Scotland

Cognitive tests used in Scotland to diagnose dementia include General Practitioner Assessment of Cognition (GPCOG), Clock Drawing Test (CDT) and the Six-item Cognitive Impairment Test (6-CIT), as well as longer assessments such as the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination III (ACE-III). A formal diagnosis is a combination of these cognitive tests, medical history, physical exams, and sometimes brain scans like a computed tomography (CT) or magnetic resonance imaging (MRI).

CT and MRI are widely available in NHS hospitals and are the routine first-line modalities to exclude other causes and support sub-typing. Scotland has positron emission tomography (PET)-CT infrastructure (regional centres in Aberdeen, Dundee, Edinburgh, Glasgow), however Alzheimer’s disease-related tracers PET is not commissioned. NHS Scotland does not commission amyloid PET and fluorodeoxyglucose (FDG)-PET for dementia. Single-photon emission CT (SPECT) is available and commonly used where functional imaging is required. Practically, this means most people receive CT or MRI scans, while nuclear medicine is reserved for selected cases by local policy.

Genetic testing for dementia in Scotland is available through the NHS specialist referrals for specific cases like young-onset dementia and privately for individuals who want to explore risk or familial patterns. The NHS may offer testing for certain genes through its Scottish Strategic Network for Genomic Medicine if a person has a suspected genetic cause. Clinical genetics may assess suspected autosomal-dominant dementias (APP/PSEN1/PSEN2).

Cerebrospinal fluid (CSF) Aβ42/40, total tau and p-tau are accessible in tertiary centres and used when diagnosis is uncertain or to support differential diagnosis, aligned with the United Kingdom (UK) guidance. Blood-based biomarkers (e.g., plasma p-tau, Aβ42/40) are emerging within Scotland’s Brain Health agenda and research pilots, but are not yet a universal routine. The national direction is targeted use integrated with clinical assessment rather than blanket testing.

All territorial health boards deliver memory services, with diagnosis and ongoing management shared between old-age psychiatry, geriatrics, neurology and increasingly well-resourced primary care teams. Most regions now operate multidisciplinary memory clinics or community cognitive pathways that enable earlier referral, structured assessment and streamlined links to imaging, biomarkers and social-care partners. The one-year Post-Diagnostic Support (PDS) guarantee (delivered widely by Alzheimer Scotland in partnership with NHS boards) remains a distinctive national offer, providing dedicated care-coordination, tailored education, carer support, and future-planning conversations that help families navigate benefits, community services and anticipatory care planning. Uptake is strong, although the quality and intensity of PDS vary between boards, prompting ongoing national audit and improvement efforts.

Quality-improvement programs for older adults in hospital, coupled with updated Ageing & Frailty Standards, aim to reduce regional variation in both acute and community settings, strengthen delirium prevention, and promote transitions of care that minimise avoidable admissions. Several boards are embedding dementia-friendly design principles and enhanced specialist nursing roles within acute wards, while community teams are expanding reablement, home-support and integrated social-work links. Palliative and end-of-life care are available through generalist and specialist pathways, with local boards tailoring access according to geography, care-home capacity and third-sector partnerships. Increasing emphasis is placed on anticipatory care plans, advance decision-making and support for family care partners, ensuring that people living with dementia can remain at home or in familiar settings for as long as possible.

In NHS Scotland, the core components of dementia care, GP consultations, specialist assessments, memory clinic diagnostics, and all prescribed medications, are provided free at the point of use, as prescriptions carry no charge for residents. This includes routine follow-up, neuropsychological testing, or community mental health support delivered by NHS teams.

Costs arise mainly in the social care domain, which is locally administered through Scotland’s integrated health and social care partnerships. While Scotland provides Free Personal Care and Free Nursing Care for eligible adults (covering tasks such as hygiene, dressing, mobility support and clinical care needs), families may still face out-of-pocket expenditures. These can include:

● home adaptations not covered by grants or local budgets;
● private care hours beyond the assessed package;
● transport to day care or appointments;
● respite or short-break options not commissioned or capped by local provision.

