El Salvador

Neurologists and psychiatrists rely on globally used cognitive tools translated to Spanish, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and supplementary tests such as the Clock-Drawing Test. Clinical practice in San Salvador aligns with broader Latin American cognitive assessment norms, which prioritise brief validated instruments due to time constraints and limited specialist availability.

El Salvador has significantly expanded its public imaging capacity, making CT and MRI widely available and free of charge across the MINSAL hospital network. In 2023 alone, more than USD 50 million were invested in strengthening radiology and emergency services, the largest investment of that kind in the country’s history. Today, advanced imaging is available in major public hospitals such as Hospital Nacional Rosales, Hospital El Salvador, San Rafael, Usulután, San Miguel, and Zacamil, with additional installations ongoing. The ISSS subsystem likewise provides CT and MRI within its own hospitals for insured workers. These upgrades might strengthen the diagnostic capacity for dementia, ensuring that brain imaging required for cognitive work-ups can be accessed across both public systems without out-of-pocket costs.

Positron emission tomography (PET) imaging exists primarily within ISSS oncology protocols, focusing on fluorodeoxyglucose F-18 (18-FDG) PET for cancer staging. Published ISSS and MINSAL technical documents mention PET scanners in policy contexts, but Alzheimer’s disease-specific PET scans (amyloid/tau) are not part of routine clinical practice.

Routine genetic testing for Alzheimer’s disease (e.g., APOE genotyping, familial Alzheimer’s disease gene panels) is not integrated into national diagnostic pathways. Individuals seeking such testing might rely on private regional laboratories in neighbouring countries or United States-based testing services, following patterns documented across Latin America where genetic services are underdeveloped.

No official documentation outlines nationwide availability of cerebrospinal fluid (CSF) Alzheimer’s disease’s biomarkers (Aβ42, Aβ42/40, t-tau, p-tau). Case-by-case lumbar-puncture analyses may occur within tertiary centres or through research collaborations, but this is not standardised nor widely accessible. Blood-based biomarkers, such as plasma p-tau181 or Aβ42/40, are not yet incorporated into routine clinical use in El Salvador.

In El Salvador, the most structured dementia-oriented services operate within the ISSS, which runs a small network of Memory Clinics in its larger outpatient system. While the MINSAL offers universal access to neurology and diagnostic imaging in major public hospitals, ISSS Memory Clinics represent the closest thing to specialised, organised dementia care in the country, though they remain accessible only to formal workers and their dependents.

The country’s main tertiary referral centre, Hospital Nacional Rosales, has been constructed in late 2025, and is now in the phase of equipping and adaptation work. It will house neurology services and allow for performing neuroimaging scans for cognitive disorders.

Alongside public facilities, the private sector fills essential gaps in specialist access, and other private clinics offer neurologist appointments and rapid neuroimaging, mostly based in the capital San Salvador. Outside the metropolitan region, specialised diagnostic capacity remains limited, and individuals often depend on general outpatient clinics or travel to the capital for advanced cognitive assessments.

Structured dementia day-care programs and multidisciplinary memory units are scarce. What exists tends to come through civil-society initiatives rather than formal state programs, and services such as cognitive stimulation, carer training, and psycho-educational support are typically offered through NGOs or private practitioners rather than through the public system.

Palliative care has slowly expanded beyond its traditional oncology focus. Organisations such as The Foundation of Palliative Medicine of El Salvador (PALIAMED) provide home-based support, psycho-social counselling, and training in the management of advanced illnesses. Their contribution is recognised by the International Association for Hospice and Palliative Care (IAHPC), which lists PALIAMED among national palliative-care providers.

Treatment costs in El Salvador reflect the country’s segmented health-financing structure, which divides care between the MINSAL public system, the ISSS social-insurance system, and a large private sector. Within the public and ISSS pathways, symptomatic Alzheimer’s disease medications and specialist visits are covered when prescribed according to formulary and referral rules. Public hospitals perform diagnostic imaging such as CT and MRI at no direct cost to people, while ISSS beneficiaries receive similar coverage within the insurance network. Out-of-pocket spending becomes significant when families choose private specialist consultations, brand-name medications, or private diagnostic imaging to avoid long waits or to access services unavailable locally. High-cost treatments, especially disease-modifying biologics such as anti-amyloid antibodies, are not listed in public or ISSS formularies and would be entirely private if pursued abroad.

El Salvador does not provide a dedicated state cash benefit or structured allowance for carers of people living with dementia, and existing disability benefits do not address the intensive, long-term demands of Alzheimer’s disease care. As a result, the majority of carer support comes from NGOs and community associations. The central organisation in this sector is the AFAES which offers carer education, support groups, public awareness activities, and yearly campaigns aligned with World Alzheimer’s Month.

Moreover, palliative care NGOs such as PALIAMED provide training and guidance for families caring for individuals living with late-stage dementia, addressing areas such as feeding, comfort, mobility assistance, and end-of-life planning. While these services help compensate for limited state support, they also underscore the broader structural gap as dementia caregiving in El Salvador remains largely privatised and dependent on voluntary organisations rather than a formal policy framework.

El Salvador has no dementia-specific national plan and no stand-alone Alzheimer’s disease strategy published by MINSAL. Instead, dementia is indirectly governed through broader aging, disability, and primary care frameworks. El Salvador also has a National Mental Health Policy, originally guided by Pan American Health Organization (PAHO) recommendations, with updates reflected in the MINSAL’s mental health programming and community-based care expansion. However, this framework, while addressing depression, severe mental illness, suicide prevention, and some neurodevelopmental disorders, does not explicitly incorporate dementia into diagnostic pathways, community services, or referral standards. PAHO country reports note that El Salvador is strengthening its mental health strategies, which could later incorporate cognitive disorder.

Although no dementia plan is under development publicly, ongoing health-system reforms may indirectly strengthen dementia pathways. For example, The World Bank is financing initiatives aimed at improving access, quality, and continuity of care across El Salvador’s public health network, particularly in primary care, referral systems, and diagnostic capacity. Investments in PHC teams, digital health, and service integration are especially relevant for dementia, since improved referral coordination and expanded imaging capacity might reduce delays in diagnostic evaluation.

Other reforms include MINSAL’s modernisation of hospital infrastructure, such as the imaging expansion at Hospital El Salvador, and the rollout of community-based aging and disability programs, which could set the groundwork for future dementia-specific policies.