Iceland

Iceland has a specialist Memory Clinic at Landspítali, the National University Hospital, which provides assessment for patients with suspected cognitive impairment and dementia. Published studies from the Icelandic Memory Clinic show that patients enrolled from the clinic were assessed using the Mini-Mental State Examination (MMSE) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), followed by standard clinical and comprehensive neuropsychological assessment. There is no official Icelandic clinical guideline specifying which cognitive screening tests are routinely used in everyday practice.

CT and MRI are available through Landspítali and are accessible for the diagnostic evaluation of dementia. The radiology department provides CT, MRI and PET/CT services, with referrals from primary care or specialist clinics. PET imaging, including PET/CT, is also available at Landspítali.

Genetic testing for Alzheimer’s disease is available through specialist clinical genetics services but is not performed routinely.

CSF biomarkers are available and are integrated into specialist diagnostic assessment. Studies from the Icelandic Memory Clinic demonstrate routine measurement of CSF amyloid-β42, total tau and phosphorylated tau, together with additional research biomarkers such as neurofilament light chain (NfL), GFAP and YKL-40. Lumbar puncture is offered as part of the diagnostic work-up when clinically indicated. Amyloid PET is also available through Landspítali for selected cases. Blood biomarkers are an active area of research, but there is no evidence that plasma Alzheimer’s disease biomarkers are yet routinely implemented in clinical practice across Iceland.

Iceland has a well-developed and centralised dementia care system. The country’s main specialist service is the Memory Clinic (Minnismóttaka) at the Department of Geriatrics, Landspítali University Hospital in Reykjavík, which has served as the national referral centre for dementia diagnosis, multidisciplinary assessment and follow-up. A smaller specialist memory service is also available at Akureyri Hospital in northern Iceland.

Iceland provides a range of dementia-specific community services, although most specialised programmes are located in the capital region. Dementia-specific day care is concentrated in the Reykjavík metropolitan area, where several specialised day centres operate, while municipalities across Iceland provide more general community centres, home care and respite services for older adults.

The Icelandic Alzheimer’s Association operates two specialised dementia day centres, Fríðuhús and Drafnarhús, which provide individualised day programmes aimed at reducing social isolation, maintaining functional independence, and supporting family caregivers. Activities include exercise, music, crafts, cooking, outdoor walks, reading groups, and day trips, while similar specialised day centres are available throughout Iceland’s municipalities.

Iceland has a palliative care system integrated into the national health service rather than dementia-specific palliative facilities. Specialist palliative care is available through hospital teams, community services and hospice care, including the national hospice in Reykjavík, and is accessible through referral pathways across the country.

In Iceland, the financial responsibility for treating Alzheimer’s disease is primarily borne by the state through the publicly funded healthcare system, administered by Iceland Health (Sjúkratryggingar Íslands). Consultations, specialist care, and approved Alzheimer’s medicines are publicly subsidised. Prescription medicines are covered only if they are included in the national reimbursement scheme or approved through a medicine certificate, with patients paying regulated copayments under the national medicine co-payment system until the annual out-of-pocket ceiling is reached. Families therefore bear only a limited share of treatment costs through these statutory copayments, although they may incur additional expenses for non-covered or private services.

Iceland provides financial and practical support for informal caregivers, including those caring for people with Alzheimer’s disease, through its general social insurance system rather than dementia-specific schemes. The principal financial support is the Spouse and Carer Benefit (Maka- og umönnunargreiðslur), administered by the Social Insurance Administration (Tryggingastofnun). The benefit is available to individuals who reduce or cease employment to provide care for a spouse or another adult household member receiving an old-age pension, disability pension, or rehabilitation benefits. Eligibility depends on loss of income, cohabitation with the care recipient, and income thresholds; it is not specific to Alzheimer’s disease, but people with Alzheimer’s disease may qualify if they meet the underlying eligibility criteria.

The Icelandic Alzheimer’s Association provides education, counselling, psychological services, caregiver support groups, and advocacy for people with dementia and their families. The organisation also operates a free nationwide counselling service and advice telephone line for people with dementia and their relatives. While these services provide substantial educational and psychosocial support, they do not provide direct financial assistance to caregivers.

Iceland adopted a National Dementia Action Plan (2020–2025) in May 2020, following a parliamentary resolution in 2017 that called for a coordinated national approach to dementia care. The strategy aims to improve the quality, accessibility, and coordination of services for people living with dementia and their families while promoting earlier diagnosis, greater public awareness, and a more dementia-inclusive society. It applies to all forms of dementia, including Alzheimer’s disease.

The Action Plan sets out 48 actions across six priority areas: strengthening patient autonomy and legal protections; promoting prevention and risk reduction; improving timely diagnosis and post-diagnostic support; enhancing rehabilitation, independence, and support for family carers; ensuring coordinated, person-centred services that meet changing needs across the course of the disease; and expanding research, workforce education, and national data collection. The strategy also emphasizes multidisciplinary collaboration across health and social care, improved care pathways, and the development of evidence-based services to ensure consistent, high-quality dementia care nationwide.

Iceland has not publicly announced a successor to its 2020–2025 National Dementia Action Plan, although dementia-related initiatives continue to be implemented within the existing policy framework.

Iceland’s most influential contribution to Alzheimer’s research is the discovery of genetic variants that either increase or decrease disease risk. Researchers at deCODE Genetics identified the rare TREM2 R47H variant, which substantially increases the risk of late-onset Alzheimer’s disease, establishing microglial dysfunction as a key mechanism in neurodegeneration. They also discovered the APP A673T mutation, a rare protective variant that reduces amyloid-β production and protects against Alzheimer’s disease and age-related cognitive decline. These findings have had a major impact on the development of anti-amyloid therapies and precision medicine approaches.

Icelandic researchers are international leaders in identifying blood-based biomarkers for Alzheimer’s disease. Using samples from the AGES-Reykjavik Study, investigators have combined high-throughput proteomics with long-term clinical follow-up to identify hundreds of circulating proteins associated with future Alzheimer’s disease, including protein signatures that differ according to APOE ε4 carrier status. These studies aim to develop minimally invasive blood tests for early diagnosis and identify new therapeutic targets.

The University of Iceland and Landspítali National University Hospital conduct translational research on cerebrospinal fluid (CSF) biomarkers, neuroinflammation, and lipid metabolism in Alzheimer’s disease. Researchers have evaluated biomarkers such as neurofilament light (NFL), GFAP, YKL-40, S100B, and ceramides to improve early diagnosis and better understand disease mechanisms before dementia develops. These studies support the implementation of biomarker-guided diagnosis in clinical practice.

Through the AGES-Reykjavik Study, Iceland has created one of the world’s most comprehensive longitudinal cohorts for studying brain aging and dementia. Researchers combine genetics, MRI, cardiovascular risk factors, epigenetic aging measures, and cognitive assessments to identify predictors of Alzheimer’s disease decades before symptoms appear. Recent work has shown that accelerated biological aging, measured using DNA methylation markers, is associated with brain atrophy and increased dementia risk, supporting precision prevention strategies aimed at modifying risk across the lifespan.