Lesotho

Recent work in Lesotho has adapted cognitive screening for dementia, most notably the brief Community Screening Instrument for Dementia (brief CSI-D), which pairs a cognitive interview with an informant interview. After the results, doctors classify participants as probable, possible, or normal. Also, they are occasionally drawing on culturally adapted Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) variants. However, the recent studies emphasize hurdles such as low literacy, linguistic and cultural differences as well as logistical constraints, prompting locally trained enumerators and test modifications to ensure validity.

In Lesotho, advanced neuro-imaging capacity is concentrated in the capital: Magnetic resonance imaging (MRI) services are available at Queen Mamohato Memorial Hospital (QMMH) and computed tomography (CT) scanning at Maseru District Hospital. Beyond Maseru, access drops sharply, most district facilities lack cross-sectional imaging, relying instead on basic X-ray and ultrasound, so patients who need brain MRI, complex CT protocols, or contrast studies are typically referred to South Africa for higher-end work-ups. This centralization creates practical barriers: travel logistics, out-of-pocket costs, coordination delays, and occasional cross-border appointment backlogs can slow time-sensitive diagnostics. As a result, clinicians often triage with clinical criteria and simpler tests first, reserving referrals for cases where imaging will clearly change management.

Lesotho does not offer routine in-country genetic testing for Alzheimer’s disease, such as apolipoprotein E (APOE) genotyping or pathogenic variants in PSEN1/PSEN2/APP.

Lesotho’s Standard Treatment Guidelines (STG) do not mention cerebrospinal fluid (CSF) biomarkers such as amyloid-β (Aβ₄₂, Aβ₄₀) or tau (total or phosphorylated) assays, nor do they reference emerging blood-based Alzheimer’s disease biomarkers like plasma p-tau, Aβ ratios, or neurofilament light chain (NfL). In practice, these diagnostic tools are not part of routine clinical care within the public health system. This reflects both cost and capacity constraints. Namely, CSF biomarker testing requires specialized immunoassay equipment and trained personnel, while blood-based biomarkers, though promising globally, remain limited to research or high-income private laboratories.

Lesotho does not yet have a formal national memory-clinic network or dedicated dementia units. Diagnosis and ongoing management of cognitive disorders primarily occur within hospital-based psychiatry and neurology services in Maseru, mainly at QMMH and the Mohlomi Mental Hospital. Dementia diagnosis in Lesotho is largely centralized in Maseru, where specialist mental health services are concentrated at the country’s only psychiatric referral hospital. Limited mental health infrastructure and specialist availability outside the capital may restrict access to formal cognitive assessment for older adults in rural districts, contributing to delayed recognition and diagnosis of dementia. Also, Lesotho traditionally relies on South Africa to provide complementary secondary and tertiary healthcare.

In parallel, palliative and supportive care services are gradually expanding, reflecting a broader national push to improve quality of life for people living with chronic and terminal conditions. Notable initiatives include the Starlight Oasis of Hope Hospice, opened in 2025, and recent oncology infrastructure upgrades that aim to reduce the need for cross-border referrals to South Africa. However, dementia-specific palliative pathways remain underdeveloped as there are no specialized dementia wards, care protocols, or trained geriatric teams focused on long-term cognitive decline. As a result, most people living with dementia depend on family carers and general palliative programs, highlighting a growing gap between expanding end-of-life care services and the specialized needs of neurodegenerative conditions.

Lesotho does not yet have dementia-specific digital initiatives, but it is piloting a range of digital health and financing tools that could eventually support care for older adults and people with chronic diseases. These include e-referral and appointment systems, District Health Information Software 2 (DHIS2)-linked patient registers, Short Message Service (SMS) medication reminders, and mobile-money copayments. Together, they aim to improve navigation (clear referral pathways and clinic reminders), adherence (medication prompts and alerts for drug stock-outs), and payment predictability (standardized fees and cashless transactions). In the future, these systems could be adapted to dementia care by adding carer messaging, cognitive-screening alerts in primary care, transport vouchers for imaging appointments, and bundled benefits to reduce out-of-pocket costs.

The 2025 study using the brief CSI-D in Lesotho found that about 4.9% of older adults screened met criteria for probable dementia, meaning noticeable cognitive decline affecting daily life. When the researchers analyzed risk factors, they saw that depressive symptoms, being 75 years or older, and being underweight significantly increased the likelihood of dementia, all conditions that may reflect underlying frailty, poor nutrition, or reduced brain resilience. In contrast, higher physical activity and even obesity were linked to lower odds of dementia, suggesting that staying active and maintaining adequate body weight might have a protective effect in this population. These findings align with broader global research showing that both mental health and physical well-being play important roles in cognitive aging.