Serbia

In Serbia, routine cognitive assessment in neurology and psychiatry services typically includes the MMSE and MoCA (both validated in Serbian), along with the Clock-Drawing Test for quick screening. In tertiary memory clinics, expanded neuropsychological batteries are used for differential diagnosis and monitoring disease progression.

CT and MRI are available in public hospitals but often involve long waits, while private centers offer quicker access at out-of-pocket cost. PET/CT is available in Belgrade but is mainly used for oncology. Amyloid PET remains limited to research or selected academic cases, though nuclear medicine capacity is gradually expanding.

APOE genotyping and other dementia-related genetic tests are available in private laboratories, primarily in larger cities, and are paid out-of-pocket. They are not part of standard public diagnostic protocols. Local research confirms that the APOE ε4 allele is associated with increased Alzheimer’s disease risk in the Serbian population.

CSF biomarker testing (including amyloid and tau markers) is available in select tertiary university centers, primarily for complex or atypical cases, but is not widely accessible across the country. Blood-based biomarkers remain in the research phase and are not yet part of routine clinical practice in Serbia.

In Serbia, the development of dedicated memory services has gained momentum, particularly in major academic and clinical centres. For example, the first outpatient Center for Memory Disorders and Dementia was established in 2008 at UKCS’s Neurology Clinic in Belgrade and it is currently serving persons with cognitive impairment and dementia, marking an important step in specialist care infrastructure. Together with memory services within the Clinical Center of Vojvodina and in Clinical Center of Nis, the centre is a central institution that provides multidisciplinary assessments, diagnostic imaging, neuropsychological testing and counselling, often as part of tertiary-level neurology or psychiatry departments. In parallel, private neurology practices in urban centres act as supplemental access points for patients who may seek more rapid or direct consultation. On the palliative care front, Serbia has had a national strategy in place since 2009, while the home-based hospice services have been expanded ever since. Aside from palliative care offered by public hospitals and centres, there is a number of private hospices such as charity foundation, Bel Hospice.8 While these services offer important support for advanced illness, dementia-specific palliative care pathways remain under-developed. That means that, although general palliative frameworks exist, integration with dementia care is still evolving.

Under the RFZO scheme, symptomatic dementia medications that appear on the approved lists (such as List A or A1) receive reimbursement and are subject to regulated copayments or participation fees. For example, donepezil is listed under the A/A1 category with a specified copayment percentage and patient share. However, when patients opt for private prescribing, non-listed brands, or formulations not covered under public insurance they must pay OOP. Rehabilitation services, such as occupational therapy (OT), physical therapy (PT) and speech therapy, are formally covered when prescribed within public institutions, yet the actual availability varies significantly by the region.

The care of persons with dementia in Serbia places substantial responsibility on families and informal caregivers. While there is no specific nationwide “caregiver salary” or benefit exclusively dedicated to dementia carers, families may access care allowances via social-protection channels. For example they can apply for scheme called “third-party care and assistance’’ through Institute for Social Insurance or the Pension and Disability Insurance Fund of the Republic of Serbia. However, these schemes provide financial support based on functional dependency rather than a specific diagnosis of dementia. In addition, NGOs like SUAB provide training programs for caregivers, peer support groups, counseling and public awareness campaigns. Despite these supports, the fragmentation of long-term care (LTC) services in Serbia, with health, social protection and pension systems operating largely separately, means that holistic caregiver support remains inconsistent and uneven across the country.

Serbia currently lacks a dedicated, stand-alone national dementia strategy. Instead, dementia is addressed within broader policy frameworks covering active ageing and mental health. For example, the Strategy for Active & Healthy Ageing from 2023 incorporates aeging-related functional decline, cognitive health and inter-sectoral care for older persons. Similarly, the national mental-health protection programs like the Mental Health Protection Program in the Republic of Serbia for the period 2019-2026 include older-age and community-based service elements, but do not separate out dementia as a distinct policy domain.

In the near future, Serbia’s policy momentum for dementia is expected to come via the finalization and implementation of the active ageing strategy and mental health reforms. These vehicles are identified as the most viable platforms for introducing dementia-specific actions, such as raising awareness of cognitive impairment, promoting earlier diagnosis, training primary-care staff, and expanding community supports for affected persons and caregivers. The strategy document from 2023 explicitly signals these as priority areas. Additionally, palliative care capacity is expanding: for instance former UKCS’s Batajnica COVID hospital is now transformed into the advanced care for older persons, including those with cognitive impairment. Although this care center is not made for dementia patients only, it still marks a structural step up in end-of-life and supportive care that can be further leveraged.

Beyond participation in externally sponsored clinical trials, Serbia has emerged as a regional contributor to Alzheimer’s biomarker and imaging research. Academic teams from UKCS have published peer-reviewed work on CSF biomarkers following the A/T/N classification framework, including amyloid-beta (Aβ42/40 ratio), total tau (t-tau), and phosphorylated tau (p-tau)—used to characterize Alzheimer’s pathology in local patient cohorts.

Parallel research has focused on genetic and inflammatory biomarkers. For instance, Bašić et al. (2024) demonstrated that the APOE ε4 allele increases Alzheimer’s risk in Serbian cohorts and correlates with altered CSF Aβ42 and p-tau levels. Meanwhile, Serbian biochemistry groups have explored plasma-based markers such as matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1), showing associations with neuroinflammation and cognitive decline. Although these blood-based biomarkers remain at the research stage, they reflect a shift toward less invasive diagnostic tools.

In terms of imaging innovation, Serbia’s tertiary hospitals maintain a robust nuclear-medicine infrastructure, including PET/CT and SPECT facilities in Belgrade, Novi Sad and Nis. These support both clinical diagnostics and translational research in neurodegeneration. While amyloid PET is not yet routine in clinical care due to cost and reimbursement limitations, several academic collaborations leverage this capacity for research imaging and validation of biomarker correlations.