Bahamas

The Bahamas has no national guideline requiring the use of a specific cognitive screening instrument for dementia assessment. In clinical practice, healthcare professionals are likely to use internationally recognised tools such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Mini-Cog, Clock Drawing Test, General Practitioner Assessment of Cognition (GPCOG), verbal fluency tests, and informant-based questionnaires, depending on the clinical setting and the patient’s presentation. However, the specific instruments routinely used in public hospitals and private memory clinics have not been publicly documented.

The Bahamas Alzheimer’s Association has also promoted early detection through community cognitive screening initiatives during World Alzheimer’s Month. Alzheimer’s Disease International (ADI) reported free cognitive screening events in 2021, and similar public screening activities were held in 2024. These programmes are intended to increase awareness and identify individuals who may require further assessment but are not designed to establish a dementia diagnosis. As in international practice, cognitive screening results should be interpreted alongside the individual’s educational background, literacy, language, sensory impairments, and functional status. No cognitive assessment tool specifically validated for the Bahamian population was identified, and a definitive diagnosis requires comprehensive clinical evaluation rather than screening scores alone.neuropsychological testing services were not identified, and cognitive assessment may be influenced by educational, cultural, and language factors. No locally validated cognitive screening instrument for Saint Kitts and Nevis was identified.

Structural brain imaging is available in The Bahamas, particularly in Nassau, through Princess Margaret Hospital and private hospitals and diagnostic imaging centres that provide CT and MRI services.

These investigations are used to support the assessment of cognitive impairment by identifying structural abnormalities that may explain or contribute to symptoms, including stroke, vascular disease, brain tumours, hydrocephalus, subdural haematoma, traumatic brain injury, and other neurological conditions. MRI also provides greater detail for evaluating cerebral atrophy, white-matter changes, and patterns of neurodegeneration. However, no national dementia-specific imaging protocol or standardized referral pathway has been identified, and access is likely to depend on specialist referral, insurance coverage, and geographic location.

No evidence was found that amyloid PET, tau PET, FDG-PET for dementia assessment, quantitative volumetric MRI, or centralized neuroradiology review for complex dementia cases are routinely available within The Bahamas. Patients requiring advanced molecular imaging for Alzheimer’s disease are therefore likely to be referred overseas, most commonly to the United States or another regional centre, subject to clinical indication and funding arrangements.

No national dementia genetics service or dedicated neurogenetics clinic was identified in The Bahamas. Routine APOE genotyping does not appear to be part of standard clinical assessment, and there is no evidence that testing for rare familial dementia mutations, such as APP, PSEN1, PSEN2, MAPT, GRN, or C9orf72, is routinely available. Where genetic testing is clinically indicated, such as in selected cases of young-onset dementia or a strong family history of neurodegenerative disease, samples may be collected locally and referred to overseas laboratories for analysis. Access is likely to depend on specialist referral, insurance approval, laboratory arrangements, funding, and the availability of appropriate clinical interpretation.
No dementia-specific genetic counselling programme was identified in The Bahamas. This limited domestic genetics infrastructure could become increasingly important if disease-modifying anti-amyloid therapies, such as lecanemab or donanemab, are introduced, as APOE ε4 status is commonly considered during treatment discussions because of its association with an increased risk of amyloid-related imaging abnormalities (ARIA).

Routine clinical access to Alzheimer’s disease-specific biomarkers in The Bahamas remains unclear. Local laboratories are able to perform the standard investigations used to identify potentially reversible or contributing causes of cognitive impairment, including thyroid function tests, vitamin B12 and folate levels, full blood count, renal and liver function tests, blood glucose, electrolyte analysis, and infection screening, as part of the initial dementia work-up.

