Costa Rica

Cognitive assessment in Costa Rica follows a structured, clinically driven model anchored in CCSS protocols and the practices of the National Geriatrics & Gerontology Hospital (HNGG). Initial testing typically occurs in primary care, where physicians use brief tools such as the MMSE and clock-drawing tasks to determine whether further evaluation is necessary. Once patients are referred to hospital specialists, cognitive testing becomes more standardized and comprehensive. Specialists at HNGG and other tertiary centers conduct detailed clinical interviews, gather informant histories, assess functional decline, and administer more extensive neuropsychological tests tailored to the patient’s age, education, and symptom profile. Although formal neuropsychology services exist, they are mostly concentrated in the Central Valley. The private sector mirrors this approach and can offer faster scheduling, but testing remains clinically oriented rather than part of any organized early-detection program. ASCADA, the national Alzheimer association, provides educational material on memory problems but does not conduct formal cognitive screening.

Structural neuroimaging is considered a routine component of dementia work-ups within Costa Rica’s public system. CT scans are widely available across CCSS hospitals and often serve as the first-line modality, especially because MRI capacity remains constrained in major public centers. MRI is recommended in HNGG’s diagnostic protocols, particularly for cases where vascular changes, atypical presentations, or early-onset symptoms require higher-resolution imaging, but long wait times mean that MRI is not uniformly applied in practice. PET/CT capacity exists primarily for oncology diagnostics, and the University of Costa Rica’s radiopharmacy supports tracer production, yet amyloid-PET for dementia is not part of standard care. Its use, where it occurs, is limited to private-pay situations or research-oriented evaluations and is not covered within CCSS pathways. Altogether, imaging availability is strongest in San José and nearby hubs, with more limited access in rural regions.

Genetic testing for dementia is not integrated into Costa Rica’s national clinical pathways. CCSS protocols do not recommend routine APOE testing or screening for familial Alzheimer-related mutations, reflecting the global consensus that such tests have limited value for typical late-onset presentations. When genetic analysis is pursued, it tends to occur in two contexts: private-sector consultations, where patients or families request APOE or panel testing, and research collaborations involving Costa Rican academic institutions or international partners.These cases are relatively rare and generally limited to individuals with early-onset dementia, unusually aggressive symptom progression, or strong multigenerational family histories. There is no national registry or coordinated program for hereditary dementia assessment, and no systematic provision for pre-test or post-test counselling within public services.

Biomarkers occupy a transitional space in Costa Rica’s diagnostic landscape. CSF biomarkers, Aβ42/40, total tau, and phosphorylated tau, are referenced in academic publications as consistent with international best practice. However, they are not standard in public clinical pathways due to limited laboratory infrastructure, cost considerations, and the absence of formal CCSS protocols governing their use. Some private neurology centers publicize CSF biomarker panels, though uptake is modest and typically out-of-pocket. Tertiary hospitals may occasionally refer patients for CSF testing in complex or atypical presentations, but this remains discretionary rather than systematic. Blood-based biomarkers, while gaining global traction, have not yet been adopted in Costa Rica: neither public nor private clinical services have incorporated plasma p-tau or other emerging assays into routine diagnostic decision-making. As a result, biomarker use remains selective, research-linked, and largely confined to private settings.

Costa Rica’s specialized dementia services are anchored by the National Geriatrics & Gerontology Hospital (HNGG), which functions as the country’s principal reference center for cognitive disorders. HNGG not only receives complex referrals from across the CCSS network but also publishes diagnostic protocols, manages a dedicated Memory and Behavior Unit, and trains clinicians in geriatric assessment. Although HNGG sets national standards, much of the day-to-day dementia care occurs in neurology and psychiatry outpatient clinics located in public hospitals and, increasingly, in private-sector facilities. These services are heavily concentrated in the Greater Metropolitan Area, creating a gradient of access in which families outside San José may rely more on primary care for follow-up and management.

Costa Rica has also developed a relatively robust palliative-care ecosystem, with national programs, interdisciplinary teams, and NGO involvement supporting patients with chronic and terminal illnesses. Dementia-specific palliative pathways, however, are still being formalized. While general adult palliative teams are accustomed to supporting individuals with advanced dementia, standardized triggers, protocols, and planning tools tailored specifically to cognitive decline are still in development. Integration efforts are ongoing as part of national strategies to strengthen chronic-care services and reduce variability across regions.

The financial architecture of treatment mirrors the structure of Costa Rica’s universal health system. All medications included in the LOM are covered under CCSS, provided they are prescribed according to institutional protocols. This includes routine visits, chronic care follow-ups, and specialist oversight in hospital memory clinics. Families therefore do not pay directly for symptomatic Alzheimer medications or core medical management provided through the public system.

Out-of-pocket spending emerges primarily in two contexts. First, families who seek faster access to specialists, imaging, or medication adjustments may opt for private consultations, which are fully self-funded. Second, services that fall outside the core medical package, such as private occupational therapy, physiotherapy, speech therapy, or structured cognitive-rehabilitation programs, require direct payment. Public hospitals and NGOs do offer some rehabilitative and educational services, but availability varies, and waiting lists can be long. Non-medical costs also add financial strain, including transportation, respite care, and time lost from employment, all of which remain largely uncovered.

Caregivers in Costa Rica play a central role in dementia management, and much of the national infrastructure for supporting them is delivered through ASCADA, the national Alzheimer association and a member of Alzheimer’s Disease International. ASCADA provides education workshops, support groups, helplines, navigation assistance, and public-awareness campaigns. It is often the first touchpoint for families seeking guidance, and its programming helps counterbalance variability in public-sector psychosocial services. ASCADA also partners with universities and community organizations to expand caregiver training and promote early recognition of dementia symptoms.