Self-Directed Support (SDS) allows people living with dementia and carers to manage personal budgets and choose how care is delivered, but any top-ups above assessed need fall to the family.

“Dementia in Scotland: Everyone’s Story” (2023–2033) is Scotland’s third national dementia strategy and the first to be explicitly co-produced with people living with dementia, unpaid carers, frontline staff, local authorities, and third-sector organisations. It frames dementia squarely within a rights-based, person-centred and public-health approach, emphasising independence, autonomy, and participation across all stages of the condition. The strategy adopts a whole-system view: building population-level prevention and brain-health literacy, strengthening timely and high-quality diagnosis, consolidating the one-year Post-Diagnostic Support (PDS) guarantee, expanding community-based supports, and embedding dementia-inclusive practice across housing, transport, and community planning.

It also integrates dementia policy with broader Scottish reforms such as the National Care Service (NCS) program, ageing and frailty standards, and integrated health and social care partnerships. To translate the long-term vision into practical steps, the Scottish Government issued an Initial 2-Year Delivery Plan (2024–2026), which assigns concrete actions to NHS boards, Health and Social Care Partnerships (organizations formed to integrate services provided by Health Boards and Councils in Scotland), local authorities and Alzheimer Scotland. Early commitments include strengthening PDS consistency, improving referral pathways between primary care and memory services, enhancing local coordination, and supporting the growth of dementia-friendly communities, particularly in rural and island areas where access disparities persist.

Brain Health Program: This flagship program initiated by the Scottish Government and Alzheimer Scotland and co-designed by clinical leaders in neurology, psychiatry, geriatrics and public health, aims to embed brain-health pathways into routine care. It pilots a structured model combining risk profiling, lifestyle intervention, digital self-management tools, and earlier identification of cognitive decline. The Aberdeen Brain Health Centre (demonstrator site) has been independently evaluated in 2025, showing increased uptake of prevention interventions, better patient understanding of risk reduction, and clearer triage to memory services. The learning from this site is intended to shape a nationally scalable model, with attention to workforce, data-sharing, and equitable access across geography.

Promoting Excellence Framework: Scotland’s long-running Promoting Excellence framework underpins dementia skills and competency development across the entire health and social care workforce, from universal dementia awareness to specialist clinical expertise. Updated training modules and e-learning continue to be rolled out across NHS boards, care homes, home-care agencies and community organizations. As social care reforms proceed, the framework remains central to maintaining consistent quality of dementia care, reducing regional disparities, and supporting newer roles such as dementia link workers, dementia advisors, and community navigators.

The Scottish Brain Health Service (BHS) model represents an important approach to cognitive disorders. Unlike conventional memory-clinic pathways that focus on diagnosis once symptoms emerge, the BHS model emphasises lifetime brain health, incorporating:

● risk profiling (vascular, lifestyle, genetic factors when appropriate),
● targeted prevention and behaviour-change support,
● earlier detection of cognitive change,
● digital and data-enabled tools, and
● structured linkage to memory services when diagnostic assessment is needed.

The model has been piloted in several sites, including the Aberdeen demonstrator, which has informed national implementation planning. Early evaluations indicate improved engagement with prevention advice, streamlined triage, and better understanding of modifiable risk factors.

Scotland’s academic centres, particularly in Edinburgh, Glasgow, Dundee, and Aberdeen, also contribute to methods innovation. These include development of advanced neuroimaging approaches (e.g., PET–MRI hybrid platforms, quantitative MRI analyses), CSF assay refinement, and blood-based biomarker research (p-tau, NfL, GFAP). However, despite scientific leadership, routine NHS adoption remains limited: amyloid-PET and FDG-PET are not commissioned for standard dementia diagnosis, and blood biomarkers await national policy decisions on cost-effectiveness, governance, and workforce readiness.