Saudi Arabia

Initial screening typically occurs when an individual or their family raises concerns with a primary healthcare provider. In Saudi Arabia, cognitive screening tests which have either been used or validated for use include the following:

(1) Arabic version of the Mini Mental State Examination (MMSE)
(2) Arabic version of the Montreal Cognitive Assessment (MoCA – A)
(3) The Alzheimer’s disease eight-item tool for dementia (AD8), which is an informant-based screening questionnaire used to detect early cognitive impairments
(4) Cognistat cognitive assessment
(5) The Basic Activities of Daily Living (BADL) scale is used as a screening tool
(6) Mini – cog Cognitive Impairment Screening Tool
(7) General Practitioner Assessment of Cognition (GPCOG)

More comprehensive neuropsychological batteries which are used or validated for use include:

(1) The Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery (CERAD – NAB), which was translated into the Saudi dialect of Arabic
(2) Arabic version of Addenbrooke’s Cognitive Examination – Revised (ACE-R)
(3) Saudi version of the Neuropsychiatric Inventory (SNPI).

Research initiatives continue working on validating more appropriate screening tools for the Saudi population.

Saudi Arabia has about 14 MRI and 34 CT units per 1 million people (in 2023), which places it on par with The Organisation for Economic Co-operation and Development (OECD) averages. On the other hand, the presence of PET scanners is significantly lower in Saudi Arabia when compared to OECD averages, with only 21 scanners in the entire country (2018), at a rate of 0.6 per 1 million people. Although comprehensive statistics on waiting times in Saudi Arabia are lacking, anecdotal evidence suggests significant delays in accessing diagnostic imaging services.

In the public healthcare sector, access to brain scans is free of charge, in line with the universal healthcare policy of Saudi Arabia. On the other hand, prices in the private healthcare sector vary significantly from provider to provider. One source quotes prices ranging from SAR 700 to SAR 1300 (USD 185 to USD 355) for MRI scans, from SAR 500 to SAR 900 (USD 135 to USD 240) for CT scans, and 9500 to 15000 SAR (USD 2530 to 4000) for PET scans.

Although APOE genotyping is available through private laboratories and direct-to-consumer testing, it is not routinely included in the standard diagnostic workup for dementia in Saudi Arabia. However, it may be ordered by specialists in specific clinical contexts — particularly in accordance with guidelines for patients being considered for disease-modifying immunotherapies.

Recently, the Saudi Food and Drug Authority (SFDA) approved an innovative in vitro diagnostic test designed to facilitate the early detection of Alzheimer’s disease. It does so by measuring the concentration of the pTau181 protein in blood plasma, providing accurate results in under 20 minutes. The availability of more traditional and invasive biomarker testing, such as CSF investigation, is somewhat limited, as these methods are not considered to be a part of the standard diagnostic workup for dementia. In addition, plasma p-tau217 testing is currently accessible through send-out services to specialised laboratories within the region.

Healthcare infrastructure is well developed in Saudi Arabia, and the Saudi government is heavily investing in its expansion. Hospitals specialising in dementia treatment and care are readily available, albeit concentrated in population centres such as Riyadh, Jeddah and Dammam. In addition, concerns persist about the low number of geriatric psychiatrists and neurological specialists per capita. When it comes to hospitals specialising in dementia treatment and care, the following are considered to be the most prominent in Saudi Arabia:

(1) King Faisal Specialist Hospital and Research centre (KFSHRC) is considered to be the most renowned tertiary healthcare institution in Saudi Arabia, and is particularly prominent in the fields of dementia treatment and care. Based in Riyadh, its Neuroscience Centre is internationally renowned, offering the most advanced neurological care in medical and surgical diagnostic, interventional and therapeutic procedures.

(2) King Fahad Medical City (KFMC) is one of the largest and fastest growing medical complexes in the Middle East. It is known for hosting the National Neuroscience Institute, one of the primary research institutions in the field of neurosciences in the Middle East.

(3) Mouwasat Hospitals is a leading private hospital group in Saudi Arabia, with locations in 7 cities, including Dammam, Riyadh and Madinah. Its hospitals feature dedicated Geriatric Medicine Departments that explicitly list the diagnosis and treatment of conditions like Alzheimer’s disease, senile dementia, and memory loss as core services.

(4) Dr. Soliman Fakeeh Hospital is a private hospital located in Jeddah, which specialises in providing treatments for geriatric medical issues, including that for Alzheimer’s disease and related dementias. In addition, the institution provides specialised care for dementia patients.

When it comes to palliative care, a recent academic article notes that Saudi Arabia currently has 22 palliative care units, 8 community palliative home care services, and 4 palliative care hospice facilities. These services are primarily concentrated in urban centres, leading to disparities in access for people in rural and remote areas. To address these challenges, Vision 2030 includes initiatives to integrate palliative care into primary healthcare, expand training programmes, and improve opioid availability for pain management. Despite these efforts, continued focus on resource allocation, workforce development, and service distribution is essential to ensure equitable access to palliative care across Saudi Arabia.

