Netherlands

GPs and specialists in memory clinics employ various tests. The Mini-Mental State Examination (MMSE) is commonly employed by GPs as a screening instrument for dementia. However, the NHG working group advises against using the Montreal Cognitive Assessment (MoCA) for dementia diagnosis in general practice, as its superiority over the MMSE has not been demonstrated in primary care populations. In specialised memory clinics, both tests are used, but their performance and diagnostic accuracy may vary across different settings. Dutch centres and researchers have also developed specialised tools, such as the informant-based Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) to assess functional decline and the non-verbal Cross Cultural Dementia Screening Test (CCD) for use in migrant populations.

The Netherlands doesn’t have a single, centralised public dementia screening programme, but instead is implementing a national TAP-dementia (Timely, Accurate, Personalised diagnosis of dementia) research project to improve diagnosis.

Structural brain imaging with either Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) is a standard and available part of the diagnostic evaluation for patients with suspected dementia. Positron Emission Tomography (PET) imaging technology, including amyloid-PET, is available in the Netherlands but is generally restricted to public specialised centres and academic hospitals.

Genetic testing for familial Alzheimer’s disease (i.e., linked to mutations on APP, PSEN1, PSEN2 genes) is available. Access is typically restricted to specialised memory clinics, such as the Alzheimer Centre Amsterdam, and is offered to patients who meet strict eligibility criteria. However, traditional criteria are too stringent and fail to identify many individuals who carry these mutations in the Netherlands. In other countries where the health care systems differs and in other genetic ancestry groups, the performance of the criteria may be different. Testing for the APOE gene, a common risk factor for late-onset Alzheimer’s disease, is not recommended for routine clinical diagnosis or risk prediction, but is used in research settings.

Analysis of cerebrospinal fluid (CSF) is an established diagnostic tool used in Dutch specialist memory clinics. As a less invasive, cheaper, and more accessible alternative, blood tests are poised to become a standard tool in Dutch memory clinics. The Dutch researchers are developing and validating blood-based biomarkers, which are currently only utilised in a research context.

Memory clinics and specialised diagnostic services are accessible across the Netherlands, not just in major cities. Major Alzheimer’s disease care and research centres include Amsterdam UMC, Leiden University Medical centre, Erasmus MC in Rotterdam, Maastricht University Medical centre, and Radboud UMC in Nijmegen. Patients benefit from a primary care network, with GPs playing a central role in coordination, and access to case managers or dementia nurses who guide families through care options. The Dutch Memory Clinic Network offers a directory to locate services throughout the country at:
https://www.geheugenpoliklinieken.nl/over-het-ngn/overzicht-geheugenpolis

Access to significant long-term care is then determined by a national assessment body, the Centrum Indicatiestelling Zorg (CIZ), which provides an indication based on need, ensuring equitable access for all residents. A wide range of day and community support is available nationwide, often arranged through local municipalities. This includes over 1,350 care farms, with around 400 specialising in dementia care, which offer structured activities in an agricultural setting. For peer support, there are over 275 Alzheimer Cafés spread across every region, in both large and small towns. These monthly gatherings for people living with dementia and Alzheimer’s disease and their families or friends provide a welcoming space to ask questions to experts, share experiences with others in similar situations, and learn more about dementia and coping strategies.

The Netherlands is also known for innovative residential models like De Hogeweyk (dementia village), publicly funded facilities through the national long-term care act (Wlz) and are accessible to anyone with the appropriate CIZ indication. Opened in 2009, De Hogeweyk is a purpose-built neighborhood where residents living with severe dementia live in a safe, enclosed, yet open environment. The core concept is to create a familiar social world. Residents live in small group homes of six to seven people, with each house decorated to match one of several distinct lifestyles. Residents are free to wander the village, visit the supermarket, café, or theatre, and participate in social clubs, all staffed by nearly twice as many trained caregivers who wear plain clothes and interact as neighbours or assistants.

