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					            International Psychogeriatric Association                                                                                                                                    Neuroimaging in Dementia Workshop
                                                                                                          CME and Disclosures                                                                    Registration Form
                                                                                     Accreditation                                                                              Participant Information                                      enRollment is limited

 Neuroimaging                                                                        This activity has been planned and implemented in accordance with the Essential
                                                                                     Areas and Policies of the Accreditation Council for Continuing Medical Education
                                                                                                                                                                                Please print your name as you would like it
                                                                                                                                                                                to appear on your name badge.
                                                                                                                                                                                                                                             to 50 participants and is on a
                                                                                                                                                                                                                                             first-come, first-serve basis.
                                                                                     (ACCME) through the INTERNATIONAL PSYCHOGERIATRIC ASSOCIATION.

 in Dementia                                                                         IPA also works in accordance with the quality guidelines of the European
                                                                                     Accreditation Council for Continuing Medical Education (EACCME), an institution of         LAST NAME                                FIRST NAME                     DEGREE (ie MD, DO, PhD, RN)
                                                                                     the European Union of Medical Specialists (UEMS).

 Workshop                                                                            CME Credits
                                                                                                                                                                                ADDRESS 1

                                                                                     Six	hours	of	European	External	CME/CPD	accreditation	will	be	sought	via	the	IPA,	and	
                                                                                                                                                                                ADDRESS 2
                                                                                     registered with the European Accreditation Council for Continuing Medical Education
                                                                                                                                                                                CITY,	PROVINCE/STATE	                    POSTAL/ZIP	CODE,	COUNTRY
                                                                                     Educational Disclaimer

         euroimaging has                                                             The primary purpose of the INTERNATIONAL PSYCHOGERIATRIC ASSOCIATION                       TELEPHONE                                FAX

         shifted from being                                                          programming is to provide educational opportunities that enhance patient care.
                                                                                     Information	presented,	as	well	as	publications,	technologies,	products	and/or	
         used solely to “rule                                                                                                                                                   E-MAIL ADDRESS                           IPA Member Number
                                                                                     services discussed are intended to inform participants about the knowledge,
out” other unsuspected brain
                                                                                     techniques and experiences of physicians who are willing to share such information
disorders, to a state where it                                                       with	colleagues.	A	diversity	of	opinions	exist	in	the	medical	field,	and	the	views	of	
is increasingly employed to                                                          the workshop’s faculty are offered solely for educational purposes. Faculty members’       Workshop Registration                        After 10        RegistRation fees
support diagnoses. In fact,                                                                                                                                                                                                  OctOber
                                   Workshop Description
                                                                                     views do not represent those of the IPA and do not constitute endorsement by IPA.                                                                       include all sessions, course
many clinical guidelines for                                                         IPA disclaims any and all liability for all claims which may result from the use of        q IPA Member                 $225              $300          materials, lunch and breaks.
                                   With the many advances in technology, it is       information,	publications,	products	and/or	services	discussed	at	this	program.             q IPA Non Member             $325              $400
dementia now emphasise
                                   important for psychogeriatric professionals,                                                                                                 q Junior Registrant*         $175              $250
the need for informed and          clinicians, and researchers to be well-           Disclosure of Commercial Relationships
appropriate application of         informed as to the usefulness of these
                                                                                                                                                                                *Applies	to	Residents,	Fellows	and	those	training	in	healthcare	or	scientific	research.	Status	
                                                                                     IPA	policy	requires	faculty	to	discuss	any	significant	financial	or	other	relationship	    must	be	certified	in	writing	by	the	participants	and	submitted	with	registration	form	and	
different imaging modalities       diagnostic measures. This programme will
                                                                                     with the manufacturer(s) of any commercial product(s) or service(s) discussed in           payment.
in varying clinical situations.    educate participants about the four main
                                                                                     their presentation. This policy is intended to make participants aware of speakers’
                                   imaging modalities and how to apply them in

