Hong Kong

Tools like the Cantonese Mini-Mental State Examination (CMMSE) and the Hong Kong Montreal Cognitive Assessment (HK-MoCA) are the most widely used in Hong Kong. Abbreviated Mental Test (AMT), Clock drawing test, Geriatric Depression Scale, and the Clinical Dementia Rating scale are also used, but less frequently.

Computed Tomography (CT) and Magnetic Resonance (MRI) scanners are available across Hong Kong in both the public Hospital Authority system and numerous private hospitals. There is no evidence to suggest that amyloid or tau Positron Emission Tomography (PET) is available for routine clinical diagnosis within the mainstream Hospital Authority system. However, Hong Kong Sanatorium & Hospital offers dual-tracer PET imaging for amyloid and tau. Other facilities like the Gleneagles Hospital Hong Kong, CUHK Medical Centre, and Hong Kong Adventist Hospital – Tsuen Wan also possess PET scanners for brain imaging.

Individuals seeking to learn their APOE status can do so readily through the private sector. Direct-to-consumer companies offer APOE genetic testing, using a simple, non-invasive mouth swab that can be collected at home. For a more clinical setting, private laboratories provide the test from a blood sample, facilitated through a physician.

Cerebrospinal fluid (CSF) biomarker testing is rarely conducted, in part because it is not available in the clinical setting. Their application is confined to specialised memory clinics for diagnostically challenging cases and for research purposes. While Hong Kong is a world leader in the area of blood-based biomarkers research, this advanced test is not used routinely for Alzheimer’s disease diagnosis in Hong Kong. The Hospital Authority has stated that it is still only “exploring the feasibility” of introducing the technology into the public system and has not yet integrated it into standard clinical practice. The test is only commercially available to the public through a private start-up company.

Medical services, including memory clinics and specialist out-patient clinics, are provided across the Hospital Authority’s (HA) seven administrative clusters. In addition to public services, a number of private hospitals offer specialised neurological and memory care. For instance, the Hong Kong Adventist Hospital – Tsuen Wan operates its own Memory Clinic, providing an alternative for patients who can afford private care or wish to bypass public sector waiting lists. HA also provides, the Community Geriatric Assessment Teams and Psychogeriatric Teams, mobile units that extend specialist medical care beyond the hospital walls. These teams provide on-site services to elderly residents, including those living with Alzheimer’s disease and dementia.

Community support is anchored by the Dementia Community Support Scheme, which operates in all 41 District Elderly Community Centres and serves over 2,000 people annually. This public framework is supplemented by non-governmental organisations like the Jockey Club Centre for Positive Ageing and the Hong Kong Alzheimer’s Disease Association, which offer specialised day care, caregiver training, and residential services. For those with advanced needs, palliative care is available in all seven HA clusters, alongside community outreach teams that support patients in residential care homes. Despite the system’s comprehensive design, accessibility is severely undermined by critical bottlenecks and cost barriers. The average waiting time for a subsidised residential care home is a staggering 36 months, and as of December 2024, there were 16,588 applicants on the central waiting list. Thousands of elderly individuals have been reported to pass away while waiting for a placement. The wait for subsidised day care averages 10 months, while a new appointment at a psychogeriatric specialist clinic has a median wait of 11 weeks.

The public healthcare sector provides subsidised services for eligible persons, with minimal co-payments for consultations and standard medications like Donepezil, Rivastigmine, and Memantine, which are generally covered under the drug formulary. New disease-modifying therapies like Lecanemab, while approved, are not yet publicly funded, requiring patients to bear the full private cost, which can be substantial. Public programs such as the Comprehensive Social Security Assistance (CSSA) and the Samaritan Fund are designed to support people with low-income and assets, leaving some families who earn too much to qualify but not enough to afford private care without financial help.

The government’s framework, managed by the Social Welfare Department and Hospital Authority (HA), provides the core of subsidised services. Access to all long-term care, including community care (like day care centres) and residential facilities, is gated by the Standardised Care Need Assessment Mechanism for Elderly Services (SCNAMES). However, this system has long waiting times, with waits for subsidised residential care averaging 36 months, creating a “care vacuum” that places immense stress on families. While specialised initiatives like the Dementia Community Support Scheme (DCSS) offer integrated medical-social support, their limited capacity means they serve only a small fraction of the dementia population.

