Dominica

There is no documented national population-level dementia screening programme. Case-finding appears to be opportunistic and clinically driven, triggered by symptom presentation in primary care and reinforced by community awareness and NGO-led caregiver engagement rather than systematic screening. In Dominica, both theMontreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are primarily available and administered in English, which is the country’s official language for government, education, and healthcare. While a significant portion of the population speaks Antillean Creole (Kwéyòl), there is currently no official, globally standardized version of these tests in the local Kwéyòl dialect available through the official MoCA portal. In clinical practice, healthcare providers may offer informal oral translations or cultural adaptations to assist patients who are more comfortable with Creole, but official scoring typically relies on the English versions.

Diagnostic capacities in Dominica are primarily centralized at the Dominica-China Friendship Hospital in the capital city of Roseau, where a state-of-the-art Magnetic Resonance Imaging (MRI) machine was commissioned by the Chinese embassy in 2021 as a first for public hospitals in the OECS region. This facility, located in the hospital’s dedicated three-story Medical Technology Wing, provides both plain and contrast MRI studies alongside advanced CT scanning services, digital mammography, and fluoroscopy. Additionally, private diagnostic options such as Medicus Diagnostic Inc. in Roseau offer supplementary Computed Tomography (CT) scan services and various radiological examinations to accommodate the island’s growing medical needs. However, Positron Emission Tomography (PET) scans are not currently available in Dominica, and patients requiring this specific technology are typically referred to regional centers in Martinique or the Dominican Republic.

There is no evidence in accessible Dominica-specific sources that APOE genotyping or other dementia-related genetic tests are included in routine public diagnostic pathways. If undertaken at all, genetic testing is more plausibly initiated by the specialist and accessed off-island, rather than integrated into standard clinical practice.

Similarly, there is no indication that CSF biomarkers (Aβ, tau) or emerging blood-based Alzheimer’s biomarkers are part of standard diagnostic pathways in Dominica. Where such testing occurs, it is likely external to the national system, obtained through overseas specialist care or research contexts rather than routine public-sector diagnosis.

Dominica does not operate dedicated memory clinics or dementia-specific specialist units. Instead, dementia care is delivered through a generalist model anchored in primary care and the national referral hospital, the Dominica-China Friendship Hospital in Roseau, where inpatient and outpatient services manage more complex cases. Access to specialist expertise is limited: geriatric care is provided by only two known on-island geriatricians, both in private practice and outside government coverage, and there is no formally established multidisciplinary dementia team (neurology, geriatrics, psychiatry, allied health) within the public system. Advanced diagnostics and specialized interventions are not consistently available on island, leading to reliance on private services or overseas referral when clinical complexity increases. In the absence of formal specialist infrastructure, non-state actors, DFF, provide much of the practical dementia-specific support, including caregiver training, support groups, and navigation, effectively supplementing limited specialized service capacity.

While the basic examinations and medicine is covered by the government, long-term dementia treatment and care generate substantial indirect and uncovered costs. Ongoing pharmacological treatment is vulnerable to supply constraints and variability, leading some families to purchase medicines privately. Non-pharmacological care, such as behavioural management, rehabilitation, assistive devices, and home adaptations, is not systematically financed through public programs. In addition, transportation and mobility costs remain a major barrier: rising bus fares, limited accessible transport, and the physical demands of travel disproportionately affect older people with cognitive impairment and their caregivers. Specialist dementia care is highly concentrated and largely privatized. With only two known on-island geriatricians, both operating in private practice and outside government coverage, families who require specialist follow-up, medication adjustment, or complex care planning must pay out of pocket or seek care abroad. When treatment escalation requires advanced neuroimaging, specialist consultations, or institutional care options not available locally, households often face costs related to overseas referral, including travel, accommodation, and private medical fees.

Caregiver support is one of the most visible and structured elements of Dominica’s dementia response and is predominantly NGO-led. The DDF plays a central role through support groups, caregiver training, community engagement, and meaningful activity programs for people living with dementia. Historically, the Foundation has also provided practical assistance to care homes during periods of acute system stress, highlighting its function as both a service provider and a resilience mechanism. In a small health system with limited specialized infrastructure, this caregiver-focused support acts as a critical navigation and stabilization layer, partially offsetting gaps in formal long-term care services.

