Spain

In Spain, clinicians and researchers have access to a variety of cognitive tests for Alzheimer’s disease screening and assessment that are validated for the Spanish-speaking population. Brief screening tools such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Phototest are commonly used, while more detailed assessments include the Addenbrooke’s Cognitive Examination III (ACE-III) and the Memory Alteration Test (M@T).

Moreover, innovation in digital and self-administered formats is expanding: for example the FACEmemory® test developed by the Ace Alzheimer centre Barcelona allows individuals to complete a memory screening online from home. The centre also provides cognitive screenings for free to anyone over 50 years old, without requiring a specialist referral.

Structural imaging with CT and MRI are widely available in the public health system and are a standard part of the diagnostic workup. The primary use of these scans is for differential diagnosis, enabling clinicians to rule out other causes of dementia, such as tumors or vascular damage.

The Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) confirmed in 2025 that amyloid-PET is widely available inSpainfor clinical practice. This marks a significant transition from a research tool to a clinical diagnostic one. Investment in this area is ongoing, exemplified by the installation of the first public-assistance PET and MRI scanner at the Hospital de Bellvitge in 2023.

Access to genetic testing to diagnose Alzheimer’s disease in Spain’s public system is regulated by “clinical utility”. There is a clear distinction between tests for genetic risk and tests for deterministic genes. Testing for deterministic genes is typically recommended only in families with a strong, multi-generational history of early-onset Alzheimer’s disease.

While private laboratories in Spain offer gene panels directly to physicians, coverage within the public system is more complex and highly regulated. This includes several genetic study panels: Panel 1 for Alzheimer’s disease, which screens the PSEN1, PSEN2, ApoE, and APP genes; Panel 2 for frontotemporal dementia, screening the MAPT, PGRN, FUS, VCP, and TARDBP genes; Panel 3, also for frontotemporal dementia, which quantifies the intron 1 expansion of the C9orf72 gene; and Panel 4 for vascular dementia, which screens the NOTCH3 and TREX1 genes. The Common Services Portfolio outlines the general criteria for covering genetic tests: they must have demonstrated “clinical utility” for diagnosis, prognosis, or treatment selection. The portfolio covers diagnostic and presymptomatic analyses, and mandates that genetic counseling accompany any test performed within the public health system. In 2023, an agreement was approved to create a specific, unified Catalog of Genetic Tests to ensure equitable access across the country. This new catalog includes Neurological and neuromuscular diseases and Neurodevelopmental disorders, including cognitive deficit as priority areas. However, official documents detailing this new catalog do not explicitly list apolipoprotein E (APOE) genotyping or Alzheimer’s disease-specific genes as being included in the initial-priority rollout.

Although CSF and blood-based biomarkers exist in Spain and are part of research and specialised clinic work-up, implementation into the public health system across all settings with an homogenous coverage along the regions is still in progress. The Spanish Society of Neurology’s consensus statement concludes that while blood biomarkers for Alzheimer’s disease are a promising tool for early diagnosis, they should currently be used only in specialised units within a clinical context and supported by ongoing research, not yet in general practice or population screening.

Spain hosts several specialised facilities for Alzheimer’s disease diagnosis, treatment, and research, primarily located in major cities like Madrid and Barcelona. Key centres include the ACE Alzheimer centre Barcelona, Fundación CIEN and the Reina Sofía Alzheimer centre in Madrid, the Memory Unit at Hospital Clínic de Barcelona, and research hubs like the Barcelonaβeta Brain Research centre and CIBERNED. In 2018, Spain had 116 specialised outpatient consultations focused exclusively on cognitive impairment and dementia, and 29 integrated multidisciplinary outpatient assessment teams identified nationwide. In less urban regions, memory services are typically provided through general hospitals.

Day centres and home help services are widely available across the country, provided by a mix of public (municipal), private, and non-profit associations. The national confederation CEAFA coordinates 320 local family associations that are crucial frontline service providers. specialised residential care is also widespread, particularly from private chains offering non-pharmacological therapies like sensory stimulation rooms and music therapy.

The Spanish model for palliative care is not primarily facility-based but consists of multidisciplinary palliative care teams (doctors, nurses, psychologists) who conduct their work in the patient’s home. While this model exists, its application to people living with Alzheimer’s disease is an emerging challenge. A 2024 report from the Foundation Pasqual Maragall confirms that “real access to palliative care teams” and “improvement of referral processes” are major unresolved challenges, and that people living with dementia receive palliative care less frequently than oncology. A key difficulty is the unpredictable course of the disease, which is why the Spanish Society for Palliative Care recommends that planning must be done early, before the person loses the capacity to express their will.

The National Health System (SNS) covers medicine, but patients must pay a small, capped monthly copayment. For most pensioners, this is a predictable amount, typically between €8.23 and €18.52 per month. However, therapy (like cognitive stimulation) and long-term care (such as day centres or residences) are not covered by the health system. They are handled by the separate social care system (Dependency Law), which requires a larger, means-tested copayment based on the patient’s own pension. Dependency Law is Each region administers its own programs, which may differ in terms of eligibility criteria, benefit amounts, and application procedures. For instance, in the Community of Madrid, individuals can receive up to €747.25 per month depending on their degree of dependency (Grade I, II, or III) and the specific assistance program they qualify for.

