1. HOW CAN NEUROIMAGING HELP UNDERSTAND, DIAGNOSE, AND DEVELOP TREATMENTS FOR ALZHEIMER'S DISEASE? Part D1 – AD brain scans – perfusion SPECT NUCLEAR MEDICINE GRAND ROUNDS Stanford University J. Wesson Ashford, M.D., Ph.D. Clinical Professor (affiliated), Department of Psychiatry and Behavioral Sciences Senior Research Scientist, Stanford / VA Aging Clinical Research Stanford University and VA Palo Alto Health Care System January 5, 2010 Slides at: www.medafile.com (Dr. Ashford’s lectures)www.medafile.com

6. Relation of SPECT severity to duration of dementia (years) Shih, Ashford et al., 2000 SPECT severitySPECT gradeDementia Duration Normal0start= 0 years Near-Normal11 Mild22 Mild-moderate33 Moderate44 Moderate-severe55 Severe66 Severe-profound77 Profound88

10. SPECT scans – normalization to cerebellum on Left to Right, to Talraich space

11. Ashford et al, 2000 SPECT scan locations of cortex, local elements shown with Brodman areas, colored according to correlation with estimation of dementia severity (derived from the Mini-Mental State Exam)