Neuroimaging referral for dementia diagnosis: The specialist s perspective in Ireland

Abstract

Background: Neuroimaging is an increasingly important tool in the diagnostic workup of dementia. Neurologists, geriatricians, and old-age psychiatrists are involved in key tasks in the diagnostic pro- cess, frequently referring patients with suspected dementia for neuroimaging. Methods: The research design was a postal survey of all geriatricians, old-age psychiatrists, and neu- rologists in the Republic of Ireland (N 5 176) as identified by the Irish Medical Directory 2011–2012 and supplementary listings. Results: Almost 65% of specialists did not have access to 2-[18F]fluoro-2-deoxy-D-glucose positron emission (FDG-PET) or FDG-PET/computed tomography (CT), and 80.3% did not have access to perfusion hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) or dopaminergic iodine-123-radiolabeled 2 b -carbomethoxy-3 b -(4-iodophenyl)-N- (3-fluoropropyl) nortropane SPECT. Most specialists (88.7%) referred patients with mild cognitive impairment or suspected dementia for magnetic resonance imaging (MRI), 81.7% referred for CT, and 26.8% for FDG-PET or FDG-PET/CT. Only 44.6% of respondents were aware of dementia- specific protocols for referrals for neuroimaging. Conclusion: Specialist access to imaging modalities other than CTand MRI is restricted. Improved access may affect patient treatment and care