However, no public evidence was found that laboratories in The Bahamas routinely perform Alzheimer’s disease-specific biomarker testing, such as CSF amyloid-β42/40 ratio, total tau, phosphorylated tau, plasma p-tau181 or p-tau217, plasma amyloid-β assays, neurofilament light (NfL), or other commercially available biomarker panels. Although lumbar puncture may be available through hospital specialists when clinically indicated, any cerebrospinal fluid samples requiring Alzheimer’s-specific analysis would likely need to be sent to overseas reference laboratories. Consequently, while The Bahamas has the laboratory capacity to support the initial evaluation of cognitive impairment, no publicly documented pathway for biomarker confirmation of Alzheimer’s disease was identified, which may limit future access to biomarker-guided diagnosis and disease-modifying therapies.

Specialist dementia care in The Bahamas is provided through a combination of public hospitals, private healthcare providers, residential care facilities, and community health services rather than through a coordinated national memory-care network. The Family Medicine Center Memory Clinic in Nassau is the only clearly identified dedicated memory clinic, offering assessment for individuals with concerns about memory, thinking, or daily functioning and providing a structured entry point into private dementia care.

The Princess Margaret Hospital, the country’s principal tertiary referral and teaching hospital, also plays a central role in dementia assessment and management through its medical, psychiatric, radiology, rehabilitation, and outpatient services, although no dedicated multidisciplinary public memory clinic has been identified. On Grand Bahama, Rand Memorial Hospital provides specialist medical and diagnostic services, but patients requiring highly specialized dementia assessment may still need referral to Nassau or overseas.

Long-term care is supported by the government-operated Geriatric Hospital, which provides residential nursing and rehabilitation for older adults who can no longer be adequately cared for at home, including individuals living with advanced dementia. The Department of Public Health further supports dementia care through community clinics across the islands, which assist with the recognition of cognitive impairment, chronic disease management, medication monitoring, caregiver guidance, and referral to specialist services. Additional care is available through private hospitals, including Doctors Hospital, and a range of public, private, charitable, and faith-based residential and home-care providers. However, no comprehensive national registry identifies facilities with dedicated dementia units, secure environments, dementia-trained staff, respite services, behavioural support programmes, or formal quality accreditation, making it difficult to assess specialist long-term care capacity across the country.

No national estimate of the direct or indirect cost of dementia care in The Bahamas was identified. Although some healthcare services may be funded through the public system, National Health Insurance (NHI), private insurance, or employer-sponsored health plans, patients and families may still incur substantial out-of-pocket expenses for prescription medicines, private consultations, home-care services, residential care, respite, rehabilitation, continence products, mobility aids, home modifications, transportation, and, where necessary, overseas treatment. Informal caregiving may also result in significant indirect costs through reduced employment or lost income for family members.

The geography of The Bahamas can increase the financial burden of dementia care, particularly for residents of the Family Islands who may need to travel to New Providence or Grand Bahama for specialist consultations, diagnostic imaging, medication reviews, or institutional assessment. The importance of overcoming these geographic barriers is reflected in the National Health Insurance (NHI) telehealth programme, which was introduced to improve access to healthcare for residents of the Family Islands by reducing the need for travel to major population centres. Nevertheless, patients requiring in-person specialist assessment or services unavailable locally may still incur significant transportation and accommodation costs. No publicly available fee schedules were identified for the Geriatric Hospital, private nursing homes, home nursing services, or adult day care programmes.

The Bahamas Alzheimer’s Association is the country’s principal dementia-focused organization, providing public education, advocacy, and community awareness initiatives. Through its activities and collaboration with Alzheimer’s Disease International (ADI), the Association has organized World Alzheimer’s Month campaigns, “Let’s Talk About Dementia” educational webinars, free community cognitive screening events, awareness walks, World Alzheimer’s Day activities, fundraising events, church services, membership drives, and the development of an Alzheimer’s Memory Garden to promote public understanding of dementia. While the Association serves as the main national source of dementia information and support, publicly available information does not clearly describe the scope or frequency of ongoing caregiver services such as support groups, counselling, respite programmes, or home visits, and these services should therefore be confirmed directly with the organization.

Additional support may be available through government social services, the Senior Citizens Division, the Geriatric Hospital, community nursing services, faith-based organizations, private home-care agencies, residential care facilities, and informal family networks.4 However, no evidence was found of a national statutory caregiver allowance, paid caregiver leave, guaranteed respite entitlement, routine caregiver-needs assessment, pension credits for family caregivers, or a nationwide dementia-specific training programme for informal carers. As a result, family members continue to provide the majority of long-term dementia care, particularly for people living outside Nassau.

