Iran

At the primary-care level, Cognitive screens such as the Mini-Cog and Mini-Mental State Examination (MMSE) are used, often alongside an informant tool, AD8-Farsi , which has been implemented in Iranian primary-care settings to differentiate mild cognitive impairment from aging. For communities with lower literacy, clinicians increasingly use Persian versions of Montreal Cognitive Assessment (MoCA)-Basic and Rowland Universal Dementia Assessment Scale (RUDAS), both adapted for cultural and education bias. For example, RUDAS was specifically designed to be more culturally fair and less influenced by factors like education and language diversity than the original MoCA. While the RUDAS is considered to have less educational bias, some tasks still show bias, while a MoCA version specifically designed to reduce this bias exists. A simple self-assessment app (“M-Check”) has also been launched in Persian as an adjunct to clinic-based screening. A recent study from 2024 suggests that MoCA is most commonly used as the main quick test in Iranian clinics, as it is more accurate than MMSE at spotting very early problems like mild cognitive impairment. Clock-Drawing Test is sometimes preferred, as it quickly reveals planning and visual-spatial skills. ACE-III (or the shorter Mini-ACE) is also used to look in more depth and help tell normal aging from different types of dementia. Iranian clinics have also developed the Persian version of telephone screening (TICS-M) and computerised memory batteries, reflecting a push to broaden access and standardize measurement across settings.

To detect memory problems, doctors mainly use computed tomography (CT) and magnetic resonance imaging (MRI) scans: CT helps rule out strokes, tumours, or bleeding, while MRI gives a more detailed look for patterns linked to dementia. Since the Health Transformation Plan from 2014 public hospitals, especially in provincial capitals and big cities, have added scanners and expanded services, so getting a CT/MRI is predominantly accessible in urban areas and big cities. It should also be mentioned that private centres are often quicker but more expensive. At the same time, there is a gap in capacity and equal access to technology. While studies show that the number of CT/MRI units tripled from 2014 to 2023, they were clustered first in bigger referral hospitals, leaving people from smaller or remote areas with longer waits or necessity to travel to other bigger cities. More advanced scans like positron emission tomography (PET), which can help in differentiating between Alzheimer’s disease and other types of dementia (such as frontotemporal dementia or dementia with Lewy bodies), but are not used as routine for memory problems. They are available for special purposes in university hospitals, but are more commonly used for cancer diagnosis. In practice, most people living with early dementia symptoms or memory complaints will first have a CT to rule out strokes, tumours, or bleeding and then an MRI for a closer look at brain changes. Finally, PET is reserved for situations that require a more in-depth investigation.

Genetic testing for Alzheimer’s disease in Iran is available but not routine in diagnosis. University hospitals and private genetics laboratories can test the APOE gene, especially the “ε4” variant, which raises lifetime risk. In the Iranian clinical context, data regarding APOE alleles is frequently published, yet such testing remains primarily confined to research initiatives or specialised cases. Beyond APOE, gene testing for familial Alzheimer’s disease is available in Iran at university hospitals and some private genetics laboratories, usually when there is strong family history or very early symptoms. Genetic testing for mutations in the PSEN1, PSEN2, and APP genes is a precise diagnostic method for identifying early-onset familial Alzheimer’s disease. .

Research into biomarkers for dementia and Alzheimer’s disease in Iran remains emerging and largely confined to academic centres. For example, a 2024 Iranian study published in Caspian Journal of Neurological Sciences examined cerebrospinal fluid (CSF) core biomarkers, including Aβ42, total tau (t-tau) and phosphorylated tau (p-tau), and assessed their diagnostic utility for Alzheimer’s disease in an Iranian clinical sample. A broader 2018 review from Iran detailed the conceptual and technical criteria for Alzheimer’s disease biomarkers and highlighted the country’s growing interest in CSF, plasma, and imaging markers, although it noted infrastructural and cost barriers. More recently, a longitudinal Iranian-based study published in Scientific Reports in 2024 investigated CSF soluble TREM2 (sTREM2) and neuroimaging biomarkers in Alzheimer’s disease, reflecting advanced translational research activity at centres such as Iran University of Medical Sciences and Tehran University of Medical Sciences. Despite these advances, the routine clinical use of CSF biomarkers, blood-based panels, or advanced neuroimaging (such as PET-amyloid/tau) is still very limited in Iran. Families seeking dementia-specific biomarker services often need referral abroad, and national diagnostic pathways currently do not include biomarker testing as standard practice.

Iran’s dementia care infrastructure includes memory clinics for diagnosis, non-governmental organisation (NGO)-run day centres, and university-affiliated outpatient services. Most of them are concentrated in Tehran and a few large provincial capitals. Some of the most notable institutions are Roozbeh Hospital at Tehran University of Medical Sciences (TUMS), which is the country’s oldest teaching psychiatry hospital and home to the Memory & Behavioural Neurology, as well as the clinics under Iran University of Medical Sciences’ School of Behavioural Sciences & Mental Health, where outpatient cognitive assessment, imaging referrals and family counselling are organised within academic settings. Since 2017, Iran has piloted the Memory Clinics in Iran (MCI) Initiative TUMS with the Ministry of Health and Medical Education’s support to standardize early detection and clinical pathways. Although it has been spread nation-wide since 2020, the implementation remains concentrated in major centres. Palliative care in Iran remains underdeveloped and largely oncology-focused, concentrated mostly in urban areas. There are both geographical and capacity limits when it comes to structured services tailored to non-cancer conditions such as dementia.

