Top Things to Know: Vascular Neurology Considerations for Anti-amyloid Immunotherapy

Published: December 11, 2024

Prepared by Sonija Shrestha, DNP, Associate Science and Medicine Advisor

  1. Anti-amyloid antibodies are the first FDA-approved disease-modifying treatments for Alzheimer’s Disease, bringing hope for early intervention.
  2. ARIA, a serious side effect of these therapies, can cause brain swelling (ARIA-E) or bleeding (ARIA-H), sometimes leading to permanent brain injury or even death.
  3. While ARIA can be dangerous, many cases show no symptoms or only mild ones like headache or confusion.
  4. Cerebrovascular experts will play a central role in managing patients with Alzheimer’s, given the vascular complications linked to amyloid immunotherapy.
  5. Patients with cerebral amyloid angiopathy (CAA), marked by microbleeds or cortical superficial siderosis, face heightened risk for ARIA and need careful evaluation before starting treatment.
  6. People on antithrombotic drugs and amyloid therapy could increase the risk of serious brain hemorrhages.
  7. For patients needing clot-busting treatments like tPA, amyloid immunotherapy could make bleeding in the brain more likely.
  8. High-dose corticosteroids may help in managing severe ARIA cases, though more data is needed to confirm their effectiveness.
  9. New real-world data from the Alzheimer's National Registry (ALZ-NET) will soon shape personalized treatments, improving safety and outcomes for amyloid immunotherapy.
  10. Health care professionals and patients should have advanced care discussions before starting amyloid therapies, especially to address the potential risks of stroke treatments and emergency interventions.

View the summary for Vascular Neurology Considerations for Antiamyloid Immunotherapy

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Citation

Greenberg SM, Aparicio HJ, Furie KL, Goyal MS, Hinman JD, Kozberg M, Leonard A, Fisher MJ; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Vascular neurology considerations for antiamyloid immunotherapy: a science advisory fromthe American Heart Association. Stroke. Published online December 11, 2024. doi: 10.1161/STR.0000000000000480

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