Neuroimaging in dementia and Alzheimer's disease: Current protocols and practice in the Republic of Ireland

Introduction: Neuroimaging plays an essential supportive role in the diagnosis of dementia, assisting in establishing the dementia subtype(s). This has significant value in both treatment and care decisions and has important implications for prognosis. This study aims to explore the development and nature of neuroimaging protocols currently used in the assessment of dementia and Alzheimer's disease (AD). Methods: An online questionnaire was designed and distributed to lead radiography personnel working in computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) departments (n = 94) in both hospital-based and out-patient imaging centres in the Republic of Ireland. Results: Response rates for each modality ranged from 42 to 44%. CT, MRI, and PET were used to specifically diagnose dementia or AD by 43%, 40% and 50% of responding centres respectively. Of these, dementia-specific neuroimaging protocols were utilised in 33%, 50% and 100% of CT, MRI and PET centres respectively, with the remainder using either standard or other non-specific protocols. Both radiologists and clinical specialist radiographers participated in the development of the majority of protocols. The Royal College of Radiologists (RCR) guidelines were most commonly referenced as informing protocol development, however, none of the MRI respondents were able to identify any guidelines used to inform MR protocol development. Conclusion: Currently there is no consensus in Ireland on optimal dementia/AD neuroimaging protocols, particularly for PET and MRI. Similarly the use of validated and published guidelines to inform protocols is not universal.European Commission - European Regional Development Fun

Current Practice in the Referral of Individuals with Suspected Dementia for Neuroimaging by General Practitioners in Ireland and Wales

Objectives: While early diagnosis of dementia is important, the question arises whether general practitioners (GPs) should engage in direct referrals. The current study investigated current referral practices for neuroimaging in dementia, access to imaging modalities and investigated related GP training in Ireland and North Wales. Methods: A questionnaire was distributed to GPs in the programme regions which included approximately two thirds of all GPs in the Republic of Ireland and all general practitioners in North Wales. A total of 2,093 questionnaires were issued. Results: 48.6% of Irish respondents and 24.3%of Welsh respondents directly referred patients with suspected dementia for neuroimaging. Irish GPs reported greater direct access to neuroimaging than their Welsh counterparts. A very small percentage of Irish and Welsh GPs (4.7% and 10% respectively) had received training in neuroimaging and the majority who referred patients for neuroimaging were not aware of any dementia-specific protocols for referrals (93.1% and 95% respectively). Conclusions: The benefits of direct GP access to neuroimaging investigations for dementia have yet to be established. Our findings suggest that current GP speciality training in Ireland and Wales is deficient in dementia-specific and neuroimaging training with the concern being that inadequate training will lead to inadequate referrals. Further training would complement guidelines and provide a greater understanding of the role and appropriateness of neuroimaging techniques in the diagnosis of dementia.European Commission - European Regional Development FundUniversity College DublinBangor UniversityTrinity College Dubli

Multiphoton Bloch-Siegert shifts and level-splittings in a three-level system

In previous work we studied the spin-boson model in the multiphoton regime, using a rotation that provides a separation between terms that contribute most of the level energies away from resonance, and terms responsible for the level splittings at the anticrossing. Here, we consider a generalization of the spin-boson model consisting of a three-level system coupled to an oscillator. We construct a similar rotation and apply it to the more complicated model. We find that the rotation provides a useful approximation to the energy levels in the multiphoton region of the new problem. We find that good results can be obtained for the level splittings at the anticrossings for resonances involving the lower two levels in regions away from accidental or low-order resonances of the upper two levels.Comment: 29 pages, 13 figure

Importance of furthering knowledge about neuroimaging in dementia.

<p>Importance of furthering knowledge about neuroimaging in dementia.</p

Confidence in selecting the most appropriate neuroimaging modality.

<p>Confidence in selecting the most appropriate neuroimaging modality.</p

Reported availability of neuroimaging modalities for direct referral.

<p>Reported availability of neuroimaging modalities for direct referral.</p

Counties included in the European Regional Development Fund INTERREG Ireland Wales programme area.

<p>Counties included in the European Regional Development Fund INTERREG Ireland Wales programme area.</p

Importance of neuroimaging for the diagnosis of dementia.

<p>Importance of neuroimaging for the diagnosis of dementia.</p