Belgium

Belgium primarily uses the MMSE for cognitive assessment, with the MoCA available in Flemish and French. Screening migrant populations is challenging, as standard tools often fail culturally, and awareness of neutral tools like RUDAS is low. No national dementia screening program exists.

MRI and CT are widely available for Alzheimer’s diagnosis, with MRI in nearly all hospitals and CT in over 90%. Advanced imaging like FDG-PET or amyloid-PET is limited, used mainly for complex, atypical, or young-onset cases.

Genetic testing for familial or early-onset Alzheimer’s is available at Erasme ULB, using next-generation sequencing with results in three months.

CSF analysis for core Alzheimer’s biomarkers is centralized at BIODEM, University of Antwerp, while blood-based biomarker tests, FDA-approved, remain limited to research, not routine clinical practice in Belgium.

Specialized memory clinics for diagnosing Alzheimer’s disease are accessible across Belgium, not just in major cities. They are geographically distributed throughout all provinces in both Flanders and Wallonia, with locations in cities like Brugge, Genk, Liège, and Libramont. These clinics, typically located within general and university hospitals, are officially recognized by the federal health authority (INAMI-RIZIV), ensuring a national standard of quality. Additionally, the Brussels-Capital region hosts several advanced university-based clinics that are also major centers for European research. These centres are recognized by the European Alzheimer Disease Consortium as European reference centres for scientific research, diagnosis, and treatment.

A dense network of community and day care services is available throughout the country to support individuals living with dementia living at home and to provide respite for carers. In Flanders, the regional government’s Department of Care provides official, searchable online directories of all accredited home care services and day care centres, organized by province. A diverse array of accredited home care services is available to provide support within the person’s own residence. This ranges from personal care and nursing provided by services for family care to practical assistance with household tasks and specialized home nursing. Unlike in Flanders, where a central government portal is the primary search tool, the most direct and practical information in Wallonia comes from the Ligue Alzheimer ASBL and the AVIQ agency. The Ligue Alzheimer offers detailed, downloadable listings of home care and day care services, conveniently organized by province, on its website. A large number of residential homes also operate in Brussels.

Palliative care is integrated into all care settings, including at home, in hospitals, and in residential care facilities. All nursing homes are legally required to provide palliative care, and specialized mobile teams support staff in general hospitals. Generally, Belgium has a strong policy framework and is home to leading academic institutions like the End-of-Life Care Research Group. Their research agenda specifically targets critical issues such as palliative care in nursing homes, advance care planning for people living with dementia, and evaluating care pathways at the end of life.

For people living with dementia, families, and professionals seeking information, guidance, and coordination of palliative care services, the primary points of contact are the regional palliative care federations. These organizations work to promote the palliative care culture and coordinate the actions of various service providers within their respective regions.12,13,14

The standard approved medications like cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and the N-methyl-D-aspartate (NMDA) receptor antagonist memantine are reimbursed in Belgium. When reimbursed, these medicines are subject to the third-party payer system, meaning the person pays only a small co-payment at the pharmacy. However, the reimbursement of these symptomatic drugs has been a subject of intense debate in Belgium. The National Health Insurance Institute has previously considered halting their reimbursement as a cost-saving measure. This proposal was met with opposition from people living with dementia advocacy groups and neurologists because, although the medications are not curative, they can meaningfully ease symptoms and delay loss of independence for some people, making continued reimbursement both medically beneficial and cost-effective. This ongoing debate creates a climate of financial uncertainty for families, as a policy change could instantly add a significant monthly medication cost to their budget. Newer, more advanced disease-modifying therapies are not yet routinely reimbursed.

Physiotherapy is a well-reimbursed service that includes a small, fixed co-payment. For example, the standard co-payment for a 30-minute session in 2025 is €6.5 Occupational therapy is poorly reimbursed in Belgium, especially in primary care settings. Access to reimbursement is often restricted, for instance, to people who have gone through a formal rehabilitation program.6,7 Co-payments are significantly higher than for physiotherapy. For example, the co-payment for a functional examination can be €47, and for a practice session to learn to use aids, it can be €41.55 Psychiatrists, as medical specialists, are covered by the compulsory insurance system, but there is a standard co-payment, which was around €12 in 2020.8

The main benefit for individuals over 65 years of age is the Allowance for Assistance to the Elderly, which has different names and administering bodies depending on the region: the Zorgbudget voor ouderen met een zorgnood in Flanders, the Allocation pour personnes âgées in Wallonia (AVIQ), and the Allocation pour l’aide aux personnes âgées in Brussels (Iriscare). Eligibility for these income-tested allowances is based on age (65+), residency, and a recognized level of dependency. Additional federal benefits include the Integration Allowance (AI) for people living with disabilities aged between 21 and 65 years of age and the Guaranteed Income for Elderly People for those over 65 years of age with insufficient resources. For carers who reduce their work, palliative care leave offers a monthly benefit of up to €787 for employees and €1,092 for the self-employed.

