Maldives

There is no evidence of standardised cognitive tests (e.g., MMSE, MoCA) being in routine, standardised use for dementia diagnosis. The national health system lacks approved guidelines and standards for dementia care. Historically, identification of cognitive decline has occurred when families raise concerns or when functional impairment becomes evident during primary-care or hospital encounters. Since 2024–2025, however, there has been a notable shift toward earlier community engagement. The Alzheimer’s Society of Maldives (ASM), in partnership with local authorities and health actors, has begun running targeted community screening and awareness activities aimed at identifying suspected dementia cases and key risk factors. A 2025 protocol outlines city-level screening initiatives in Malé, Addu City, Fuvahmulah, and Kulhudhuffushi, signaling a move toward geographically focused, risk-based detection rather than nationwide universal screening. While these efforts remain pilot-scale and awareness-oriented, they represent the first structured attempt to identify cognitive impairment earlier and outside hospital settings, particularly in urban population centres where access and follow-up are more feasible.

Structural computed tomography (CT) scans and magnetic resonance imaging (MRI) are available in the Maldives and listed as services in both the main public hospital, Indira Gandhi Memorial Hospital (IGMH), and the main private hospital, ADK Hospital. These modalities are primarily used to exclude secondary causes of cognitive decline (such as stroke, tumours, or hydrocephalus) and to support differential diagnosis. Advanced molecular imaging for dementia, most notably amyloid-positron emission tomography (PET) or tau-PET, is not described as part of routine clinical practice in the Maldives and is not currently available in-country. When such imaging is considered clinically necessary (for example, in atypical or early-onset cases), access is typically arranged overseas under the Aasandha referral mechanism. As a result, diagnostic certainty relies heavily on clinical assessment and structural imaging, with molecular confirmation reserved for a very small subset of patients able to navigate overseas referral pathways.

There is no evidence that genetic testing is available as a routine clinical service. In rare cases, such as a strong family history or suspected early-onset disease, genetic testing may be pursued, but this is typically arranged privately or through overseas laboratories rather than within the public system. Coverage under Aasandha is not standardised for genetic testing, and access depends on individual clinical justification, referral approvals, and the availability of overseas diagnostic partners. Consequently, genetics currently plays a marginal and ad hoc role in dementia diagnosis in the Maldives.

Advanced Alzheimer’s disease biomarkers, including cerebrospinal fluid (CSF) amyloid-β and tau analysis, or emerging blood-based biomarkers, are not documented as part of standard clinical practice in the Maldivian health system. Tertiary clinicians primarily rely on clinical history, caregiver reports, cognitive testing, and structural imaging to reach a diagnosis. Where biomarker confirmation is considered necessary, such as in diagnostically ambiguous cases or for potential trial eligibility, testing is typically pursued abroad under Aasandha referral rules. This reliance on overseas access reflects both infrastructure limitations and the absence of formal national guidance integrating biomarkers into routine dementia care. As a result, most diagnoses are syndromic rather than biologically confirmed, consistent with service-led models in small island health systems.

Maldives does not have a formal, nationwide memory-clinic network or a dedicated dementia care pathway embedded across all atolls. In practice, specialist diagnosis, treatment initiation, and follow-up are concentrated in Malé, primarily at Indira Gandhi Memorial Hospital (IGMH). Relevant services cluster around the National Centre for Mental Health, with additional involvement from geriatrics and internal-medicine clinics rather than stand-alone cognitive or memory units. This centralised model reflects both workforce constraints and the country’s geography, with specialist expertise and diagnostic capacity unevenly distributed beyond major population centres.

Non-governmental organisations (NGOs), most notably the Alzheimer’s Society of Maldives (ASM), play a critical navigation and support role, helping families understand referral pathways, access services, and manage follow-up once a diagnosis is made. Government policy on ageing and elderly care has increasingly acknowledged dementia as a growing challenge, with plans to expand community-based and residential long-term care services. However, implementation of such policies generally remains gradual, and access outside Malé, Addu City, and a handful of regional hubs is still constrained by inter-island travel, staffing shortages, and limited continuity of specialist follow-up. As a result, dementia care remains hospital-centric and urban-focused, with community and palliative services still in an early phase of development.