Another innovative model is the 24-hour residential Green Care Farm. Building on the day care concept, facilities like Reigershoeve provide full-time residential care in a small-scale, homelike farm setting for people living with dementia. At Reigershoeve, 27 residents live in four group homes, participating in farm chores and enjoying the freedom of a safe, rural environment. Like De Hogeweyk, these facilities are funded through the public insurance system, making them an accessible alternative to traditional nursing homes.

Buurtzorg, meaning “neighborhood care”, is a Dutch home-care organisation that operates on a nurse-led model. It utilises small, self-governing teams of up to 12 nurses who provide holistic care to 50-60 patients within a specific neighborhood, eliminating traditional layers of management. This approach allows nurses to deliver a full range of services, from medical care to personal support, fostering strong relationships with clients and their families to help them remain independent. The model is designed for individuals living with chronic conditions, including dementia and those needing end-of-life care. Additionally, Buurtzorg has a specialised mental health branch, Buurtzorg T, which works with the community nursing teams to provide integrated psychiatric treatment and coaching for dementia patients experiencing complex behavioural symptoms at home.

Palliative care is integrated into the Dutch system, with a focus on comfort throughout the disease progression, especially within nursing homes. For the terminal phase, hospice care is available for individuals with a life expectancy of three months or less. While many traditional hospices lack facilities suitable for patients who wander, the system is adapting with specialised hospices tailored or designed for dementia patients’ needs, such as Hospice Kamillehof in Eindhoven. Furthermore, many standard nursing homes with dedicated dementia units provide integrated palliative and terminal care services. These facilities, along with standalone hospices, are distributed across all provinces, ensuring end-of-life care is accessible locally.

All medicine is fully covered by the insurance in the Netherlands. For some medications, an additional personal co-payment may be required, though generally this is capped at €250 per year.

As the disease progresses and the need for intensive, 24-hour care arises, funding shifts to the Long-Term Care Act (Wlz). The primary cost becomes a monthly personal contribution that is calculated based on the patient’s (and often their partner’s) income and personal assets, such as savings and investments. This contribution has two tiers: a low contribution (up to €1,076.60 per month in 2025) which applies to those receiving care at home or for individuals in a nursing home whose partner still lives at home, and a high contribution (up to €2,954.40 per month in 2025) for single individuals in a care facility. Under Wlz, all care associated with nursing home care is covered. This includes physiotherapy, occupational therapy, a dietician assistance, or dental treatments.

The annual caregiver appreciation, a modest payment or gift voucher, is provided by municipalities under the Social Support Act (Wmo), with the amount varying by location. The primary way for a caregiver to receive regular payment is to be formally hired by the care recipient through their Personal Budget. However, this transforms the caregiver into a service provider, and the income is taxable, can affect social benefits, and does not accrue pension or unemployment rights. There are no special tax deductions for caregivers themselves; tax benefits for healthcare costs can only be claimed by the person receiving care, providing an indirect benefit at best.

The Netherlands has several schemes and care levels designed to support caregivers, which in turn enable better care for the patient. One example is the dementia case manager, a professional guide for the patient and caregiver who provides emotional support, coordinates services, and helps navigate the complex system. Another scheme is respite care, which provides temporary relief to prevent caregiver burnout through services like day programs or short-term stays in a care facility. This support is structured within three main legislative pillars. The Social Support Act (Wmo) provides municipal-level support like home help and day activities to help people live at home longer. Long-Term Care Act (Wlz) funds intensive, 24-hour care for those living with advanced dementia, either at home or in a residential facility. The Healthcare Insurance Act (Zvw) covers essential medical care and the case manager.

Although the Non-Governmental Organisation (NGO) sector doesn’t offer direct financial help to caregivers, Alzheimer Nederland and MantelzorgNL offer invaluable practical information, advocacy, and peer support through resources like helplines and local Alzheimer Cafés.