Despite a solid NGO presence, dedicated public financial benefits for caregivers are not documented, and Costa Rica does not have a dementia-specific social-support allowance. Instead, families rely on a combination of public health coverage for medical care and their own resources to manage non-medical needs. While CCSS coverage reduces catastrophic medical spending, caregivers frequently absorb the costs of transport, private respite, paid home care, and lost work hours. As a result, much of the support structure remains psychosocial and educational rather than financial, with NGOs and community groups playing an outsized role in bridging gaps in the formal system.

Elderly care is sustained by a combination of family networks, nonprofit initiatives and state programs such as CONAPAM and the Red Cuido care network, which collectively assist highly vulnerable older adults and helped implement the country’s pioneering 2014 National Alzheimer Plan. Nonprofits like the Yamuni Tabush Foundation further strengthen healthy aging through training and community support, while legislation, from the 1999 Comprehensive Law for Older Adults to the criminalization of elder abandonment in 2020, reinforces protections. Despite challenges such as low employment rates among older adults, widespread informal work, and high levels of elder abuse and discrimination, Costa Rica’s integrated family, NGO and public systems place it at the forefront of dignified, rights-based elderly care in Latin America.

Costa Rica occupies a unique place in the Latin American dementia-policy landscape: in 2014, it became the first country in the region to adopt a formal National Alzheimer’s Plan, a milestone that predates similar efforts elsewhere in Central and South America. The plan emerged through close collaboration between the Ministry of Health, its Mental Health Technical Secretariat , the National Council on Ageing (CONAPAM), and the Alzheimer association ASCADA. Together, these bodies framed dementia as a public health and social care priority rather than a niche geriatric issue. The strategy outlined several core objectives, raising public awareness, enabling earlier recognition and diagnosis, strengthening care pathways across CCSS, improving professional training, and expanding support for caregivers. ADI continues to list Costa Rica among countries with an active, formal national plan, underlining the country’s early leadership in this field.

Although the original plan was a foundational document, it also served as a policy catalyst: it legitimized dementia as a multisectoral issue, elevated its visibility in public discourse, and provided the rationale for subsequent investments in memory services and clinical protocols.

In general Costa Rica is rapidly aging and is projected to become a super-aged society by 2050, with more than 20% of its population over age 60, which is why the government has acted proactivley to deal with this issue. Since the publication of the 2014 plan, Costa Rica has made incremental, service-level progress rather than announcing a comprehensive second-generation national strategy. Among the most notable developments is the issuance of the Ministry’s Norma National for cognitive impairment and dementia, which standardizes clinical criteria, referral pathways, and expected roles within CCSS. These technical norms have strengthened consistency across public services, particularly for primary care diagnosis and specialist referral.

In parallel, Costa Rica has updated its pharmacotherapy formulary, with the 2024 addition of the rivastigmine patch as a significant example of clinical modernization. The country has also advanced its palliative-care framework, integrating dementia more explicitly into chronic, progressive illness pathways. Despite this progress, a fully refreshed dementia plan, one that mirrors newer WHO and ADI guidance, has not yet been publicly released. The absence of an updated, centralized policy document means that advancements are occurring through piecemeal reforms, institutional circulars, and targeted program updates rather than through a single strategic roadmap.

Moreover, CONAPAM works with community homes, day centers and church-based programs to support highly vulnerable older adults, reaching over 15,000 people each year. It also played a key role in implementing Costa Rica’s pioneering First National Alzheimer Plan, the first dementia plan in any low- or middle-income country, which aims to improve the quality of life of people with dementia, estimated at about 10.7 per 1,000 Costa Ricans.

Innovation in Costa Rica tends to be service-driven rather than research-driven. The HNGG’s structured memory-clinic model has introduced standardized cognitive assessment pathways, improving diagnostic quality and consistency across CCSS. Expanded MRI access, not yet sufficient to meet demand but significantly better than a decade ago, has also strengthened diagnostic capacity.

The most technically significant innovation is UCR’s PET radiopharmacy platform, which has elevated national capacity for imaging-based research. While amyloid-PET remains highly selective, used mainly in private contexts or rare, complex diagnostic cases, its availability marks a major step forward relative to regional peers. These innovations signal Costa Rica’s gradual shift toward more modern diagnostic methods, even if access remains limited outside the Greater Metropolitan Area.

It is worth mentioning that there are several obstacles for research activities in Costa Rica. A recent analysis of Alzheimer’s research capacity in Costa Rica highlights that, despite high-quality clinicians and growing ageing needs, the country produces very little scientific research on dementia, only about 30 studies using Costa Rican patient data. Major barriers include the limited number of doctors trained in research methods, strict restrictions on accessing and publishing patient data, poor integration of medical, scientific, and policy dialogue, and the lack of research-ready patient datasets, as electronic medical records were not designed for investigative use. Interviews with Costa Rican researchers confirm that these gaps, combined with bureaucratic obstacles, significantly hinder progress. Proposed solutions include expanding research training for clinicians, lifting data-access limitations, fostering collaboration among doctors, scientists and policymakers, and establishing a centralized Alzheimer’s data repository. With appropriate legal reforms and improved coordination, Costa Rica has the expertise and institutional capacity to strengthen national dementia research and contribute more substantially to the field.