Portugal

Cognitive screening and monitoring for Alzheimer’s in Portugal commonly use MMSE, MoCA, ADAS-Cog, and CDT assessments.

CT and MRI are available at the primary care level in Portugal, while FDG-PET functional imaging is provided at leading nuclear medicine centres, including Porto’s Oncology Institute and Coimbra University Hospital.

In Portugal’s public sector, genetic testing for early-onset familial Alzheimer’s is limited to reference centres like INSA, with hospital genetics departments in Coimbra and Porto also offering molecular diagnostic capabilities for APP, PSEN1, and PSEN2.

CSF testing (Aβ42, total tau, p-tau) in Portugal is primarily conducted in specialized neurology departments at tertiary hospitals to confirm Alzheimer’s disease. Research institutions are increasingly exploring blood-based biomarkers as a less invasive alternative.

Specialized memory clinics are overwhelmingly concentrated in the major metropolitan hubs of Lisbon, Porto, and Coimbra, where they function within university hospitals like Santa Maria or São João.

For ongoing support, specialised Day Centres are rare and primarily located in coastal urban centres, exemplified by Alzheimer Portugal’s facilities in Lisbon and Matosinhos. The National Network of Integrated Continuous Care (RNCCI), which theoretically provides specialized long-term care, is currently saturated with a national waiting list exceeding 10,000 individuals, making access in regions like the Alentejo practically non-existent. Consequently, rural areas often depend on ad-hoc municipal innovations, such as the mobile dementia support teams in Mogadouro that travel to patients’ homes, rather than a structured national network.

Portuguese health regulator (Entidade Reguladora da Saúde, ERS) found that the nationwide distribution of specialized palliative care units is highly uneven, with most capacity concentrated in Lisbon and Vale do Tejo and little or no provision in regions like Centro and Algarve.

he direct medical treatment costs of Alzheimer’s disease are largely publicly funded, with Alzheimer’s disease pharmacological treatment reimbursed under Infarmed’s “comparticipação” rules (patients may pay only a partial share depending on the reimbursement tier), and treatment delivered within SNS structures covered by the state. However, non-SNS therapy (e.g., private cognitive/occupational therapy) is typically paid out-of-pocket. There are no copayments for treatment-related consultations and many prescribed exams within primary care under the Decreto-Lei 96/2020, though patient shares still apply to medications and to services not covered by this exemption. Overall, while drugs and SNS-based treatments are mostly covered, families bear a significant direct financial burden, especially for non-medical and informal care, which account for the majority of Alzheimer’s disease-related costs in Portugal (estimated ~€1.8 billions of ~€2 billions total, with informal care dominating).

Portugal provides formal recognition and financial support for informal caregivers of people living with Alzheimer’s disease through the legal status of the informal caregiver (Estatuto do Cuidador Informal). Once recognised, caregivers may qualify for the monthly allowance for the main informal caregiver (Subsídio de Apoio ao Cuidador Informal Principal), granted by the national social security service (Segurança Social). Additional support includes home-care services, day centres, and respite care delivered through the national network of long-term integrated care (Rede Nacional de Cuidados Continuados Integrados – RNCCI). Some care-related expenses can also be partially deducted from income tax.

Alongside state programmes, Non-Governmental Organizations (NGOs) offer further assistance. Alzheimer Portugal provides a helpline, caregiver training, support groups, and dementia-specific day centres. Non-profit social institutions, including Santa Casa da Misericórdia supply home support, day services, and residential care.

Portugal has a national dementia strategy called the Health Strategy for Dementia. The strategy focuses on improving prevention, early detection and timely, accurate diagnosis of dementia across the country. It aims to ensure that people living with dementia receive continuous, equitable and person-centred care throughout all stages of the disease, strengthening the role of primary care and guaranteeing access to specialised assessments, appropriate pharmacological treatments and non-pharmacological interventions.

It also prioritises the development of integrated care pathways linking health, social and community services. Emphasis is placed on improving public awareness, reducing stigma, enhancing training for professionals and informal caregivers, and ensuring families have adequate support and guidance. The strategy calls for regional implementation plans so that services can be adapted to local needs and ensure more consistent and coordinated dementia care nationwide.

There are currently no publicly announced new national dementia strategies forthcoming in Portugal.

Researchers at the Instituto de Medicina Molecular (iMM) are working on a “synaptic armor” peptide (TAT-TrkB) that prevents the destruction of vital neuronal receptors, aiming to preserve brain communication even in the presence of Alzheimer’s disease toxins.

Researchers at the Center for Neuroscience and Cell Biology (CNC) are working on the “gut-first” hypothesis, demonstrating how environmental toxins (like BMAA) trigger mitochondrial dysfunction in the gut that subsequently drives neuroinflammation in the brain.

Researchers at Fraunhofer Portugal AICOS are working on the AUTONOMOUS project, developing smartwatch-based artificial intelligence (AI) that learns a patient’s specific routines to provide real-time prompts that assist with daily tasks and independence.

Researchers at the Van Andel Institute and University of Coimbra are working on a genomic study of the Portuguese population to identify rare, population-specific genetic variants that may confer natural protection against the disease.