Holy See

No Vatican-specific dementia testing protocol has been published. Cognitive assessment would therefore follow specialist clinical practice, either through Vatican neurologists, geriatricians and psychiatrists or through Italian dementia centres. Assessment would ordinarily involve brief cognitive screening followed, when necessary, by comprehensive neuropsychological evaluation. Italian national guidelines cover the diagnosis and management of both dementia and mild cognitive impairment and provide the relevant clinical framework for external specialist care.

The Vatican Polyclinic provides diagnostic imaging, including conventional radiology and ultrasound, but there is no evidence that Vatican City operates its own CT, MRI or PET facility. Patients requiring structural brain imaging can therefore be referred to Rome’s extensive hospital and diagnostic network. CT and MRI are routinely available in Italian tertiary hospitals, while FDG-PET and amyloid PET are accessible at selected specialist and research centres.

There is no evidence of routine dementia genetic testing within Vatican City itself. APOE genotyping and testing for rare familial Alzheimer’s mutations would therefore require an appropriately equipped Italian genetics or neurological centre. As elsewhere in Europe, genetic testing would mainly be relevant to unusual early-onset or strongly familial cases rather than routine late-onset dementia.

There is no evidence that CSF amyloid/tau testing, plasma Alzheimer biomarkers, amyloid PET or tau PET are performed within Vatican City’s own healthcare facilities. This does not mean that Vatican residents lack access. Rome contains major academic and specialist centres capable of advanced dementia investigation. Where clinically indicated, a Vatican’s FAS patient could therefore be referred externally for CSF or imaging biomarkers. Advanced biomarker tests are often missing locally, but patients can access them in Rome through Vatican-linked networks like the Bambino Gesù Children’s Hospital and partner Catholic medical institutions that handle complex diagnostics, cell therapies, and rare disease research.

The Vatican’s greatest strength is the unusually broad range of healthcare services available relative to its very small population. The Directorate of Health and Hygiene operates a Polyclinic within Vatican City that provides access to a wide range of medical specialties relevant to the assessment and management of older people and patients with cognitive disorders. These include internal medicine, neurology, geriatrics, psychiatry, psychotherapy, physiotherapy, cardiology, endocrinology, laboratory medicine and diagnostic imaging, alongside numerous other specialist services. This means that many of the components required for an initial dementia assessment, including neurological evaluation, assessment of comorbidities, laboratory investigations and imaging, can potentially be coordinated within the Vatican healthcare system itself. The availability of geriatric, neurological and psychiatric expertise is particularly important because dementia diagnosis frequently requires differentiation from depression, delirium, medication effects and other neurological or age-related conditions.

Nevertheless, no dedicated memory clinic, cognitive disorders centre, dementia ward, dementia-specific day centre or specialized residential dementia facility has been identified within Vatican City. Given the country’s exceptionally small resident population, establishing a comprehensive standalone dementia infrastructure would be neither clinically nor economically comparable to what would be expected from a larger national healthcare system. Instead, the Vatican effectively operates within the much larger healthcare ecosystem of Rome. Patients requiring more complex neurological investigation, multidisciplinary dementia assessment, advanced biomarker testing, hospitalization or long-term specialist services can therefore be referred to Italian institutions located only a short distance outside Vatican territory.

Rome provides particularly strong tertiary-level dementia capacity. Italy maintains a nationwide network of Centres for Cognitive Disorders and Dementias (CDCDs), which constitute the principal specialist structures for dementia diagnosis, treatment and follow-up. These centres generally bring together neurologists, geriatricians and other professionals and can provide detailed neuropsychological assessment, differential diagnosis, pharmacological management and monitoring. The Italian National Institute of Health (ISS) also maintains a national mapping system covering CDCDs, dementia day centres and residential facilities, meaning that Vatican residents and eligible personnel are geographically surrounded by a comparatively dense network of specialized services.

One of the most relevant nearby institutions is the Memory Clinic at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, located in Rome only a few kilometres from Vatican City. The clinic combines expertise in neurology, geriatrics and cognitive disorders and was specifically developed to establish coordinated and preferential diagnostic and therapeutic pathways for people with suspected cognitive impairment and dementia. Its location makes it a particularly plausible tertiary referral option when diagnostic needs exceed the capabilities of the Vatican Polyclinic. Gemelli’s broader hospital infrastructure also provides access to advanced neuroimaging, laboratory medicine and multiple specialist disciplines, allowing cognitive symptoms to be investigated within a comprehensive multidisciplinary setting.

