Chile

In clinical and research settings, several cognitive tests have been validated for the Chilean population in Spanish language. The Mini-Mental State Examination (MMSE) is widely used in Chile as a baseline tool. Montreal Cognitive Assessment (MoCA) is also validated and recommended in the clinical guidelines. The Phototest is also used in primary care, particularly in rural settings.

The structural neuroimaging (CT and MRI) is a guaranteed and accessible component of the standard dementia workup in Chile. The GES N-85 Specific List of Services explicitly includes coverage for both. Any patient with suspected dementia is entitled to a CT or MRI scan as part of their 60-day diagnostic confirmation process. Advanced molecular imaging is restricted and their use is limited to research or private settings.

Testing for the apolipoprotein E (APOE) allele or for the rare, autosomal dominant mutations in the PSEN1, PSEN2, or APP genes that cause familial AD is not available in Chile.

The GES N-85 basket does include CSF analysis, but this is for differential diagnosis – to rule out infections, inflammation, or malignancies. It does not include the specific immunoassays for p-tau required for a biological AD diagnosis. In Latin America, including Chile, one study showed that MRI is the most widely used, while CSF biomarkers are the least common, though many professionals are interested in adopting them.

Blood-based biomarker tests are still in the research phase and have not yet been integrated into standard clinical practice in Chile. At the same time, a private commercial market has developed. One non-invasive blood test is marketed for the early detection of Alzheimer’s disease.

Specialised, multidisciplinary units are located within public hospitals (secondary or tertiary care). Their function is to receive complex referrals from the primary care network, perform the definitive differential diagnosis, and establish the comprehensive treatment plan. The national dementia plan has actively funded the creation of these units outside the capital, representing a tangible effort at decentralisation. Identified public units include the Memory and Neuropsychiatry Centre at the Hospital del Salvador, the Memory Unit at the Valdivia Base Hospital, the Memory Unit at the Magallanes Clinical Hospital, and the Memory Unit at the Dr. Guillermo Grant Benavente Regional Clinical Hospital. Private clinics are overwhelmingly concentrated in Santiago and offer immediate access to those who can pay.

In the public system, there are two main non-residential day centre programmes. The MINSAL Centros de Apoyo Comunitario para Personas con Demencia were created under the National Dementia Plan, and they provide community-based care for people with dementia and training for their caregivers. The SENAMA Day Centres for the Elderly (CEDIAM) offer general support for older adults, focusing on social and recreational activities rather than dementia care. There are only 22 public, SENAMA-funded residential facilities nationwide, compared to over 900 private ones.

For people with severe healthcare needs who cannot leave home, the Home Care Programme (PAD) provides home visits by a team from the local Family Health Centres (CESFAM), including doctors, nurses, and kinesiologists. This is the main long-term public support option, as residential care is very limited.

While Chileans have a legal right to palliative care for dementia with the establishment of the new law, the system to provide it is still being built, and access is not yet guaranteed in practice. Ministry of Health teams are developing the regulations, supported by a $13 billion budget (from 2022) intended for new hires and supplies, to progressively expand the 136 existing palliative care units to include non-oncological patients, with an initial goal of adding 5,000 people in the first year.

The guaranteed “treatment” basket under the GES plan has a fee, which covers the medical service but does not include the high-cost pharmaceuticals used to manage Alzheimer’s disease. The fee for the guaranteed GES treatment basket for Alzheimer’s disease in Chile is 0% (free) for all FONASA beneficiaries using the public network, while ISAPRE beneficiaries must pay a 20% copayment on a standardised reference price. However, this fee only covers the services defined in the guaranteed basket and does not include high-cost pharmaceuticals that fall outside of that plan.

Coverage for occupational therapy, speech therapy, and physical therapy exists through a separate, parallel pathway. Both FONASA and ISAPRES are legally required to cover these therapies for beneficiaries with a disability. To qualify for this benefit, the person must be officially enrolled in the National Registry of Disability. Patients are required to pay a co-payment for each session they attend. The relevant healthcare benefit for these services is the elimination of the annual limit on the number of sessions covered by insurance. This allows individuals to receive ongoing therapy as medically required without a yearly cap.