Treatment and follow-up for dementia are primarily financed through Aasandha, the Maldives’ universal health insurance scheme. When patients are assessed and treated in empanelled public or private facilities, prescribed medicines, outpatient follow-ups, and relevant monitoring are covered according to Aasandha reimbursement rules. This ensures that core medical management is largely free at the point of use for Maldivian citizens.

However, costs not directly linked to clinical services often fall on families. Inter-island transport for appointments, accommodation for escorts, and ancillary caregiving expenses are typically out-of-pocket unless explicitly covered under approved referral arrangements. Similarly, branded medicines, private providers outside the Aasandha network, or expedited overseas care chosen outside formal referral pathways require direct payment. These non-medical and logistical costs can become a significant burden, particularly for families living in outer atolls.

Caregiver support in the Maldives relies heavily on civil society rather than formal entitlements. The Alzheimer’s Society of Maldives (ASM) provides public awareness campaigns, caregiver education, peer support groups, and practical navigation assistance for families dealing with dementia. ASM’s role is particularly important in a system where clinical services are centralised, and families often struggle to understand referral processes and care options.

At the policy level, the government’s new elderly and ageing framework signals an intention to expand community-based and home-support services, potentially improving respite, social support, and continuity of care. However, publicly available policy documents do not specify dedicated cash benefits, caregiver allowances, or dementia-specific social transfers. As a result, the burden of day-to-day care remains predominantly family-based, with NGOs filling critical gaps in education and psychosocial support rather than providing financial relief.

The Maldives does not yet have a formally adopted, stand-alone National Dementia Strategy, but a first national plan has been under active development. Work on the National Dementia Plan has been carried out in collaboration with the ASM and relevant government ministries, with an anticipated launch in 2025, which has not yet been implemented. This process reflects growing institutional recognition that dementia requires a coordinated response beyond hospital-based care, integrating health services, social support, caregiver assistance, and awareness-building.

While the plan has not yet been publicly released, the development process itself marks an important shift from ad hoc service delivery toward structured policy planning. ADI engagement suggests alignment with international best practice, including an emphasis on early diagnosis, community-based care, caregiver support, and stigma reduction. Until formal adoption, however, dementia policy remains fragmented, embedded across mental health, ageing, and non-communicable disease (NCD) frameworks rather than articulated as a single, enforceable national pathway.

In September 2025, the government launched a National Policy on the Elderly / Ageing with Dignity, providing a broader policy umbrella under which dementia-related commitments are expected to sit. This policy emphasises equitable access to health care, development of long-term care (LTC) services, and strengthened social protection mechanisms for older adults. Although not dementia-specific, the framework creates institutional space for formalising dementia pathways once the dedicated dementia plan is finalised.

International partners have reinforced this direction. WHO South-East Asia Regional Office (SEARO) notes that the Maldives has begun establishing national ageing and long-term care frameworks, while UN agencies in the Maldives have highlighted population ageing as a cross-sectoral development issue. In this context, dementia policy is likely to be integrated horizontally across health, social services, and community care, rather than treated as a narrow neurological or psychiatric concern. The key challenge will be translating these high-level policy commitments into funded programmes, trained workforce pipelines, and service coverage across geographically dispersed islands.

Innovation in the Maldivian dementia space is primarily operational rather than technological. The introduction of community screening and awareness protocols in 2025 represents a significant step toward earlier identification of cognitive impairment, particularly in urban centres such as Malé, Addu City, Fuvahmulah, and Kulhudhuffushi. These initiatives move detection upstream, away from crisis-driven hospital presentations.

At the service-delivery level, the development of Senior Citizens Clinics with options for home visits marks a shift toward age-friendly, person-centred care. Such models are particularly relevant in a geographically fragmented island system, where mobility and transport barriers can delay follow-up. Additionally, Aasandha’s structured overseas-referral framework functions as a system-level innovation, allowing patients to access advanced diagnostics and specialist expertise not available domestically. While not a substitute for local capacity, this mechanism helps bridge gaps in a small health system with constrained infrastructure.