North Macedonia

Clinicians use established cognitive tools, particularly the Mini-Mental State Examination (MMSE), as part of the initial diagnostic evaluation.

North Macedonia has access to structural neuroimaging, including computed tomography (CT) and magnetic resonance imaging (MRI), although national imaging capacity is limited compared with neighbouring countries and the European Union average. MRI services are concentrated in the capital, Skopje, with several regions lacking MRI scanners, while CT scanners are more widely distributed across clinical and general hospitals. Since 2017, North Macedonia has had two positron emission tomography (PET) scanners (including PET/CT), one in the public sector and one in the private sector.

Genetic testing does not form part of the routine diagnostic pathway for Alzheimer’s disease in North Macedonia.

The use of Alzheimer’s disease biomarkers is still developing in North Macedonia and has not yet become part of routine clinical practice.

North Macedonia has very limited specialised dementia services. There are no dedicated memory clinics or specialised multidisciplinary dementia referral centres providing comprehensive assessment and ongoing management. Clinical diagnosis and medical management are handled by specialists at the state level, particularly through the Department of Cognitive Neurology and Neurodegenerative Diseases at the University Clinic of Neurology, as well as the University Clinic of Psychiatry in Skopje. North Macedonia has no nationwide network of dementia-specific day care centres for people living with Alzheimer’s disease. Community support is instead provided through general social care services and disability day centres, which are distributed across many municipalities. These centres offer daytime care, rehabilitation, counselling and family support but are designed primarily for people living with disabilities rather than dementia-specific care.

Specialist palliative care services are also limited. The country’s main specialised provider is the Specialised Hospital for Geriatric and Palliative Medicine “13 Noemvri” in Skopje, which offers inpatient geriatric and palliative care as well as home-based palliative services.

The national Health Insurance Fund (HIF) is responsible for covering medicine and therapy costs for eligible insured citizens. Through a basic benefits package, the HIF finances primary care, outpatient specialist visits, inpatient care, and rehabilitative services. Prescribed pharmaceutical treatments for chronic conditions, including Alzheimer’s disease, are subsidised by the government provided the specific medications are included on the country’s official positive list of covered drugs.

North Macedonia does not have financial support specifically for care partners of people living with Alzheimer’s disease. There is no national caregiver allowance, paid family caregiving programme, or dementia-specific benefit for informal carers. Dementia care remains largely family-based, and post-diagnostic support services such as caregiver education, respite care, and support groups are generally unavailable through the public health system.

North Macedonia does provide a general social care benefit for assistance and care by another person (надоместок за помош и нега од друго лице). This monthly allowance is available to individuals who require assistance with activities of daily living following assessment by a specialist medical commission. The benefit is intended for the person requiring care rather than the care partner, and eligibility is based on functional impairment rather than a diagnosis of Alzheimer’s disease.

A recent randomised controlled trial evaluating the North Macedonia Interprofessional Dementia Care (NOMAD) programme found that the country currently offers no routine post-diagnostic support for people living with dementia or their family care partners beyond pharmacological treatment. The intervention introduced personalised care plans, home visits by dementia nurses and social workers, and caregiver psychoeducation, demonstrating improved caregiver outcomes.

One of North Macedonia’s most important research areas is investigating the genetic and vascular risk factors associated with Alzheimer’s disease. Researchers have examined the role of the apolipoprotein E (APOE) ε4 allele, the strongest known genetic risk factor for sporadic Alzheimer’s disease, together with hypertension, diabetes, and dyslipidemia. Their findings showed that carrying the APOE ε4 allele increased the risk of developing Alzheimer’s disease by approximately threefold in the Macedonian population, emphasising the combined influence of genetic susceptibility and modifiable vascular risk factors on disease onset.

Another contribution is the North Macedonia Interprofessional Dementia Care (NOMAD) program. NOMAD is the country’s first randomised trial of a home-based, multidisciplinary dementia care model, where mobile teams provide personalised care plans, caregiver education, and psychosocial support following diagnosis. The study demonstrated reductions in caregivers’ depressive symptoms, fewer neuropsychiatric symptoms in people living with dementia, and decreased use of healthcare services, showing that structured non-pharmacological interventions can substantially improve dementia care in low-resource settings.