Neither FONASA nor ISAPRE covers the cost of long-term human care, at-home caregivers, or residential nursing homes (ELEAMs), as these are not considered medical services. The Ministry of Health’s Programme for People with Severe Dependency and Caregivers provides in-home health support for severely dependent patients (measured by the Barthel Index). Separately, the Ministry of Social Development offers a Home Care Programme that provides social support (trained assistants) for patients over 60 who are in the 60% most vulnerable socioeconomic bracket per the Social Registry of Households.

Direct financial aid for caregivers is limited to a monthly stipend that can reach $32,991 CLP (35 USD dollars). Access to this payment is strictly contingent on the patient being enrolled in the public home health Programme, and not living in a residential facility.

More substantial financial support is directed to the patient, not the caregiver, through pensions like the Basic Solidarity Disability Pension (PBSI), which provides up to $250,000 CLP (265 USD dollars) monthly but is restricted to patients between the ages of 18 and 64.

Finally, vital psychosocial support, such as caregiver counselling, helplines, support groups, and respite care, is primarily provided by non-governmental organisations like Alzheimer’s Corporation Chile and COPRAD.

In Chile, the Ministry of Health strategically focuses on dementia risk reduction, an approach adapted to the local context where modifiable risk factors account for a significantly higher proportion (62%) of dementia risk compared to the worldwide average (40%).

The Chilean National Dementia Plan, introduced in 2017, is a comprehensive initiative aimed at improving the care and support for individuals with dementia in Chile. It is designed to enhance early diagnosis, improve access to treatment, and provide better quality of life for patients and their families. Key objectives include the development of public policies to increase awareness and reduce stigma around dementia, strengthening healthcare services, and ensuring a more coordinated approach between primary care, specialists, and social services. The plan also emphasizes training healthcare professionals, increasing support for caregivers, and fostering research on dementia.

A central focus of the plan is the integration of dementia care into Chile’s broader healthcare system, aiming for a holistic, person-centred approach. This includes promoting the establishment of dementia-friendly communities and strengthening the country’s capacity to manage the growing number of dementia cases due to an ageing population. The plan also sets goals for international collaboration and participation in global dementia networks.

While adopted, this national dementia plan is not fully communicated.

Researchers at the International Centre for Biomedicine (ICC) and University of Chile are working on the Neuroimmunomodulation Theory, which proposes that chronic neuroinflammation is the primary trigger for the tau protein pathology that causes Alzheimer’s disease. Researchers at the ICC are also working on a nutraceutical therapy developed from endemic Andean Shilajit that completed a Phase II clinical trial for its potential to block tau aggregation.

Researchers at the Centre for Ageing and Regeneration (CARE-UC) at Pontifical Catholic University of Chile are working on the WNT Signaling Hypothesis, which identifies the collapse of this critical neuroprotective pathway as a triggering factor for the onset of AD. Researchers at the CARE-UC are also working on repurposing the common diabetes drug Metformin as a potential neuroprotective therapy, based on the strong metabolic links between Type 2 Diabetes and Alzheimer’s disease.

Researchers at the Geroscience Centre for Brain Health and Metabolism (GERO) are working on a longitudinal cohort study to track elderly individuals with subjective cognitive complaints to discover the earliest biomarkers and functional changes that predict a future dementia diagnosis. Researchers at GERO are also collaborating with the University of Chile on the REMEMVER project, the first national data registry in Latin America to unify clinical and social data from dementia patients, a project supported by the Alzheimer’s Association.

Researchers at the Latin American Brain Health Institute at the Adolfo Ibáñez University (BrainLat) are working on an AI-powered diagnostic tool, Automated Speech Analysis, that Analyses linguistic and acoustic features of speech to detect dementia and predict its severity. This institution also co-leads the ReDLat consortium, a major multi-national effort to build a platform that characterises the unique genetic and social profiles of dementia in over 4,000 people across Latin America.