Objective: Review of dementia screening case profiles that included brain blood flow imaging to determine contribution to diagnosis.Design: retrospective medical case audit.Setting: rural NSW.Participants: 88 rural patients who underwent investigations for dementia diagnosis.Main outcome measure: contribution of brain blood flow imaging (SPECT) to the dementia screening regime.Results: The age range of those referred was 21 to 88 years, the average being 70 years. There were 44 men and 44 women. Vascular causes of dementia accounted for 27% of all those referred for brain blood imaging. Senile Dementia of the Alzheimer’s Type (SDAT) accounted for 40% of all referrals. The occurrence of mixed disease was 6%. Matching neuropsychological reports and computer tomography (CT) were available for 18 of the blood flow studies. Of these, 65% were in agreement or semi-agreement for the diagnostic outcome. Only five studies failed to reach consensus. General practitioners were responsible for 31% of the imaging referrals, the remaining referrals were from the regions two gerontologists, three physicians and two neurologists.Conclusions: Brain blood flow imaging did contribute to the final diagnosis of dementia type for these patients influencing patient management.