                                                                                     financial	or	other	relationship(s)	so	that	attendees	may	form	their	own	judgments	
     o educate our members         clinical practice.
                                                                                     about material discussed during the educational activity. Full disclosure of faculty’s         Payment Information
     and the field about                                                             commercial relationships will appear in individual program materials. All faculty          Full payment must accompany registration form. Please include credit card information
the latest advances in                                                               must sign a letter of agreement stating explicitly that they understand and will
                                   Learning Objectives                                                                                                                          or enclose a check, in US funds, made payable to INTERNATIONAL PSYCHOGERIATRIC
neuroimaging, IPA is pleased                                                         adhere to IPA guidelines that require full disclosure of commercial relationships,         ASSOCIATION. Registrations will be processed according to date of receipt.
                                   At the conclusion of this workshop,               unlabeled	use	of	products	and	identification	of	data	sources.
to present this innovative                                                                                                                                                      IPA Tax ID# 36-4181896.
                                   participants should be able to:
workshop, on 11 November           1. Describe the usefulness and limitations of     Unlabeled Use Disclosure                                                                   q	Check made payable to IPA (US funds only)
2008 in Florence. The                  the four main clinically applicable imaging
                                                                                     INTERNATIONAL PSYCHOGERIATRIC ASSOCIATION requires all faculty members to                  q	VISA       q MasterCard           q American Express
workshop will focus on                 techniques (CT, MRI, SPECT and PET).
                                                                                     disclose if a product is not labeled for the use being discussed or if the product is
imaging techniques that have,      2.	 Define	the	structural	(CT/MRI)	and	
                                                                                     still investigated. Such disclosures will appear in program materials.                     	    	      	       	         	          	            /
or will soon have, real clinical       functional	(SPECT/PET)	imaging	changes	                                                                                                  CREDIT	CARD	NUMbER		                     ExP	DATE	(MONTH/YEAR)
                                       seen in the subtypes of late life dementia
utility and will present how                                                         Educational Grants
                                       (AD, VaD, FTD and DLB).
best to implement the main                                                           The IPA Neuroimaging in Dementia Workshop is supported in part by an educational           NAME ON CARD
                                   3.		Have	increased	confidence	at	rating	
neuroimaging techniques in                                                           grant from GE Healthcare. Although industry support is received, all programs are
                                       medial temporal lobe atrophy on MR and
your clinical practice.                dopaminergic loss on FP-CIT SPECT.            developed and implemented solely by the IPA program committee overseeing this              SIGNATURE
                                   4. Utilize imaging information to arrive at a     workshop as well as the IPA Secretariat. Industry supporters agreed that they will not

T     his programme will               more	accurate	subtype	specific	diagnosis	     influence	the	faculty	or	directors	and	agreed	specifically	to	have	no	direct	control	or	
                                                                                                                                                                                BILLING ADDRESS WHERE CREDIT CARD STATEMENTS ARE SENT
      provide an in-depth look         of dementia.                                  input. IPA uses grant funds to support and enhance existing as well as new programs.
at four commonly available         5. Be aware of developments in imaging of
                                                                                                                                                                                                                       Register prior to 10 October and save!
diagnostic tools, including            plaques and tangles.
                                                                                     if you have any                      full payment in us funds                              RetuRn this foRm to
practical experience in scan
                                                                                     special needs                        must accompany the registration form. Please          International Psychogeriatric Association
interpretation. Utilizing real     Recommended Audience                              that require accommodation,          include credit card information, or a check           Suite 3759, 550 Frontage Road
life examples, participants will
                                   This course is recommended for geriatric          or if you should have any            made payable to the INTERNATIONAL PSYCHO-             Northfield, IL 60093, USA
be given the opportunity to        psychiatrists, old age psychiatrists,             questions, please telephone          GERIATRIC ASSOCIATION. Registrations will be          Tel: +1 847 501 3310
comment using an interactive       neurologists, geriatricians, primary care         +1 847 501 3310 or                   processed according to date of receipt. You may       Fax: +1 847 501 3317
polling system as part of the      physicians with an interest in the elderly, and
                                                                                     email        also register online at           oR RegisteR online at www.ipa-online.oRg
learning process.                  other dementia specialists as well as trainees
                                   in these areas.
    RegisteR online at www.ipa-online.oRg                                           International
                                                                                    Psychogeriatric                                         Presented by the International
                                                                                    Association                                               Psychogeriatric Association
         Workshop Programme
                                                                                    in dementia
   11 November 2008                                                                 Tuesday
                                                                                    11 November 2008
                                                                                                                                                   in Dementia
   Florence, Italy

