Liechtenstein

Initial cognitive screening can be performed by physicians in Liechtenstein, while comprehensive neuropsychological assessment is accessible through specialist services and regional Memory Clinics. Typical tools may include MMSE, MoCA and Clock Drawing Test, followed by more detailed testing of memory, attention, executive function, language and visuospatial abilities where necessary. The national Dementia Strategy emphasizes earlier recognition and improved professional education as key tools for reducing diagnostic delay.

Routine diagnostic imaging can be accessed through Liechtenstein’s domestic and, importantly, cross-border healthcare network. The government explicitly states that Liechtenstein cannot independently provide the full range of inpatient hospital services and therefore contracts with hospitals abroad; its compulsory health-insurance system recognises contracted hospitals both within Liechtenstein and outside the country. This framework allows patients requiring more advanced neurological investigation to be referred to appropriate specialist facilities, particularly in neighbouring Switzerland. CT and MRI are standard structural investigations used in specialist dementia assessment to identify vascular disease and exclude structural causes of cognitive impairment. More specialised investigations such as PET may be obtained through tertiary centres where clinically indicated, although I would avoid implying that amyloid PET is routinely used in Liechtenstein itself.

Routine APOE genotyping or testing for familial Alzheimer’s mutations should not be described as part of ordinary dementia screening in Liechtenstein. For suspected hereditary or unusually early-onset disease, however, patients can in principle be referred to specialised services outside the country through Liechtenstein’s established cross-border healthcare system. The government confirms that people compulsorily insured in Liechtenstein can receive treatment in other EU/EEA states, subject to the applicable insurance and reimbursement conditions.

APOE status has also acquired greater clinical relevance with anti-amyloid therapy. The EMA authorisation for lecanemab (Leqembi) restricts treatment to patients with early Alzheimer’s disease who are ApoE4 non-carriers or heterozygotes and who have confirmed amyloid pathology. Treatment must be supervised by a physician experienced in Alzheimer’s disease and requires access to repeated MRI monitoring because of the risk of amyloid-related imaging abnormalities (ARIA).

Liechtenstein does not appear to have a dedicated domestic tertiary dementia centre publicly documenting routine CSF amyloid/tau or amyloid-PET testing. Where advanced biomarker confirmation is clinically necessary, patients can draw on the country’s established system of contracted and cross-border specialist care. Liechtenstein explicitly purchases hospital services from foreign hospitals because its domestic system cannot independently provide the complete range of inpatient services.

Liechtenstein does not operate a large national Memory Centre; instead, dementia care is delivered through a decentralised network of GPs, specialist physicians, cross-border Memory Clinics, Demenz Liechtenstein, home-care providers and long-term-care institutions. Demenz Liechtenstein has become a central dementia-specific point of contact, providing individual counselling, family support, public education and activities for people affected by dementia. Since 2024, it has operated its own Tagestreff in Schaan, offering structured daytime support and social activities for people with dementia while providing important respite for informal caregivers. The Liechtensteinische Alters- und Krankenhilfe (LAK) forms another important part of the care infrastructure, providing residential, nursing and related services for older people with increasing support needs. Together with Spitex/home-care services, municipal senior services and day-care provision, this creates a continuum between care at home and eventual institutional placement as dementia-related dependency progresses. Liechtenstein’s model therefore relies less on a single specialised dementia institution and more on an integrated national network of community and long-term care, supplemented by specialist medical services in neighbouring countries when necessary.

Medical treatment for dementia is largely covered through Liechtenstein’s compulsory health-insurance system, although patients remain responsible for insurance premiums and statutory cost-sharing. Reimbursable services include medically necessary consultations, hospital care and medicines that meet the applicable benefit criteria. Pharmaceutical reimbursement is closely aligned with Switzerland: medicines included in the Swiss Spezialitätenliste (SL) are covered according to the conditions, limitations and reimbursement prices specified in that list. This framework encompasses the standard pharmacological management available for dementia where the relevant medicine meets reimbursement requirements, while specialist and hospital treatment can also be obtained through Liechtenstein’s established domestic and cross-border provider network.

