Brazil

Several instruments are used in Brazil for the assessment of cognitive function. The Mini-Mental State Examination (MMSE) is the most commonly utilised. However, the MMSE is not fully standardised in Brazil because it is often adapted to local culture and education levels, such as changing certain words or tasks to make them more suitable for the population. Other cognitive screening tests that are used in Brazil are: The Blessed Information-Memory-Concentration Test, Cognitive Abilities Screening Instrument – Short (CASI-S), the Addenbrooke’s Cognitive Examination revised version (ACE-R), the Montreal Cognitive Assessment (MoCA), and the CERAD’s words list. The Brief Cognitive Screening Battery is recommended by the Brazilian Academy of Neurology and included in the 2024 Ministry of Health primary care manual, which also suggests the AD-8 for screening.

The availability and accessibility of CT and MRI scanners are highly unequal. MRI machines are overwhelmingly concentrated in the private sector and in larger cities, leaving the public system with minimal capacity, while CT scanners are somewhat more available but still unevenly distributed. Access is particularly limited in the North and Northeast regions, which have far fewer devices compared to the wealthier South and Southeast. In 2012, Brazil had 1,347 MRI scanners, but their use was relatively low, averaging about 1,000 scans per device annually. PET-amyloid is offered in few centres in Brazil, while PET-tau is still unavailable.

Genetic tests are restricted to some university centres and major cities and are not available in the public health system.

Analysis of biomarkers is currently limited to university research centres and private clinics, but most patients who could benefit (i.e., those with early-onset or atypical symptoms) lack access to these facilities or cannot afford their high costs. CSF test is approved in Brazil but not reimbursed by SUS or private insurance, while beta-amyloid PET ligands are not approved for clinical use and are only accessible through research studies. Blood-based biomarker tests for Alzheimer’s disease are not yet in routine use in Brazil, but validation studies are underway to make them accessible through the public health system. The access to the blood test PrecivityAD2™ is available only through the existing network of healthcare providers who have a relationship with a specific laboratory. CSF biomarkers are becoming more available in Brazil through a program supported by Eli Lilly, with centers like Hospital Geral de Fortaleza using them in selected cases in line with ABN recommendations.

Most of the specialised centres for dementia care in Brazil are associated with public universities in larger cities. Within the public health system, secondary-level specialised services are known as Reference centres, though names vary by region. In São Paulo, they are called Health Reference Units for Older Adults. In Bahia, the main hub is the State Reference centre for Health Care of Older Adults in Salvador. These outpatient facilities are run by interdisciplinary teams, including geriatricians, nurses, social workers, psychologists, and therapists. They provide comprehensive care to frail older adults, including those with dementia, to help them remain in the community for as long as possible. Some of the most specialised centres are affiliated with public universities and teaching hospitals, such as the Clinics Hospital in São Paulo and the University Hospital of Brasília.

The private sector offers high-end centres like the Núcleo de Excelência em Memória (NEMO) at Hospital Israelita Albert Einstein in São Paulo, which provides advanced diagnostics and therapies but is accessible only to those with premium insurance or the means to cover the costs.

Residential care facilities are known in Brazil as Long-Term Care Facilities for the Elderly (ILPIs). The number of ILPIs in the country has doubled in the last decade, from around 3,500 in 2010 to 7,000 in 2024. This market expansion has led to the emergence of high-end, hotel-like residential facilities, particularly in major cities like São Paulo, which offer luxurious accommodations and a wide range of services.

Unlike the burgeoning market for residential ILPIs, there is no evidence of large, national chains or a structured market for dementia-specific day care or specialised in-home care. Some public initiatives do exist, but they are limited in scope and are not specialised for Alzheimer’s disease or dementia. The Ministry of Health’s Melhor em Casa (Best at Home) programme aims to provide home-based care to reduce hospitalisation. However, it is a general health programme, not a specialised Alzheimer’s disease service. Similarly, the number of home care visits that can be provided through the SUS primary care network is very limited, sometimes only one or two per week, and is subject to competing public health demands.

Palliative care is an emerging field in Brazil and is not yet systematically integrated into Alzheimer’s disease and dementia care. The primary care network, with its extensive community presence, has been identified as having excellent potential for delivering primary palliative care, but this potential is largely unrealised due to a lack of adequate training for healthcare professionals in medical and nursing school curricula. Across the entire country, there are reportedly only six dedicated hospices at the first level of care. As a result, palliative care, when available, is delivered through hospitals that have integrated palliative care teams. The National Cancer Institute, for example, has a dedicated palliative care unit (HC IV), but its focus is exclusively on cancer patients. Some private facilities, like the Hospital Placi in Rio de Janeiro, and geriatric clinics in cities like Porto Alegre also offer palliative care services that serve patients living with both cancer and non-malignant diseases like Alzheimer’s disease.