Practical support schemes are available to help people remain at home and provide relief for carers. In-home assistance for daily tasks is made highly affordable through the service voucher system (Dienstencheques), where a €9 voucher, eligible for a 30% tax credit, covers one hour of help. For carer respite, Baluchon Alzheimer Belgique offers a service where a professional carer moves into the home for several days, costing the family a subsidized rate of €65 per day. Other options include short-term stays in residential facilities and day care centres, which provide structured activities for the person living with dementia and a break for the care partner.

The Ligue Nationale Alzheimer Liga and its regional branches are the most important first points of contact for families. They provide free helplines, and organize support groups, dementia-friendly activities, and training. The Flanders Centre of Expertise on Dementia is another key resource, offering educational programs and workshops for carers to enhance their skills and provide emotional support.

Belgium’s approach to dementia and Alzheimer’s disease is implemented through regional strategies in Flanders and Wallonia. The Flemish government has rolled out its third dementia strategy The Flanders’ dementia plan (2021 – 2025) built on the vision of creating a dementia-friendly society and is structured around seven key strategic objectives:
1. Understanding the Prevalence: Continuously monitoring the number of people living with dementia to inform policy and service planning.
2. Prevention and Risk Reduction: Actively promoting brain health and initiatives to reduce the risk of developing dementia.
3. A Nuanced Perception: Fostering a more positive and realistic public perception of dementia, moving away from stigma and fear.
4. Person-Centered Care and Support: Ensuring that care and support services are tailored to the individual needs and preferences of people living with dementia and their families.
5. Support for Informal Caregivers: Recognizing and strengthening the crucial role of family members and other informal carers through dedicated support and resources.
6. Information and Awareness: Providing accessible and high-quality information about dementia to the general public and those directly affected.
7. Specialized Target Groups: Addressing the specific needs of particular groups, such as people living with young-onset dementia and individuals from diverse cultural backgrounds.

The French-speaking region of Wallonia adopted its Plan Alzheimer Wallon in 2010. While older than the current Flemish plan, it laid the groundwork for a structured approach to dementia care. The plan is centered around three main axes:
1. Enhancing Societal Awareness and Understanding: Improving public knowledge of dementia and related diseases to foster a more inclusive society.
2. Improving Quality of Life: Enhancing the quality of life for individuals living with Alzheimer’s disease and their families at every stage of the illness.
3. Advancing Knowledge and Influencing Factors: Deepening the understanding of the disease and the various factors that impact its progression.

The current Flemish Dementia Plan is set to conclude at the end of 2025. Given the established practice of the Flemish government, which has consistently launched successive multi-year plans, a new strategy for the 2026-2030 period is expected.

Additionally, The Walloon government is in the process of establishing a new five-year strategic plan for mental health.

Researchers at VIB-KU Leuven Centre for Brain Research discovered that the brain’s immune cells, microglia, play a dual role in Alzheimer’s disease, harmfully promoting plaque formation in the early stages but becoming protective later by compacting the plaques to limit their toxicity. This finding clarifies conflicting reports and suggests that therapeutic strategies targeting microglia must be timed to the specific stage of the disease. Another study by the centre found that a fragment of the amyloid precursor protein, known as APP-CTF, causes significant disruption to cellular waste disposal systems before the formation of amyloid plaques. This identifies a critical early event in the disease and suggests that therapies should target the clearance of this toxic fragment for early intervention. Finally, along with the UK Dementia Research Institute VIB-KU Leuven was involved in a landmark study that identified the precise way neurons die in Alzheimer’s disease, a process of programmed cell death called necroptosis, which is triggered by a molecule named MEG3. This discovery opens up an entirely new therapeutic avenue, as drugs targeting necroptosis are already in development for other diseases and could potentially be repurposed.

The Translate-AD project unites six Brussels-based universities and hospitals to create an innovative digital ecosystem for Alzheimer’s disease research. This platform allows for secure, federated analysis of patient data to identify new biomarkers and improve diagnosis, all without the sensitive data ever leaving the local hospital servers.

Researchers from the University of Liège (ULiège) are involved in investigating brain connectivity during sleep in the preclinical neuropathology of Alzheimer’s disease; the links between the deregulation of locomotor activity and brain changes in Alzheimer’s disease, which could lead to a tool for early diagnosis and monitoring of the disease; and a human brain organoid model to study the role of microglia in sporadic Alzheimer’s disease.