08:00 registration & coffee
                                                                                    Hotel Montebello Splendid
08:30 Introduction, Objectives, Imaging and
      current Guidelines for Dementia
                                                                                                                                   Presented in cooperation with the
      John O’brien                                                                        Cancellation                            Associazione Italiana Psicogeriatria
08.50 ct and Mr: basic Introduction, Advantages                                              Policy
      and Disadvantages, How Images are                                             This	workshop	is	subject	to	
      formed and current Imaging Methods                                            cancellation if enrollment is
      Giorgos Karas                                                                 insufficient.	In	the	event	of	
09.20 Usefulness of ct Scanning in Dementia                                         cancellation, registration fees
      Leonardo Pantoni                                                              will be fully refunded. IPA is not
                                                                                    responsible for airfare, hotel or
10.05 Morning break                                                                 other costs incurred by participants
10.25 Mr Imaging: How to rate Medial                                                in the event of cancellation.
      temporal Lobe Atrophy in Practice
      Philip Scheltens
11.10 Pet and SPect: basic Principles,
                                                                                         Refund Policy
                                                                                    IPA will charge a $50 US
      How Images are formed,
      Advantages and Disadvantages                                                  administrative fee for cancellations
      Jan booij                                                                     received on or before 10 October
                                                                                    2008. Please note that no refunds
11.40 Lunch                                                                         will be issued for cancellations
12.40 Use of Perfusion Imaging in the                                               received after this date.
      Differential Diagnosis of Dementia
      Klaus ebmeier
13.25 fP-cIt (DAtScAN) SPect Imaging: A New
      Diagnostic tool for the Assessment of DLb                                      Accommodations
      Ian McKeith                                                                    and Information
14.10 Afternoon break                                                               Hotel Montebello Splendid
                                                                                    Via Garibaldi, 14
14.30 fP-cIt SPect Imaging: How to
                                                                                    50123 Firenze (Firenze) Italy
      rate and Interpret Scans
                                                                                    Telephone: +39 055.27471
      Jan booij
                                                                                    Fax: +39 055.2747700
15.15 Pet in Dementia: current and future                                           Email:
      Applications Including Amyloid Imaging                                        Room Rate: 150 Euro + VAT (breakfast
      Agneta Nordberg                                                               included in sleeping room rate)
15.45 closing remarks
                                                                                    For directions and additional                                           Tuesday
16.00 Workshop concludes                             Faculty                        information, visit
                                                                                                                                                            11 November 2008
                                     Co Chairs:                                                                             Hotel Montebello Splendid
                                     John O’brien, Newcastle, United Kingdom                                                                                Florence
                                     Philip Scheltens, Amsterdam, The Netherlands
                                                                                    Registration fees do not include hotel
                                                                                    accommodations. IPA has negotiated                                      Italy
                                                                                    a special hotel rate for workshop
                                                                                    participants. To qualify for the special
                                     Jan booij, Amsterdam, The Netherlands          rate, you must make your reservation
                                     Klaus ebmeier, Oxford, United Kingdom          by the 10 October 2008 deadline and
                                     Giorgos Karas, Amsterdam, The Netherlands      mention IPA Neuroimaging Workshop.
                                     Ian McKeith, Newcastle, United Kingdom         Please contact the Hotel Montebello
                                     Agneta Nordberg, Stockholm, Sweden             Splendid directly by telephone or
                                     Leonardo Pantoni, Florence, Italy              email.                                     Supported by an educational grant from GE Healthcare