Currently, long-term care facilities or nursing homes for older adults living with dementia in Saudi Arabia are underfinanced, with their supply not satisfying the demand for such services. The Saudi Alzheimer’s Disease Association (SADA) also maintains a number of residential long-term care facilities, in which people living with dementia with no family can live. However, it is important to note that SADA currently has a limited number of people in its care, about 1400 to 1500 (2018). Most people living with dementia in Saudi Arabia continue to fend for themselves, primarily relying on family members or hiring carers, if they can afford it. Moreover, many carers in Saudi Arabia do not have training specific to dementia or even to general care of the elderly. In addition, people living with dementia and their carers tend to experience social rejection and isolation in Saudi Arabia. While not specialising in dementia treatment, 12 social care homes of the Ministry of Human Resources and Social Development provide the elderly with comprehensive healthcare services, as well as social and psychological support.

The Saudi Arabian government offers universal health coverage for all its citizens. Under the system, anyone who decides to treat Alzheimer’s disease or related dementias in public healthcare facilities faces no direct costs of treatment. Indirect costs could exist for patients and their families, especially in terms of caregiving. Many caregivers in Saudi Arabia operate informally, and data on these costs is unreliable or unavailable. Transport costs are also significant for patients from rural areas, considering the concentration of geriatric and neurologic specialists, as well as diagnostic imaging equipment in urban areas.

Expatriates mostly use private healthcare, and having a policy is mandatory while being resident in Saudi Arabia. Private health insurance, usually provided by an employer, is typically based on a co-payment system, whereby a patient will be expected to pay something toward their treatments or care. Recently, the Saudi Arabian government instituted a Basic Health Insurance Policy system, which institutes mandatory coverage minimums for expatriates. Under the policy, treatment and care for Alzheimer’s disease will be covered up to a maximum of SAR 15000 (USD 4000) during a given policy period, with the rest being covered by co-payments.

Caregiving for people living with dementia is primarily provided by family members, owing to cultural norms and social beliefs which emphasise that the provision of care to older adults is a familial duty. Families which can afford a caregiver usually hire one. Albeit, many caregivers operate informally, and often lack the necessary training for providing support to people living with dementia. A majority of informal caregivers of people living with dementia are married women, younger than 50, employed, with modest incomes.

Gerontological social workers are employed in hospitals to collaborate with multidisciplinary care teams that include medical professionals, formal caregivers, and other non-physician health care providers to extend effective dementia care and services for older adults and family caregivers. However, for them to be an efficient channel of support for caregivers, a growing need for recruiting and training them needs to be satisfied.

To supplant the lack of formal support services for caregivers of people living with dementia, the Saudi Alzheimer’s Disease Association (SADA) launched a number of initiatives aimed at providing social and psychological support to them, as well as resources needed for them to take appropriate care of people living with dementia. For instance, with support from restaurants, cafés and other hospitality entities, on Fridays, SADA organises community support events for people living with dementia, their families and carers, to create an atmosphere of harmony and affection, and facilitate the exchange of experiences between them.

While Saudi Arabia lacks a national policy for tackling dementia, its Ministry of Health published a Protocol for the Prevention of Cognitive Impairment, which aims to guide general practitioners and physicians in managing populations at high risk of developing dementia. Moreover, it intends to standardise the practices of screening, early detection and management of dementia risk factors through a series of evidence – based recommendations among different healthcare providers, and promote healthy lifestyles as a means of reducing risks for developing dementia.

In response to a growing adult population, and in preparation for the full implementation of Vision 2030, the Ministry of Health, in collaboration with other government sectors, implemented several strategic measures, including the following:

● Introducing the National Strategy for Older Adults Health Services, which was implemented as the Older People Health programme in a primary healthcare setting. Since the services are provided at the primary healthcare level, the main scope of these services is preventive as well as curative for chronic diseases usually managed at these establishments.
● Stressing preventive services, including the Comprehensive Geriatric Assessment (CGA) and healthy aging promotions. In addition, expanding the scope of future health services for the older adults to secondary and tertiary care services.
● Improving curative, rehabilitation, and home healthcare services for the older adults.
● Encouraging universities to incorporate geriatric medicine into their curriculum.

King Abdulaziz University has unveiled the first diagnostic service for Alzheimer’s disease using integrated PET and MRI, collectively known as PET/MRI. The service is offered through its Molecular Imaging centre, operating under the umbrella of Wadi Jeddah, the investment arm of King Abdulaziz University. These scanners allow for the detection of amyloid plaques and other pathological changes. In parallel, KAU is working toward the local production of amyloid tracers to strengthen domestic capabilities and reduce reliance on external supply. Currently, Oryx, a molecular imaging company, has been the primary supplier of amyloid isotopes in recent years. KAU is also exploring the local implementation of plasma-based p-tau217 testing at the King Fahad Medical Research Center, further expanding its capabilities in minimally invasive diagnostics.

In Saudi Arabia, tele-neurology is increasingly being adopted to expand access to neurological care, improve patient convenience, and support continuity of care across geographically dispersed populations. LaTnsa is one such service, delivering remote care for patients with cognitive impairment by enabling access to specialist evaluation, follow-up, and management without the need for in-person visits.

King Faisal Specialist Hospital and Research Centre (KFSHRC) has instituted initiatives for training healthcare professionals in appropriate dementia treatment and care protocols, and potentially localising the production of PET imaging agents and tracers, which are crucial for early detection and could be used in clinical trials.