Financial support is available but is highly targeted, rather than universal. Direct cash aid includes the Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families and the non-means-tested Disability Allowance. Crucially, eligibility for the carer’s allowance and the innovative Community Care Service Voucher scheme – which allows users to purchase services from approved providers – is contingent on being on the long Central Waiting List for long-term care. This structure creates a “missing middle” of families who are not poor enough to qualify for significant aid but cannot afford private care. Indirect relief is also available through tax deductions for elderly residential care expenses and dependent allowances.

Organisations like the Hong Kong Alzheimer’s Disease Association and the Jockey Club Centre for Positive Ageing offer services the government does not systematically provide, such as early intervention, specialised caregiver training, peer support groups, and dedicated helplines. These Nongovernmental Organisations (NGOs) often operate on charitable funding, which poses a risk to their long-term sustainability.

Hong Kong University of Science and Technology (HKUST) & Hong Kong centre for Neurodegenerative Diseases have developed a revolutionary blood test for the early and accurate diagnosis of Alzheimer’s disease and mild cognitive impairment. This innovative approach simultaneously measures a panel of 21 different proteins in the blood, achieving an accuracy rate of over 96% for Alzheimer’s disease. The test has been validated across Chinese and European populations, making it a universally applicable tool. Beyond diagnostics, HKUST is also pioneering next-generation therapies, including a brain-wide genome-editing strategy delivered via a single intravenous injection, which has shown lasting effects in reducing Alzheimer’s disease pathologies in mouse models. The Chinese University of Hong Kong is at the forefront of developing non-invasive, AI-driven diagnostic tools. An international team led by its Faculty of Medicine created the world’s first AI model that can detect Alzheimer’s disease with over 80% accuracy by analysing standard retinal fundus photographs. This method uses the eye as a “window to the brain” and has the potential to become a low-cost, accessible screening tool in community settings. CUHK is also advancing digital phenotyping, developing an Automatic Speech Recognition system to detect neurocognitive disorders from speech patterns and a privacy-preserving in-home sensor system to monitor daily activities for subtle behavioral signs of Alzheimer’s disease. This work is centralised in dedicated hubs like the Lau Tat-chuen Research Centre of Brain Degenerative Diseases. The Laboratory of Neurodegenerative Diseases at the University of Hong Kong is conducting scientific studies on the neuroprotective properties of wolfberry (Lycium barbarum) extract, a staple of Traditional Chinese Medicine, to understand its molecular mechanisms in preventing neurodegeneration. In another innovative approach, HKU researchers are leveraging big data by applying machine learning algorithms to the territory-wide electronic health records of the Hospital Authority to develop predictive models for dementia risk in the Chinese population. Furthermore, in collaboration with University College London, HKU is testing the feasibility and effectiveness of delivering cognitive stimulation therapy virtually, aiming to make this evidence-based intervention more scalable and accessible. Hong Kong Metropolitan University co-leads an international, multi-disciplinary team to develop a novel gene therapy for Alzheimer’s disease. The innovative core of their approach is tackling the challenge of the blood-brain barrier. The therapy uses small interfering RNA (siRNA) to inhibit the gene responsible for producing harmful beta-amyloid protein. This therapeutic agent is delivered using specially engineered lipid nanoparticles, a nanotechnology approach designed to effectively penetrate the blood-brain barrier and evade the immune system, allowing the treatment to reach brain cells and target the disease at its source. Jockey Club Centre for Positive Ageing is a pioneering institution in Hong Kong that embodies an integrated “service, training, and research” model for dementia care. Its innovative approach lies in its commitment to evidence-based, non-pharmacological interventions and the continuous evaluation of their effectiveness. The Centre provides person-centered care through services like Reminiscence Therapy and Cognitive Stimulation, while simultaneously conducting applied research to validate these programs. A longitudinal study conducted with CUHK confirmed that JCCPA’s specialised daycare model helps maintain patients’ quality of life and reduces caregiver burden, providing local empirical evidence for their holistic approach.