**1. Introduction**

This chapter explores, on a brain circuitry level, why patients receiving extended intranasal insulin therapy continue to be able to ambulate independently, pay attention, speak, and participate in jokes even throughout late-stage AD [1–3]. We find that extended intranasal insulin administration can preserve pragmatic functioning even when there are temporal lobe and frontal lobe volume losses consistent with Alzheimer's brain (AD) volume loss. A series of CT scans of a patient receiving extended intranasal insulin from mild cognitive impairment (MCI) diagnosis and those from the same patient 5.5 years after AD diagnoses are examined. At baseline, this patient's original MCI CT scans indicated no significant intracranial pathology and normal aging brain morphology. Over time, we show how this patient demonstrates slower atrophy rates in occipital and thalamic structures as compared with the structural imaging of patients with disease progression from MCI to AD not receiving intranasal insulin therapy. Enhancing neuronal activity in the areas of the brain associated with pragmatic competence reduces the likelihood of anomia typical of late-stage AD.

This chapter is structured as follows: Section 1 examines studies of the perfusion of intranasal insulin in older adults concerning neuropsychiatric tests of cognitive decline in MCI and AD. Section 2 discusses CT scans and the medical and social history of the patient case study used in this chapter. Section 3 examines CT scans at three distinctive points in the patient's MCI to AD progression (at MCI diagnosis and 3.5 and 5.5 years receiving intranasal insulin therapy). Section 4 suggests that results demonstrating extended intranasal insulin treatment may slow disease progression

by reducing some areas of neuronal atrophy in the (thalamus) cortico-pulvinar projection system associated with the anomia typical of late-stage AD.
