Andorra

Cognitive screening can be performed in primary care, neurology or geriatric services, while more detailed neuropsychological assessment can be arranged when required. No single nationally mandated dementia screening instrument was identified. In clinical practice, established tools such as the MMSE, MoCA, Clock Drawing Test and more extensive neuropsychological batteries may be used according to the patient’s needs. SAAS specifically identifies cognitive impairment and dementia as a dedicated outpatient field and has also introduced interdisciplinary therapeutic groups combining cognitive, physical and emotional stimulation.

CT and MRI are available within Andorra’s healthcare system, including through services associated with the Hospital Nostra Senyora de Meritxell. CASS reimburses radiological investigations under its ordinary healthcare benefit framework. For people aged 65 and older, CASS operates a third-party payment mechanism. In a published MRI example, the official responsibility tariff was €172.19, of which CASS paid €129.14 and the patient paid €43.05.2 More specialized imaging, such as amyloid PET, would normally require referral to a tertiary centre in Spain or France.

There is no evidence that genetic testing part of standard dementia diagnosis in Andorra. Testing for familial Alzheimer’s disease genes such as APP, PSEN1 or PSEN2 would primarily be considered in very early-onset disease or in families with a strong hereditary pattern and would likely require specialist referral abroad. APOE genotyping is also not used as routine screening, although its clinical relevance is increasing because APOE status affects eligibility and safety assessment for newer anti-amyloid therapies.

No evidence was found that CSF amyloid/tau testing, plasma phosphorylated tau, amyloid PET or tau PET are routinely performed within Andorra’s domestic dementia pathway. However, these technologies can potentially be accessed through specialist referral arrangements in neighbouring countries. This is therefore best classified as limited domestic biomarker capacity but potentially strong cross-border access. Andorra has also shown policy and academic interest in these technologies. A government-organized scientific programme in 2023 included discussion of fluid biomarkers, blood biomarkers, digital cognitive assessment and anti-amyloid therapies, led by Professor Bruno Dubois of Sorbonne University and Pitié-Salpêtrière.

The SAAS Service of Ageing and Health is the principal specialist geriatric service in Andorra. It provides inpatient geriatric care, orthogeriatrics, hospital consultation, home hospitalization, intermediate care and outpatient assessment. Its outpatient programme includes specific pathways for cognitive impairment and dementia, frailty, dependency, falls prevention and post-hospital follow-up. The service also includes an acute psychogeriatric unit, which is particularly relevant for people with dementia who develop severe behavioural or psychiatric symptoms. El Cedre is an important publicly owned sociosanitary institution providing residential and intermediate care for dependent older people. Andorra also has a broader network of public and private residential and day-care services. By the end of 2025, the country had approximately 400 government-contracted places in sociosanitary facilities and day centres, representing 73.7% of available national capacity.

Medical dementia treatment is mostly covered but involves routine co-payments. CASS generally reimburses 75% of outpatient medical costs and 90% of hospitalization costs within the preferred healthcare pathway. Long-term care is financed separately. Eligibility for publicly supported dependency services is determined through COVASS, which assesses medical, functional and social needs. Residential and respite services usually involve co-payment, although the government subsidizes a substantial portion of costs for eligible people. In 2025, the government allocated nearly €6 million to publicly contracted sociosanitary and day-centre places.

Caregiver support is delivered through government social services, home care, respite services and AAMA. The Servei d’Atenció Domiciliària (SAD) provides personal assistance, mobility support, medication supervision, meal assistance, socialization and direct guidance for caregivers. The programme expanded significantly in 2025, supporting 167 users, including 96 new users. The government later reported that the service had no waiting list following workforce expansion and cooperation with an additional provider. AAMA provides dementia-specific support, including information on medical, psychological, social, legal, financial and ethical issues, caregiver education and psychological assistance. In 2026, AAMA also operated free support and self-care workshops for relatives and caregivers, covering stress management, self-esteem, resilience, grief and adaptation to the caregiving role.