Medical treatment for eligible beneficiaries is substantially protected through the FAS. The FAS is not a universal insurance scheme for every Vatican resident. Rather, it finances healthcare for eligible ecclesiastical, religious and lay personnel serving, or retired from, the Roman Curia, the Governorate of Vatican City State and other qualifying institutions administered by the Holy See. Coverage can also be extended to certain eligible family members. Importantly for dementia, the FAS Statute explicitly covers medical and surgical assistance for illness, including chronic and terminal conditions, meaning that dementia is not excluded simply because it is progressive or chronic.

For eligible beneficiaries, care can be delivered through both direct and indirect assistance. Direct care is provided through the Vatican Directorate of Health and Hygiene’s own facilities or through physicians, clinics and hospitals contracted with the FAS. When a required service cannot be performed within the Vatican Polyclinic, the FAS can therefore authorize treatment at an external contracted provider. This arrangement is particularly relevant to dementia because more complex neurological assessments, hospital treatment and other specialist procedures may need to be obtained in Rome rather than within Vatican City itself. Hospital admissions generally require prior FAS authorization, although special procedures exist for urgent hospitalization.

Beneficiaries are also permitted to obtain treatment from non-contracted physicians, diagnostic centres, nursing homes and hospitals under the FAS’s indirect-assistance mechanism. In these cases, patients generally pay the provider and subsequently receive a contribution or reimbursement from the Fund, subject to authorization, the applicable FAS tariff and reimbursement ceilings. Consequently, the system provides considerable freedom to obtain specialist dementia-related care outside the Vatican network, although it does not necessarily eliminate out-of-pocket expenditure when a non-contracted provider charges more than the reimbursable amount.

Long-term dementia care is less comprehensively defined than medical treatment. The current FAS Statute establishes broad coverage for chronic illness and also permits economic contributions for supplementary services, but it does not establish a clearly defined, dementia-specific entitlement comparable to a national long-term-care insurance programme. In the publicly available Vatican framework, there is no identifiable statutory dementia care allowance, guaranteed dementia residential-care benefit, dedicated caregiver payment or formal national dementia respite-care programme. The distinction is important because the costs generated by advanced dementia often shift away from medical diagnosis and treatment toward continuous supervision, personal care, residential accommodation and support for family caregivers.

There is, however, evidence that the Vatican system has historically recognized the financial problem created by chronic conditions requiring prolonged care. An earlier FAS statute explicitly provided that, for chronic illnesses involving long-term hospitalization, the FAS governing body could authorize contributions toward institutional or nursing care, depending on available financial resources. This is significant because it demonstrates that long-term nursing needs can fall within the broader concept of assistance, but the wording describes a discretionary contribution rather than an automatic entitlement to comprehensive long-term care.

There is no dedicated Vatican dementia caregiver programme comparable with those operated by national Alzheimer associations. This is partly explained by the state’s tiny and institutionally unusual population. Informal support may come from relatives, religious communities and institutional structures, while professional dementia counselling and caregiver programmes can be accessed through neighbouring Italian organizations and services.

The Holy See nevertheless places considerable institutional emphasis on the dignity and inclusion of older people. In June 2026, the Dicastery for the Laity, Family and Life convened experts specifically to consider the pastoral care of older people. In a letter for the meeting, Pope Leo XIV described old age as a complex stage of life that remains rich in possibilities and emphasized that older people continue to constitute a significant presence within the Church. The message also stressed their capacity to contribute to community and ecclesial life through experience, wisdom and voluntary activity.

This approach was reinforced by Pope Leo XIV’s message for the Sixth World Day for Grandparents and the Elderly, published on 15 June 2026 and celebrated on 26 July under the theme “I will never forget you”. The initiative places particular emphasis on preventing older people from being forgotten or socially marginalized and reflects the Holy See’s broader view that advanced age should not lead to exclusion from family, community or Church life.

The Vatican’s 2026 activities also included discussion of “aging and vitality” within the Borgo Laudato Si’ Dialogues, further demonstrating that ageing is receiving attention at an institutional level beyond purely clinical healthcare.

Vatican City does not have a dedicated national dementia strategy, dementia action plan or dementia-specific public-health programme. There is no identifiable Vatican equivalent of the national dementia plans adopted by many European states, nor a formal policy setting targets for early diagnosis, dementia-specific service development, caregiver support, professional training, epidemiological surveillance or research. Dementia therefore appears to be managed within the Vatican’s broader healthcare and social-support structures rather than as a distinct national policy area.

Instead, Vatican health policy is organized around maintaining a comparatively comprehensive internal healthcare service while allowing specialist needs to be met through relationships with external providers. Under Vatican law, the Directorate of Health and Hygiene is responsible for healthcare, public health and hygiene, occupational health protection and related health functions within the state. The Governorate itself has statutory responsibility for the protection of health, public health and public hygiene.