In Iran, Alzheimer’s disease care relies on four standard medicines: donepezil, rivastigmine (including the patch), galantamine, and memantine. These drugs are in routine clinical use and appear in national insurer claims and policy lists. Although covered by national insurance, the entire treatment can also require additional costs. Monthly Alzheimer’s disease medicines plus repeat follow-ups and sometimes rehabilitation tend to produce a larger annual out-of-pocket expense even under Iran’s standard 30% coinsurance rule. While Alzheimer’s disease drugs are typically reimbursed in the public pathway with the applicable outpatient copay, going to private pharmacies is more expensive because of the balance-billing and higher tariffs. Rehabilitation services are available in public hospitals and clinics, but coverage and uptake are uneven and often constrained by financing gaps and household costs.

There is no dedicated long-term care insurance in Iran, and public health insurance generally does not finance in-home assistance or respite care as standard benefits. As a result, families carry the costs of most day-to-day support, and formal respite options remain limited or uninsured- IDAA acts as the central pillar of non-state support, coordinating a federation of provincial groups and providing a helpline, caregiver support groups, counselling, training, and day services that help and improve care quality. World Health Organization (WHO) and other partners have also supported national training-of-trainers initiatives to upskill providers and address stigma, but these complement rather than replace financial coverage for long-term care. Informal caregiving within the family is a cultural norm in Iran, while the majority of care partners of people living with dementia are women who have access to little structured support and financing.

Alzheimer’s Disease International (ADI) and the IDAA have drafted a National Dementia Plan in 2021 with the Ministry of Health and Medical Education (MoHME) circulating it to universities.

Core objectives :
● Rising public awareness and risk reduction across the life course on the national level.
● Improving service quality and access via university-anchored memory clinics and standardised pathways.
● Strengthen system management and workforce through national training-of-trainers and caregiver training programs.

Implementation milestones:
● MCI Initiative was established in 2017, first as a pilot project at TUMS, and later on implemented nation-wide since the 2020s as a national capacity-building and service-standardisation program for dementia. In plain terms, it trains doctors and allied clinicians to recognize memory problems earlier, gives them shared tools and protocols to assess people the same way everywhere, and helps set up or strengthen memory clinics inside university and affiliated hospitals so patients can be screened, diagnosed, counselled, and referred along a clear pathway.
● Self-care packages in Persian for people with Alzheimer’s disease and carers was launched in 2023 by Ministry of Health and Medical Education (MoHME) with WHO, TUMS and the SWO.
● A national 40-hour “training-of-trainers” programme on dementia and caregiver skills was organised in October under WHO-MoHME partnership.
However, the National Dementia Plan is not fully implemented because dementia remains overshadowed by higher-priority health issues, and the system faces fragmented governance, limited specialist capacity, costly diagnostics, and inadequate infrastructure, all of which hinder coordinated action. Studies also show that poor inter-agency coordination, weak geriatric service systems, and cultural stigma contribute to delayed policy development and limited uptake of dementia-specific programs.

At Tehran University of Medical Sciences, adapted and validated the Iran Smell Identification Test (Iran-SIT). By using familiar, culturally relevant odours, their team turned olfactory testing into a quick, low-cost, non-invasive tool that helps clinicians spot early Alzheimer’s disease signals when standard memory screens are borderline, while also giving researchers a reproducible sensory marker that can be tracked over time or paired with imaging.

To reach people outside major cities and reduce delays, teams at Shiraz University of Medical Sciences have built and validated “M-Check”, a self-administered Persian mobile app for at-home cognitive self-checks. Similarly, researchers linked to Nayshabur Longitudinal Study on Ageing, have validated the Persian Telephone Interview for Cognitive Status-modified (P-TICS-M). Together, these tools give clinicians standardised remote screening options and help families decide when an in-person evaluation is needed, improving triage and freeing scarce clinic time for higher-risk cases.

At TUMS developed the Persian Illustrated Memory Impairment Screen (PIMIS) and localised MoCA-Basic and RUDAS tests into Persian. These instruments rely more on pictures and verbally delivered, education-neutral tasks, reducing bias against people with limited schooling. The result is fairer diagnosis across diverse education backgrounds, fewer false positives/negatives, and cleaner phenotyping for clinical studies.

Researchers from the Iranian Brain Imaging Database at TUMS in coordination with the National Brain Mapping Laboratory in Tehran, have standardised 3-Tesla MRI protocols (structural, diffusion, resting-state) and assembled large, quality-controlled imaging-plus-cognition datasets. Harmonised acquisition and processing allow hospitals and research groups to compare scans reliably, support machine-learning models for differential diagnosis, and track disease progression, improving everyday clinical interpretation.

Moreover, multidisciplinary teams at TUMS, Iran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, and other tertiary centres have integrated cerebrospinal fluid assays (Aβ42/40, total-tau, phospho-tau) into selected clinical cases when symptoms and MRI leave uncertainty. In parallel, they are piloting blood-based biomarkers such as plasma p-tau and Aβ42/40 to create a less invasive, lower-cost pathway. This two-track approach anchors diagnoses in biology while building local assay expertise and reference values that can support wider clinical adoption.

One control study from Guilan province, Iran, examined the association between Apolipoprotein E (ApoE) polymorphisms and Alzheimer’s disease by comparing 70 people living with Alzheimer’s disease with 100 controls using ARMS-PCR genotyping. The results showed significant differences in genotype distribution between groups: the ε3ε3 genotype was much more common in controls, while ε3ε4 and ε4ε4 were markedly higher among people living with Alzheimer’s disease. Individuals carrying ε4 alleles had a substantially increased risk of Alzheimer’s disease, with odds ratios of 5.32 for ε3ε4 and 12.15 for ε4ε4, and the ε4 allele itself strongly associated with Alzheimer’s disease risk (OR 5.63). The study concludes that ApoE ε4 is a major genetic risk factor for Alzheimer’s disease in the Iranian population, consistent with international findings.