Imaging those with cognitive impairment is not practical

As Schott and colleagues state,1 UK, European, and US guidelines recommend that all patients with cognitive impairment should undergo structural imaging, and as good modern doctors we follow these guidelines, slavishly. We have been doing computed tomography scans on these patients for 15 years. We have been requested to scan a 101 year old with memory loss. We have found the occasional asymptomatic meningioma but no relevant brain tumour and no hydrocephalus or haematoma.

The best we can achieve, as in the case quoted in the article, is to label the patient, more or less accurately, with the particular form of dementia he or she may have. In the absence of disease modifying treatment, this achieves virtually nothing in practical terms. It merely consumes valuable imaging resources at a time of increasing financial restriction.

This article is intellectually interesting, but has made a negative contribution to the rational use of imaging.