**Abstract**

Our chapter contends that extended intranasal insulin administration can preserve pragmatic functioning even when there are temporal lobe and frontal lobe brain volume losses consistent with AD disease progression. CT scans of a patient receiving extended intranasal insulin 6 years after AD diagnosis are compared with his CT scans at the original MCI diagnosis. The results demonstrate that areas of the brain associated with pragmatic functioning were not as affected as expected in late-stage AD patients. This, along with linguistic evidence of preserved pragmatic competence, indicates the likely effectiveness of intranasal insulin treatment in enhancing neuronal activity in certain areas of the brain associated with pragmatic competence.

**Keywords:** MCI, intranasal insulin, brain atrophy, pragmatics