Brazil’s public health system (SUS) provides a core list of essential Alzheimer’s disease medications fully subsidised for eligible patients. This includes drugs like Donepezil, Rivastigmine, Galantamine, and Memantine. However, access requires navigating a significant bureaucratic process. One study has shown that only about 15% of patients who use these medications actually receive them through SUS. Currently, there are no clear plans for the system to add Donanemab to its list of fully subsidised treatments.

Physiotherapy, occupational therapy, and speech therapy are also available at no cost.

Families in Brazil bear the overwhelming majority of the financial burden, shouldering an estimated 73% of all dementia-related costs.

There are no systematic state programmes to support caregivers. Families shoulder most of the burden—financial, physical, and emotional—with few formal mechanisms to assist them. Informal caregivers in Brazil face emotional and financial burdens, with families covering 73% of care costs and many caregivers working up to 10 hours daily, often at the expense of paid employment. Their main unmet needs are financial support and better understanding of dementia. The only available financial relief mechanisms are indirect and patient-focused, such as a 25% increase on disability pensions for those needing permanent assistance or the Brazil Continuous Cash Benefit (BPC) benefit for very low-income individuals.

The most direct form of non-financial support comes from non-governmental organisations (NGOs). Brazilian Federation of Alzheimer’s Associations (Febraz) offers the caretaker programme via Education and Support programme for Alzheimer’s Disease and other Dementias, which is free and online. Unimed College also provides a free Elderly Caregiver course. Additionally, the World Health Organisation’s iSupport programme has been adapted for Brazil (iSupport-Brasil) as an online psychoeducation programme aimed at improving the well-being and mental health of unpaid caregivers. This programme provides education, skills training, and support.

The National Policy for Comprehensive Care for People with Alzheimer’s Disease and Other Dementias was enforced in June 2024. It is a federal initiative that brings together different sectors such as health, social assistance, education, science, and technology. The main goal is to ensure integrated and continuous care for people living with Alzheimer’s disease and other dementias. This includes prevention, early diagnosis, treatment, social support, and access to research and innovation. The policy also seeks to improve the quality of life for both patients and their families.

The national policy is guided by several principles. Care should be interdisciplinary, combining medical, psychological, and social aspects. Families and caregivers should be supported, since they often bear most of the burden of care. The policy also promotes healthy lifestyles to reduce risks and encourages the use of new technologies for diagnosis and treatment. Another priority is to strengthen the public health system. Primary care teams should receive more training to recognise early symptoms. Information systems should be updated to monitor cases of dementia across the country. The government should also promote research and international cooperation in new treatments and medicines.

The Brain Institute of Rio Grande do Sul (InsCer) at the Pontifical Catholic University of Rio Grande do Sul (PUCRS) has become a pioneer in Brazil by commercialising Florbetaben (18F). This radiopharmaceutical, authorised by ANVISA, allows for more assertive diagnoses of Alzheimer’s through PET/CT scans by marking beta-amyloid plaques in the brain, a key biomarker of the disease.

The Brazilian Longitudinal Study of Ageing (ELSI-Brazil), led by the Oswaldo Cruz Foundation (Fiocruz) in partnership with the Federal University of Minas Gerais, the Federal University of Rio Grande do Norte, the University of Campinas, and the Federal University of Espírito Santo, follows a nationally representative sample of adults aged 50 and older to examine how biological, social, and economic factors influence ageing, health, and access to care in Brazil.

Researchers at the University of Campinas (UNICAMP) have developed a technique using an artificial neural network to analyse 3D brain images from MRI scans. This method aims to identify morphological characteristics indicative of Alzheimer’s disease and even detect signs of mild cognitive impairment, potentially leading to earlier diagnosis. The AI-driven technique can provide results much faster than conventional methods relying on human intervention.

Researchers at the Federal University of São Carlos and the Federal University of Rio Grande do Sul are pioneering accessible diagnostics by developing low-cost, blood-based biomarkers to enable earlier and more equitable detection of Alzheimer’s disease. This work is complemented by the University of São Paulo’s unique Brazilian Biobank for Aging Studies, which has enabled paradigm-shifting discoveries about the disease’s earliest stages and specific risk factors within Brazil’s diverse population.

Researchers at the Instituto de Pesquisa Pelé Pequeno Príncipe and the Federal University of Rio de Janeiro are advancing cutting-edge molecular and nanomedicine therapies aimed at restoring brain function.

Researchers at Hospital Alemão Oswaldo Cruz are conducting clinical trial focused on testing the feasibility and acceptability of a culturally-adapted caregiver support programme (originally the UK “START” model) in Brazil’s primary care setting, delivered via trained community general health workers to family caregivers of people living with dementia.