Financial protection is particularly favourable for older people: after reaching ordinary retirement age, insured patients generally face 10% coinsurance rather than the standard 20%, while the ordinary CHF 500 annual fixed contribution is borne by the state, significantly reducing direct medical expenditure for the age group most affected by dementia.

Long-term dementia care is supported through additional mechanisms outside ordinary health insurance, particularly the Betreuungs- und Pflegegeld (BPG). This benefit is designed to help finance care and assistance for people who require continuing support at home and therefore plays an important role in enabling older people with dementia to remain in the community rather than moving prematurely into institutional care. Following changes effective from 2025, the benefit is divided into different levels according to assessed care and support needs, with daily payments ranging from approximately CHF 11 at the lowest level to CHF 189 for people with the highest level of need. The scheme is publicly financed by the state and municipalities, providing an additional source of funding for dependency-related care alongside compulsory medical insurance.

Liechtenstein has unusually extensive caregiver support for a country of its size, with services combining counselling, peer support, education, respite care and financial assistance. Demenz Liechtenstein plays a central role and operates professionally moderated discussion groups (Gesprächsgruppen) for relatives of people with dementia. Participation is free of charge, and the groups provide a confidential setting in which caregivers can discuss behavioural changes, communication difficulties, emotional strain and practical problems with professionals and other families facing similar circumstances. From 2026, selected sessions also provide parallel supervision for the person with dementia, removing an important practical obstacle that can otherwise prevent caregivers from attending support programmes. Demenz Liechtenstein additionally organises a monthly Informations und Austauschnachmittag, where affected people and relatives can obtain free professional information and practical guidance on dementia diagnosis, everyday caregiving, available services, future planning and ways of coping with caregiver burden.

Caregiver support is reinforced by formal day-care and home-care services, which reduce the amount of continuous supervision that must be provided by family members. The dementia-specific Tagestreff operated by Demenz Liechtenstein in Schaan provides structured daytime activities and supervision for people with dementia, simultaneously functioning as a respite service that gives relatives time for work, appointments, rest or other responsibilities. LAK and other community-care providers similarly help bridge the gap between informal family care and permanent institutional placement. Financial support is provided through the Betreuungs- und Pflegegeld (BPG), which contributes toward the costs associated with caring for people who require continuing assistance at home; from January 2025, its six benefit levels range from CHF 11 to CHF 189 per day, depending on assessed care needs, and are financed equally by the state and municipalities.

Liechtenstein adopted its dedicated Dementia Strategy in 2012, establishing a national framework for responding to the expected increase in dementia associated with population ageing. The strategy identifies six central fields of action: public awareness and sensitisation, early detection, education and training of professionals, development of individualised and graduated care and support services, cooperation and networking between relevant actors, and support for family caregivers. Rather than concentrating exclusively on specialist medical treatment, it promotes a coordinated pathway extending from public awareness and early recognition to community support, professional care and assistance for families. Early detection is particularly important because the strategy recognised substantial underdiagnosis and sought to encourage earlier identification of cognitive impairment and more timely access to appropriate counselling and services.

The strategy consequently treats dementia as both a medical condition and a broader social-policy challenge. Its underlying principles emphasise preserving the dignity, autonomy, self-determination and quality of life of people with dementia while allowing them to remain integrated within their families and communities for as long as possible. It calls for services to be adapted to the individual and to increase gradually as care needs become more complex, rather than relying primarily on institutional placement. At the same time, the strategy explicitly recognises relatives as a central component of the dementia-care system and stresses the need for information, counselling, respite and other forms of caregiver support. Cooperation between healthcare professionals, social-care organisations, municipalities and other providers is therefore treated as essential to continuity of care. This framework subsequently provided the policy basis for the development of initiatives such as Demenz Liechtenstein, dementia-specific counselling and caregiver programmes, community-based day services and stronger coordination of dementia care, giving the country a relatively comprehensive dementia-policy foundation despite its very small population.

Liechtenstein’s 2012 Dementia Strategy is currently undergoing an important revision process as part of the country’s broader implementation of its national ageing strategy. During 2024, the Office of Public Health, Demenz Liechtenstein and other professionals and stakeholders reviewed the existing dementia framework to determine whether its objectives and measures remained appropriate more than a decade after adoption. The review concluded that the strategy’s fundamental orientation and principal areas of action remained broadly valid, but that the document required substantial substantive and linguistic revision to reflect developments in scientific knowledge, changing terminology and the evolution of dementia services in Liechtenstein. The first monitoring report on the ageing strategy, published in 2025, therefore records the revision of the Dementia Strategy as an ongoing policy measure rather than treating the 2012 document as a completed or static framework.