Dementia is addressed primarily through Andorra’s broader policies on ageing, dependency and integrated health and social care rather than through a standalone national dementia strategy. The National Sociosanitary Plan for Older People 2022–2024 provides the main policy framework, seeking to strengthen coordination between health and social services, promote healthy ageing and autonomy, support older people in remaining at home where possible, and improve care for people experiencing dependency. These measures are complemented by the wider sociosanitary system, including home-care services, day centres, residential care and dependency assessment.

At the same time, Andorra has developed increasingly dementia-specific services within the Servei Andorrà d’Atenció Sanitària (SAAS). Its Ageing and Health Service (Servei d’Envelliment i Salut) provides specialist geriatric care and includes specific outpatient pathways for cognitive impairment and dementia, alongside services addressing frailty, falls and dependency. SAAS has also participated in the APTITUDE/ICOPE healthy-ageing approach, which includes cognition among the capacities assessed in older people and aims to identify decline at an early stage. These developments indicate a growing dementia-specific clinical response within Andorra’s broader ageing and dependency framework, despite the absence of a dedicated national dementia action plan.

Current policy priorities in Andorra are focused more on strengthening the broader health, ageing and long-term-care system than on introducing a separate dementia plan. The National Health Pact (Pacte Nacional de Salut) identifies population ageing, chronic disease and the sustainability of the health system as important future challenges. Its priorities include reinforcing primary care, improving workforce planning, developing shared electronic health records, strengthening cooperation with cross-border clinical networks, and promoting research, digitalisation and innovation. These reforms are relevant to dementia care because they aim to improve continuity and coordination for people with chronic and complex care needs, although dementia itself is not treated as a separate strategic priority.

Long-term-care capacity is also being expanded in response to the progressive ageing of the population. Government plans include a new 130-place residential facility in Encamp and 54 supported apartments with an associated day centre in Sant Julià de Lòria, with these additional services expected to become available between late 2026 and early 2027. This expansion is intended to increase the range of residential, supported-living and community-based options available to older people with growing care needs. Professional capacity is being strengthened in parallel: the government-supported lifelong-learning programme for the 2025–2026 academic year includes a course specifically entitled “Com cuidem en demències i Alzheimer”, indicating increased attention to dementia-specific knowledge and skills among the care workforce.

Dedicated Cognitive Impairment and Dementia Circuit: SAAS has introduced a specific outpatient pathway for cognitive impairment and dementia within its Ageing and Health Service. The circuit is designed to improve accessibility and coordination between primary care and specialist geriatric services, creating a more structured route for the assessment and follow-up of patients presenting with cognitive decline. This represents an important move towards a more dementia-specific model within Andorra’s otherwise broadly organised ageing and geriatric care system.

Interdisciplinary Stimulation Groups: Since 2024, SAAS has operated interdisciplinary groups combining cognitive, physical and emotional stimulation for older people. Rather than addressing cognitive decline in isolation, these activities seek to preserve several dimensions of functional capacity and wellbeing simultaneously, reflecting a more holistic approach to healthy ageing, frailty and cognitive impairment.

Hospitalization at Home: The geriatric service includes a hospital-at-home model, allowing selected older patients to receive hospital-level monitoring and treatment in their own homes. For frail older people and those experiencing cognitive impairment, home-based care can be particularly valuable by reducing unnecessary transfers and disruption associated with hospitalization while maintaining continuity with the patient’s familiar environment.

Cross-Border Specialist Network: Andorra compensates for the limited tertiary-care capacity of a small national health system through established cross-border healthcare arrangements, particularly with Spain and France. CASS agreements with contracted foreign hospitals, medical centres and specialists allow patients to receive services that may not be available domestically while remaining within the public reimbursement system. This provides an important route to more advanced neurological, diagnostic or other specialist assessment when required.

Third-Party Payment for People Aged 65+: The third-party payment system reduces the immediate financial burden associated with accessing healthcare. For eligible people aged 65 and over, CASS pays its reimbursable share directly to participating providers for services including medical consultations, radiology, laboratory testing and medicines, meaning that patients generally need to pay only the portion not covered by CASS rather than advancing the full cost and subsequently requesting reimbursement. This can make routine healthcare and diagnostic follow-up more financially accessible for older people, including those undergoing assessment or treatment for cognitive impairment.