The Dutch National Dementia Strategy 2021-2030 centres around three core themes:

1. Advancing dementia research (A world without dementia): This long-term goal focuses on stimulating and strengthening the entire chain of dementia research, from fundamental studies into its causes to clinical trials for new treatments and prevention strategies. The strategy calls for significant investment in research infrastructure and talent development. The goal is to not only improve the understanding of dementia but also to translate research findings into tangible benefits for patients, such as more accurate and timely diagnoses and effective, personalised treatment plans. The strategy emphasises both national and international collaboration to maximise the impact of this research effort.
2. Reducing stigma and prejudice (Persons with dementia matter): The strategy promotes the idea that people living with dementia are valuable members of society who should be able to continue to participate in their communities for as long as possible. This involves raising public awareness and understanding of dementia, promoting respectful and supportive interactions, and ensuring that the voices and experiences of people living with dementia are heard and integrated into policy and practice. The ultimate aim is to create an environment where individuals living with dementia feel respected, supported, and empowered to live meaningful lives.
3. Improving support and services (Tailor-made support when living with dementia): This pillar emphasises a person-centred approach, where the specific needs and preferences of the individual living with dementia are at the forefront of all care decisions. It calls for a comprehensive and integrated system of support, from early diagnosis to end-of-life care, that is coordinated across different healthcare and social service providers. The strategy also highlights the importance of innovation in care, including the use of technology to enhance independence and quality of life, as well as providing robust support for informal caregivers who play a crucial role in the lives of people living with dementia.

Alzheimer Centre Amsterdam leads the public-private project ABOARD, short for “A personalised medicine approach for Alzheimer’s disease”, to develop, among others, biomarker tests that allow for an early and precise diagnosis of Alzheimer’s disease.

Researchers at Amsterdam UMC and Maastricht University are leading research that uses protein analysis to identify distinct genetic risk variants of Alzheimer’s disease. This work redefines Alzheimer’s not as a single illness but as a collection of subtypes with different underlying causes, which could lead to personalised treatments.

Researchers at Amsterdam UMC and Radboud University investigated the feasibility of integrating APOE genotyping into the Dutch Brain Research Registry, an online platform for recruiting participants into Alzheimer’s disease studies. Their results show that both the technical process and participant acceptance were high, suggesting that large-scale genotyping through registries can streamline pre-screening and accelerate the recruitment of genetically defined cohorts for dementia research.

At Amsterdam UMC, a clinical trial is testing a repurposed, low-dose version of the HIV medication Efavirenz. This research is based on the discovery that the drug can reverse the accumulation of cholesterol in brain cells, a process that leads to the buildup of toxic amyloid and tau proteins.

UMC Utrecht worked on the ABIDE project that investigated the best applications of MRI scans, cerebrospinal fluid and PET scans, and focused on involving patients and caregivers in diagnostic dilemmas. To support clinicians during this process the online ADappt tool has been developed that can be used by professionals to interpret and discuss Alzheimer’s disease diagnostics test results with their patients and caregivers.

Utrecht University is developing a gene therapy that protects the vital connections between brain cells (synapses) from damage. The strategy uses harmless viruses to deliver genetic code that instructs brain cells to produce their own protective mini-proteins, essentially turning them into tiny “drug factories” to shield themselves from Alzheimer’s-related toxicity.

The TearAD study, with involvement from Maastricht University, is investigating tear fluid as a completely non-invasive source for Alzheimer’s biomarkers. Early results from this multicentre study show that key proteins like amyloid-beta and tau can be measured in tears and correlate with disease severity, potentially opening a new path for simple screening.

A group of Dutch research institutions, companies and civil society partners led by UMC Utrecht has received 4.5 million euro to develop new, advanced MRI techniques. The goal is to “better visualise the brain processes that play a role in dementia, so that the development and testing of a possible treatment becomes more effective”.

The Netherlands champions innovative care models such as De Hogeweyk, a purpose-built village for people living with advanced dementia that allows residents to live in a more normalised and less institutional environment. This approach has garnered global attention for its person-centred philosophy.