognize that ARIA is in the differential diagnosis for these patients, particularly if they show up in our ER as a code stroke patient later.
The rest of this transcript — segmented and speaker-labeled, so you land on the exact moment something was said
Search every transcript — by keyword, by phrase, or by meaning, across every show Radar indexes
Trends — what is surging across podcasts, measured against its own baseline
Alerts — when a name you follow appears in a newly indexed episode
No account is needed to search Radar.