The revision also takes place within a broader effort to adapt Liechtenstein’s health and social-care system to population ageing and increasingly complex long-term-care needs. Subsequent government monitoring confirms the continued development of the dementia framework and the need to incorporate current scientific evidence and changing conditions in care provision.

Important priorities extend beyond dementia diagnosis itself and include strengthening support for family caregivers, ensuring sufficient professional nursing and care capacity, improving coordination between health, social and municipal services, and developing clearer structures for implementation of national ageing policy. Workforce availability is particularly significant because Liechtenstein’s ageing population is expected to increase demand for home care, day services and residential nursing at the same time that the care sector faces difficulties recruiting sufficient qualified personnel.

Electronic Health Record (eGD) – Liechtenstein’s national electronic health dossier (elektronisches Gesundheitsdossier, eGD) provides a shared digital infrastructure through which relevant health information can be made available across authorised healthcare providers. The system can incorporate documents such as medical reports, laboratory results, radiology findings and medication information, helping clinicians obtain a more complete picture of a patient’s medical history. This is particularly relevant for older people with dementia, who frequently have multiple chronic conditions, take several medicines and receive care from different professionals. The eGD can therefore support continuity between primary care, hospitals and specialists and reduce fragmentation when patients move between different parts of the healthcare system. Importantly for Liechtenstein, the framework also takes account of treatment abroad, which is valuable in a system where cross-border specialist care forms an important part of healthcare provision.

Tagestreff Demenz – Since 2024, Demenz Liechtenstein has operated a dementia-specific Tagestreff in Schaan, adding a dedicated community-based service to the country’s dementia infrastructure. The service provides people with dementia with structured daytime activities, social contact and professional support in an environment adapted to their needs. At the same time, it has an important respite function for family caregivers, giving relatives predictable periods during which professional staff assume responsibility for supervision and support. This can help sustain home-based care and potentially postpone the point at which continuous residential care becomes necessary.

Betreuungs- und Pflegegeld (BPG) – Liechtenstein’s care allowance provides direct financial support for people who require continuing assistance and care at home. Rather than limiting public financing to professional institutional services, the BPG helps finance home-based care according to the assessed intensity of the person’s care needs, making it particularly relevant to progressive conditions such as dementia. From January 2025, the six benefit levels range from CHF 11 to CHF 189 per day, with financing shared equally between the state and municipalities. By supporting care in the community, the scheme can reduce the financial pressure on households and strengthen the ability of families to maintain a person with dementia at home for longer.

Cross-border specialist integration – One of the distinctive features of Liechtenstein’s healthcare model is that its small domestic system is deliberately supplemented by specialist capacity in neighbouring countries. Instead of attempting to duplicate every expensive tertiary service for a population of only around 40,000, the country uses contracted providers and patient-mobility arrangements to give insured residents access to larger healthcare systems, particularly in Switzerland and Austria. For dementia, this can be especially important when patients require advanced neurological assessment, specialised imaging or other tertiary diagnostic expertise that is not maintained domestically. Cross-border care should therefore be viewed not simply as a weakness caused by limited domestic capacity but as a structural component of Liechtenstein’s healthcare model, although referrals, authorisation and reimbursement can add administrative complexity.

Participatory strategy revision – The ongoing revision of Liechtenstein’s 2012 Dementia Strategy is also notable for its collaborative approach. The review has involved government authorities together with Demenz Liechtenstein, professionals and other relevant stakeholders, allowing practical experience from dementia care to feed into the development of the updated framework. The 2025 monitoring report indicates that the existing strategy was considered fundamentally sound but required substantive and linguistic updating in response to new scientific knowledge and changes in service provision. This approach connects dementia policy with Liechtenstein’s wider ageing strategy and creates an opportunity to incorporate emerging priorities such as caregiver support, workforce capacity, service coordination and changing diagnostic and therapeutic possibilities.