Romania

The Romanian versions of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are used and validated tools for detecting cognitive impairment in clinical practice, forming the backbone of initial cognitive assessment in both specialist and, in some settings, primary care. The MoCA is consistently regarded as more sensitive to mild cognitive impairment and early-stage dementia than the MMSE, largely because it places greater emphasis on executive functions, attention, visuospatial abilities, and complex language tasks, which are often affected early in the disease course. Standard cut-off values commonly applied in Romania are ≤ 25 for MoCA and < 26 for MMSE, but in practice these thresholds are adjusted for educational attainment, age, and cultural context to reduce false positives or negatives. The MoCA’s broader cognitive domain coverage allows for a more nuanced characterization of cognitive profiles, particularly in highly educated individuals or in cases where memory complaints are subtle, making it especially useful for early detection and longitudinal follow-up. In contrast, the MMSE remains valuable for global cognitive staging, monitoring progression, and communicating severity, but is less sensitive to early executive and attentional deficits, reinforcing the complementary rather than interchangeable role of these two instruments in Romanian dementia assessment pathways.

Structural neuroimaging is a standard component of dementia assessment in Romania once people reach specialist care. CT and MRI are routinely used to exclude secondary causes of cognitive decline (tumors, cerebrovascular disease, normal-pressure hydrocephalus) and to support differential diagnosis between dementia subtypes. In the public system, these tests are formally covered by national health insurance but are subject to capacity limits, referral quotas, and waiting lists, particularly outside major urban centers. As a result, non-urgent outpatient CT or MRI often involves significant delays, leading some families to seek faster access through private imaging providers, fully out-of-pocket. Positron emission tomography (PET) imaging (fluorodeoxyglucose (FDG)-PET or amyloid PET) is not part of routine dementia diagnostics and is largely confined to exceptional academic or research contexts.

Genetic testing is not part of the standard dementia diagnostic pathway in Romania. Testing for apolipoprotein E (APOE) ε4 status or for monogenic forms of dementia (e.g. PSEN1, PSEN2, APP) is not described in national clinical or policy sources as a routine practice. When genetic tests are used, they are generally limited to rare early onset or familial cases, typically initiated by specialists in academic centers or accessed through private laboratories. Such testing is almost entirely out-of-pocket, with no systematic reimbursement, and there is limited evidence of structured genetic counseling being integrated into dementia care services.

There is no evidence that suggests dementia biomarker use in Romania. CSF biomarkers such as amyloid-β, total tau and phosphorylated tau do not appear to be incorporated into a diagnostic pathway and are likely concentrated in specialised neurology centres, academic hospitals and research settings. Publicly available documentation does not indicate routine nationwide reimbursement or widespread availability. Likewise, no evidence was identified that blood-based Alzheimer biomarkers have been adopted into routine clinical practice within the Romanian health system. Further country-specific data are needed to clarify patterns of funding and access.

Romania does not have a clearly documented national network of memory clinics embedded in official policy or service-mapping documents. Instead, dementia care is delivered through a fragmented specialist model, centered on hospital-based neurology, psychiatry, and geriatrics departments, as well as through national-level specialist institutes. An example is the Institutul Național de Geriatrie și Gerontologie „Ana Aslan”, which provides outpatient, day-hospital, and inpatient geriatrics and gerontology services and functions as a reference center. In practice, access to specialist dementia care is geographically uneven. Large cities such as Bucharest, Cluj-Napoca, Iași, and Timișoara concentrate specialist capacity, while smaller towns and rural areas rely more heavily on referral to general hospitals or outpatient neurology or psychiatry clinics with limited dementia-specific focus. Alongside public services, private clinics in major urban centers offer dementia and memory disorder assessments, follow-up, and care coordination, typically with shorter waiting times but entirely out-of-pocket.

At the Alzheimer’s National Conference in Romania held from 3-6 June 2025 at the World Trade Center Bucharest, the CareUp project was presented as part of Session XII: European Projects and Innovative Solutions in Elderly Care. A representative of local life-long learning NGO, Asociația Habilitas, outlined CareUp’s objectives, European partnership, funding framework, timeline, and expected results, highlighting its focus on strengthening carers’ digital skills and capacity across Europe. The conference brought together 429 participants from diverse professional backgrounds, serving as a major platform for knowledge exchange and networking in dementia care and social innovation. During the event, Asociația Habilitas received a Partnership Diploma from Romanian Alzheimer Society, recognizing its long-standing contribution to professional training and support for older adults and their families, while CareUp used the occasion to promote innovation, lifelong learning, and digital solutions for carers.

A Romanian tech startup, Father, joined an international, university-led consortium from Switzerland and the Netherlands to develop POSTHCARD, a simulation game designed to support home-based care for people living with Alzheimer’s disease. Launched by brothers Frederik-Samujel and Erik Daniel Nistor in 2015, Father contributed to building an interactive, story-driven simulator that recreates everyday challenges faced by families caring for a relative living with Alzheimer’s disease. The project’s goal is to help carers learn practical coping and care skills in a realistic but safe environment. At the time of reporting, POSTHCARD was scheduled to enter its testing phase the following year, with a planned public launch in 2020, reflecting growing interest in digital, experiential tools for dementia care education and support.

The ALZNEKIN project (Innovative strategy for Alzheimer disease: targeting neuroinflammation and DYRK/CLK kinases) was a Romanian–French collaborative research project funded by UEFISCDI under the PN-III-PM Programme, implemented between May 2017 and December 2018. The project aimed to develop an innovative therapeutic strategy for Alzheimer’s disease. Its scientific focus was on targeting neuroinflammation, oxidative stress, and tau hyperphosphorylation by designing novel imidazothiadiazole compounds capable of inhibiting the kinases DYRK1A and CLK1, which are implicated in neurofibrillary tangle formation. The compounds were physicochemically and biologically characterized for kinase inhibition, antioxidant, and anti-inflammatory effects. Beyond its biomedical objectives, the project also sought to strengthen long-term research collaboration between Romanian and French teams in neurodegenerative disease research.