Dominican Republic

There is no published population-wide dementia screening program in the Dominican Republic. Instead, the national dementia plan prioritizes awareness-raising and earlier case-finding within primary care rather than universal screening. In routine clinical practice, both public-affiliated and private clinics commonly rely on brief, standardized cognitive tools such as MMSE and MoCA as first-line screens, particularly in urban settings. This approach aligns with international guidance favoring targeted screening of symptomatic individuals rather than population-wide testing, and is consistent with pathways described by ADI’s and advertised clinical practice at Hospiten.

Structural neuroimaging is widely available in major cities. CT and MRI are offered through large hospitals and private diagnostic networks, including Hospiten and other multi-site providers. Functional and molecular imaging capacity is more limited but does exist in the capital. PET-CT and nuclear medicine services are available at centers including Clínica Abreu and INCART. While these facilities primarily serve oncology patients, they are technically capable of neurological indications when clinically justified. Geographically, this capacity is highly concentrated in Santo Domingo. Patients from other regions typically need referral and travel to the capital, which adds time, cost, and logistical complexity. As a result, imaging-supported dementia diagnosis is substantially more accessible in urban centers than in peripheral provinces.

There is no national guideline mandating genetic testing for Alzheimer’s disease or other dementias. Testing for APOE genotype or monogenic dementia panels, where available, is offered on a private, case-by-case basis and is not considered a routine component of diagnosis. This mirrors broader regional practice in Latin America, where genetic testing is generally reserved for early-onset cases, strong family histories, or research contexts rather than standard clinical pathways.

In tertiary level centers in Santo Domingo, lumbar puncture with CSF analysis can be performed when clinically indicated, typically within specialist neurology services such as those at Hospiten. However, there is no public evidence that standardized Alzheimer’s CSF panels (e.g., Aβ42, tau, p-tau) or blood-based biomarkers are used systematically nationwide. Their use appears limited to specialist centers and selected cases, rather than embedded as a routine diagnostic step across the health system.

The Dominican Republic does not operate a nationwide, stand-alone memory clinic network. Instead, dementia care is delivered through neurology, psychiatry, geriatrics, and internal medicine services, heavily concentrated in Santo Domingo and other large cities. Private and mixed private–academic providers (Hospiten and Clínica Abreu, including its diagnostic units) anchor specialist assessment, follow-up, and access to advanced diagnostics. Nuclear medicine units in the capital expand the clinical envelope (primarily oncology-led but neurologically capable), reinforcing an urban hub-and-spoke reality rather than territorially even coverage.

For long-term and social care, the older-persons agency Consejo Nacional de la Persona Envejeciente (CONAPE) operates or backs Hogares de Día (day centers), residential support, and community programs. These services indirectly support people with dementia and caregivers through supervision, meals, basic health monitoring, and respite, though they are not dementia-specific everywhere and coverage varies by municipality. Palliative care exists in major urban hospitals, but dementia-specific palliative pathways (advance care planning, behavioral symptom management, caregiver counseling integrated with end-of-life care) are still emergent rather than standardized.

Medication and outpatient follow-up costs are partially reimbursed under social health insurance (multiple ARS schemes, including the public insurer SeNaSa), subject to plan tier, network use, and copays. Formularies and complementary benefit matrices outline broad coverage categories rather than molecule-by-molecule entitlements; reimbursement flows through the ARS/PDSS schedule and contracted tariffs. In practice, families frequently incur copays or out-of-pocket expenses when opting for branded drugs, private pharmacies, or out-of-network providers, costs that can accumulate over time given the chronic nature of dementia treatment.

Caregiver support is policy-recognized through numerous programs, but uneven in reach. CONAPE runs or supports initiatives for older adults that include home-care assistance (hygiene/personal care in residential settings), day homes, emergency shelter options, and caregiver professionalization pilots. These interventions provide skills training, respite models, and social assistance, helping families manage daily care and reduce burnout. At the regional level, Iberoamérica Mayores documents and disseminates good practices that inform national approaches. The National Dementia Response Plan calls for expanded caregiver access and support, but dedicated cash benefits or universally guaranteed allowances for dementia caregivers are not yet in place. As a result, caregiver burden remains substantial, particularly outside the capital.

The Dominican Republic adopted a National Dementia Response Plan (2020–2025) that aligns with international guidance on early detection, standardized access, service coordination, and system monitoring. Strategically, the plan positions dementia within broader ageing and non-communicable disease frameworks rather than as a siloed condition, an approach that supports integration with primary care and social services.

Implementation, however, is asymmetric. Progress is most visible in urban centers, where private capacity, specialist density, and insurance navigation are strongest. Key policy gaps include:
• the absence of a territorial memory-clinic model
• limited routine use of biomarkers beyond specialist centers
• variable primary-care training in dementia recognition outside cities
• financing protections for long-term care and caregivers that lag behind clinical intent.
Looking ahead, policy priorities implied by current practice include: strengthening primary care case-finding and referral nationwide; formalizing dementia-specific palliative pathways; expanding day center and respite coverage beyond pilot geographies and clarifying benefit entitlements (medications, imaging, follow-up) to reduce out-of-pocket exposure. Achieving these would translate the plan’s strategic commitments into more equitable, nationwide delivery.

Through the remainder of 2025, the emphasis remains on implementing and consolidating the existing 2020–2025 framework rather than launching a successor strategy. Key near-term priorities include scaling caregiver and professional training, expanding “communities of care” and respite-oriented pilots, and strengthening intersectoral coordination, particularly with social protection and older-persons services supported by CONAPE. These efforts aim to move beyond episodic clinical care toward more continuous, community-anchored support. A parallel policy thread focuses on reducing territorial inequities. Ongoing initiatives, documented regionally by Iberoamérica Mayores, highlight attempts to adapt urban-centric models (training curricula, day-center concepts, caregiver education) for use outside Santo Domingo. The challenge through 2025 is less strategic design than delivery at scale, particularly in provinces with limited specialist presence.

The most significant innovation lever is the DR’s participation in LatAm-FINGERS, which introduces harmonized lifestyle-intervention protocols, standardized cognitive batteries, and common data models across participating sites. This approach strengthens local research capacity, supports comparability with international cohorts, and creates a foundation for future prevention pathways in primary care. Beyond trials, innovation is incremental and system-focused: adapting standardized cognitive testing to routine clinics, integrating vascular risk management into dementia prevention, and improving data capture for monitoring and planning. While advanced biomarker-driven research remains limited, these steps are pragmatic and aligned with near-term policy goals.