The Bahamas does not have a dedicated national dementia strategy with a defined budget, implementation framework, or measurable targets. Dementia is instead addressed through broader policies relating to healthy ageing, non-communicable diseases, mental health, social protection, and public healthcare. Relevant initiatives include the National Health Insurance (NHI) programme, services provided through the Senior Citizens Division, public geriatric care, and advocacy led by the Bahamas Alzheimer’s Association.

More broadly, The Bahamas has developed policy initiatives to strengthen services for older adults. Regional reporting indicates that the government prepared an Older Persons Policy and Action Plan (2022–2026), focusing on areas such as healthcare, healthy ageing, mental health, housing, economic security, alternative care, emergency preparedness, and social participation, alongside proposed legislation to strengthen the rights of older persons. However, these ageing policies do not constitute a national dementia plan and do not establish dementia-specific measures such as a national registry, standardized diagnostic pathways, memory clinic coverage targets, caregiver entitlements, biomarker access, treatment standards, or a national dementia research programme.

Although The Bahamas has not announced a dedicated national dementia strategy, several broader healthy ageing and health system initiatives could strengthen future dementia care. The emerging PAHO Country Cooperation Strategy 2026–2031 identifies population ageing as a growing national priority, noting projections that approximately one in four Bahamians could be aged 60 years or older by 2042. The framework emphasizes healthy ageing, rehabilitation, mental health, and improved services for older adults, creating a policy environment that could support future dementia initiatives, even though no dementia-specific programme has yet been announced.

The government has also continued to advance policies for older persons through the National Policy and Action Plan for Older Persons (2022–2026) and the proposed development of legislation to strengthen the rights and protection of older adults.

In 2019, the NHIA proposed significant reforms to NHI Bahamas following a nationwide public consultation involving more than 500 participants and 80 stakeholders across multiple islands. The proposed changes aimed to strengthen progress toward universal health coverage by revising employer premium contributions, expanding eligibility protections for small businesses and seasonal workers, introducing a national fee schedule for high-cost care, improving enrolment and compliance mechanisms, enhancing annual performance reporting, and expanding the Standard Health Benefit Package to include pediatric cancer treatment. Although these reforms were not dementia-specific, they reflected the government’s broader commitment to improving equitable and sustainable access to healthcare services across The Bahamas.

At the service level, the establishment of the Family Medicine Center Memory Clinic, together with community cognitive screening initiatives led by the Bahamas Alzheimer’s Association, demonstrates increasing interest in earlier dementia detection and highlights an opportunity to develop more standardized referral pathways between community, primary, and specialist care.

The Family Medicine Center Memory Clinic represents the most notable recent innovation in dementia care in The Bahamas by providing a dedicated entry point for individuals experiencing memory or cognitive concerns, rather than relying solely on referrals through general medical or psychiatric services. The clinic’s online memory questionnaire may also encourage earlier help-seeking by identifying individuals who would benefit from a formal clinical assessment, although it is intended as a screening tool rather than a diagnostic test.

Community-based awareness has also expanded through the work of the Bahamas Alzheimer’s Association, which has organized free cognitive screening events, educational activities, and World Alzheimer’s Month campaigns aimed at improving public awareness and promoting earlier detection of dementia. The Association’s Alzheimer’s Memory Garden further contributes to reducing stigma by creating a visible community space dedicated to remembrance, education, and advocacy. These initiatives represent important steps toward improving dementia literacy, even though they are not part of a coordinated national dementia programme.

The continued expansion of NHI Telehealth Services also offers opportunities to improve access to cognitive care for residents of the Family Islands by reducing the need for travel to New Providence for some consultations. Although no dedicated tele-dementia service has been identified, telemedicine could support specialist advice, follow-up appointments, caregiver education, and multidisciplinary collaboration between community clinics and clinicians based in Nassau.