Like many Commonwealth countries, Dominica still lack a National Dementia Plan and require support from WHO and other institutions to develop one. It is estimated that in Dominica 574 people live with dementia within a population of about 72,400, and this number is expected to increase, underscoring the growing need for a national dementia strategy. However, in October 2024, the government announced to have start working o developing a national strategy.2 Dementia is currently addressed indirectly, through general mental health provisions of Mental Health Act from 1987, strengthening, non-communicable disease frameworks, and broader discussions on ageing rather than through a dedicated, standalone policy instrument.3 Civil-society submissions and advocacy materials, most visibly from the DDF and allied actors, consistently emphasize the need for a government-led strategy that explicitly recognizes dementia as a growing public-health and social care priority, particularly in the context of population ageing and rising chronic care needs.

In June 2025 the Ministry of Health, Wellness, and Social Services, via its Social Services Division), convened a national dialogue on the current situation of senior citizens in Dominica, with a strong focus on elderly care. The consultation brought together a broad mix of stakeholders, including care institutions, social security, civil society, and faith-based organizations, to move discussions from reflection toward coordinated action. Glenora Pacquette, head of the Social Welfare Services Unit, outlined objectives centered on reviewing the status of older persons, examining the Economic Commission for Latin America and the Caribbean (ECLAC) Ageing Caribbean Report, aligning its recommendations with Dominica’s context, identifying national priorities, and jointly planning next steps. She emphasized the consultation as a strategic space for direction, alignment, and transformation. Dr. Kyra Paul, Permanent Secretary, underscored that elderly care must prioritize dignity, rights, and compassion, extending beyond basic assistance to include specialized support for dementia, chronic illness, and mobility challenges. She also highlighted elder abuse as a national concern, sometimes occurring within families, and called for collective action to protect vulnerable older people. The Department of Social Services indicated that outcomes from SWOT analyses of social programs, reviews of legal protections, and the development of standard operating procedures for senior-care institutions would help identify practical solutions to challenges faced by caregivers and service providers nationwide.

In August 2025, Dominica continued multi-stakeholder consultations to inform the development of a national dementia plan and revised mental health legislation, in collaboration between the Ministry of Health, Wellness and Social Services and the Pan American Health Organization (PAHO). This marked the second consultation in a process involving more than 50 stakeholders. Participants represented a broad cross-section of society, including the Attorney General’s Chambers, emergency services, the Dominica Prison Service, NGOs, academia, faith-based groups, the business community, and youth organizations. Field consultations were also conducted with health and social services staff at facilities such as the Dominica-China Friendship Hospital and Reginald Armour Hospital. In a latest budget address, Cassani Laville, Minister of Health, Wellness and Social Services, also emphasized a whole-of-society approach to mental health, calling for mental illness to be treated with the same urgency as non-communicable diseases. Key themes emerging from the consultations included workplace access to mental health services, substance use, youth homelessness, and the role of religious institutions in counselling. Stakeholders highlighted the importance of inclusive policymaking, with youth participants noting that their perspectives were meaningfully incorporated into the process.

Innovation in Dominica’s dementia landscape is service and governance-oriented rather than biomedical. The most visible innovations include NGO-led caregiver support, training, and advocacy, combined with broader health system transformation efforts aimed at strengthening primary care, governance, and chronic disease management. While not dementia-specific, these reforms create a platform that could be leveraged for integrated neurocognitive care, particularly in areas such as task-shifting to primary care, community follow-up, and caregiver engagement. In this context, innovation is incremental and adaptive, focused on making limited resources work more coherently rather than introducing novel technologies.

In January 2025, DDF’s founder, Rianna Patterson has been awarded a full UK Research Institute-funded PhD scholarship at the University of Nottingham (School of Medicine). Her doctoral research will examine the feasibility of technology-enabled dementia care for marginalized communities, with a focus on Caribbean populations in London.