Indirect support for carers is primarily structured around the Dependency Law. State financial assistance includes benefits like PECEF for family care (max €180 – €455.40/month depending on grade), PEVS to cover private accredited services (max €313.50 – €833.96/month), and PEAP for personal assistants (max €313.50 – €747.25/month). Available services include Home Help (SAD) with hours linked to dependency grade (e.g., Grade III: 46-94 hours/month), Day/Night Centres, Residential Care, and Telecare.

Specific carer support includes the state-funded Convenio Especial, allowing non-professional caregivers (linked to PECEF) to maintain Social Security contributions for future pensions. Employment law grants rights to unpaid leave (excedencia, up to 2 years with job reservation for the first year), reduced working hours, and requesting work schedule adaptations. Tax relief is available through state IRPF allowances (€1,150+ for ascendants >65/disabled living with taxpayer) and deductions (€1,200 for ascendants with disability >=33%), plus regional deductions (e.g., Madrid offers €515.50 deduction for care of ascendants).

However, it is important to acknowledge that these support mechanisms are not at the disposal of everyone who needs them. Strict eligibility criteria, severe bureaucratic delays in processing Dependency Law applications, and significant regional disparities often leave many vulnerable individuals and their caregivers waiting months or even years without adequate assistance.

Non-governmental organizations (NGOs) like CEAFA (through local AFAs), Fundación Alzheimer España (FAE), and Fundación Pasqual Maragall provide specialised training (e.g., IMSERSO’s CRE Alzheimer also offers free online courses), psychological support (individual/group therapy), peer networks, and respite care programs (also offered regionally).

The latest national strategy in Spain was the National Plan on Alzheimer’s and Other Dementias 2019-2023. The strategy is built around four primary goals. The first is to raise societal awareness and transform the public perception of dementia to reduce stigma. The second focuses on placing the person at the centre of social and health care, emphasising prevention, early diagnosis, and access to appropriate treatments. The third goal is to uphold the rights, ethics, and dignity of individuals living with dementia and their care partners, ensuring they receive proper support and services. The final objective is to promote research, innovation, and knowledge to advance the understanding and treatment of the disease.

Spain has also recently launched a comprehensive, multi-sector strategy to address all brain conditions, both neurological and psychiatric. Its key goals relevant to Alzheimer’s disease include promoting investment in neuroscience research, developing integrated care models, and improving early detection strategies, all of which are critical for tackling dementia.

However, while these national strategies exist, their practical implementation has been significantly limited. The rollout of these plans lacks uniform funding and execution, meaning that the initiatives and resources do not cover all regions in Spain equally, resulting in significant regional disparities in care.

The Alfa Study is a large, long-term study of cognitively healthy individuals, most of whom are descendants of people living with Alzheimer’s disease. It functions as a “trial-ready” cohort to provide verified participants for global prevention clinical trials, accelerating the development of new treatments.

The DABNI study is an innovative, population-based research initiative that integrates clinical care and biomarker research to advance understanding and early detection of Alzheimer’s disease in adults with Down syndrome. By embedding research directly into a free, public health program, DABNI has pioneered a holistic model that simultaneously improves people living with dementia care, expands early diagnosis, and redefines Down syndrome as a genetically determined form of Alzheimer’s disease.

The Vallecas Project, a recently completed 10-year longitudinal study, followed over 1,200 healthy older adults with deep phenotyping and advanced multimodal MRI scans. Its primary goal is to use this massive dataset to develop a computational algorithm that can accurately predict an individual’s near-term risk of developing dementia.

Hospital Clínic Barcelona has become the first centre in Spain to formally integrate the highly accurate p-tau217 blood test into its routine diagnostic process for cognitive impairment. This innovation has been shown to correctly diagnose 78% of people with a simple blood test, avoiding the need for more invasive and expensive lumbar punctures.

BBRC researchers are part of an international collaboration that is validating this novel blood biomarker, which specifically measures tau tangles that are closely correlated with cognitive symptoms. This discovery is a critical step toward the biological staging of Alzheimer’s disease (like in oncology), rather than just its detection.

The ABvac40 Phase 2 study focuses on a Spanish-developed active immunotherapy vaccine that trains the people’s own immune system to fight a toxic amyloid peptide. The highly promising Phase 2 results showed a signal of cognitive benefit and, most importantly, zero cases of the dangerous brain-swelling side effect (ARIA-E) that plagues current antibody treatments.

To overcome the “black box” problem of AI diagnostics, Spanish research groups are developing XAI models that visually highlight which brain regions an AI used to make its diagnosis. This approach builds clinical trust and transparency, making AI a viable tool for real-world use in analyzing MRI and PET scans.

Altoida Digital Biomarker Study used a smartphone-based application to capture digital biomarkers of neurocognitive performance from participants in Barcelona and other sites.