Importantly, the Directorate’s responsibilities extend beyond services physically provided within Vatican territory. Its regulations explicitly assign it responsibility for maintaining relations with international and foreign healthcare institutions and bodies, alongside implementing the health guidelines and directives established by the Vatican’s governing authorities. The Directorate provides medical care, public-health services and emergency assistance.

No Vatican dementia strategy is currently known to be under development. There is, however, evidence of growing Holy See engagement with healthy ageing, caregiving and brain health, suggesting that issues closely connected with dementia are receiving increasing institutional attention even without being incorporated into a formal national plan. A particularly important example was “The Memory: A Symposium Addressing the Opportunities and Challenges of an Aging Global Population,” held in Vatican City on 9-10 May 2025. Organized by the Pontifical Academy for Life and partners including AARP and the Età Grande Foundation, the meeting brought together experts and representatives from more than 20 countries, including scientists, healthcare professionals, international organizations and civil-society groups. Discussions covered brain health, family caregiving, healthcare access, healthy longevity, age discrimination and the particular challenges created by population ageing in developing countries. Dementia was directly relevant: sessions considered how societies could better support family caregivers of people living with dementia and how neurological and lifestyle interventions could help preserve brain health.

The symposium was also significant because it produced the Vatican City Declaration of the Pontifical Academy for Life, AARP and the Muslim Council of Elders, turning the discussions into a broader set of international commitments. These included promoting brain-health strategies, recognizing and strengthening the role of family caregivers, supporting healthier and longer lives, combating age discrimination and protecting the rights and dignity of older people. The initiative therefore represents more than a general pastoral discussion of ageing: it demonstrates an emerging Vatican interest in several policy areas directly relevant to dementia prevention and care. Nevertheless, these activities are primarily international, ethical and advocacy-oriented rather than a Vatican domestic dementia policy. There is currently no indication that the symposium or declaration will lead to a Vatican dementia action plan, national dementia targets or a dedicated domestic programme. It is better understood as evidence that the Holy See is increasingly active in shaping the international discussion on brain health, caregiving and healthy ageing, while Vatican City’s own dementia needs continue to be addressed through its general healthcare system and access to Italian services.

Cross-border specialist care: One of the most distinctive features of the Vatican healthcare model is its ability to combine substantial internal outpatient capacity with referral to Italy for highly specialized or resource-intensive care. The Directorate of Health and Hygiene is formally responsible for maintaining relations with foreign and international healthcare institutions, providing an institutional basis for this approach. For a state with fewer than 1,000 residents, this is particularly efficient: rather than duplicating expensive tertiary infrastructure, including advanced CT, MRI and PET imaging, specialist dementia units and complex hospital services, the Vatican can maintain routine and specialist outpatient care internally while drawing on Rome’s extensive hospital network when necessary. This model is particularly well suited to dementia, where initial assessment and follow-up can occur locally but advanced imaging, biomarker testing or complex neurological evaluation may require tertiary facilities.

Integrated multidisciplinary Polyclinic: Despite the state’s extremely small size, the Vatican Polyclinic provides access to a remarkably broad range of specialties. For dementia care, the coexistence of neurological, geriatric, psychiatric, psychological, internal-medicine and laboratory expertise creates potentially favourable conditions for a multidisciplinary approach to cognitive decline. Such integration is valuable because dementia assessment often requires consideration of neurological disease alongside psychiatric symptoms, medication effects, cardiovascular and metabolic risk factors and other conditions that can cause or exacerbate cognitive impairment. The principal limitation is that this capacity has not been organized into a dedicated memory clinic or formal dementia pathway; nevertheless, the breadth of the Directorate’s services provides a strong clinical foundation from which suspected dementia can be investigated and referrals coordinated. The Directorate itself describes its mandate as encompassing medical assistance, public health, prevention and emergency care.

The Memory Symposium: The Vatican has also taken an unusually visible role in the international discussion surrounding ageing and brain health. In May 2025, The Memory: A Symposium Addressing the Opportunities and Challenges of an Aging Global Population brought international experts to Vatican City to discuss the implications of global population ageing. The collaboration with AARP placed issues such as brain health, caregiving, healthy longevity, healthcare access, financial security and age-friendly communities within a broader ethical and social discussion about ageing. This is significant for dementia policy because it moves beyond treatment alone and recognizes the interconnected importance of prevention, caregiver support, social participation and maintaining cognitive health throughout later life. Although the symposium did not establish a Vatican dementia programme, it demonstrates the Holy See’s capacity to act as a convening and advocacy platform for international healthy-ageing policy, a role considerably larger than would normally be expected from a state of its population size.