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 is an essential part of the diagnostic workup for Alzheimer’s disease within Spain’s public healthcare system. These imaging modalities are primarily used for differential diagnosis, enabling clinicians to rule out other causes of cognitive impairment, such as tumours or cerebrovascular disease. However, access to structural neuroimaging is not uniform across the country, with regional inequalities and long waiting times affecting timely diagnosis in some autonomous communities.

The Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) confirmed in 2025 that amyloid PET is available for clinical practice in Spain, reflecting its transition from a predominantly research tool to a clinical diagnostic modality. Nevertheless, access remains uneven between autonomous communities, and not all regions currently offer amyloid PET within the public healthcare system. Investment in advanced imaging continues, exemplified by the installation of the first public-assistance combined PET/MRI scanner at 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. 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.

Cerebrospinal fluid (CSF) biomarkers are part of routine diagnostic practice in specialised memory clinics and neurology services in Spain, where they are used to support the diagnosis of Alzheimer’s disease when clinically indicated. Blood-based biomarkers have recently obtained CE marking and represent a promising advance for earlier and more accessible diagnosis. However, their implementation in the public healthcare system is still underway, and access and availability remain variable across regions. Current expert recommendations support the use of blood-based biomarkers within specialised clinical settings as implementation progresses, rather than in general practice or population-wide 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 310 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 Spanish National Health System (Sistema Nacional de Salud, SNS) currently funds the approved symptomatic medications for Alzheimer’s disease, including donepezil, rivastigmine, galantamine, and memantine. Patients contribute through a capped monthly co-payment, which for most pensioners is a predictable amount, typically between €8.23 and €18.52 per month. Anti-amyloid therapies (ATTs) for Alzheimer’s disease, such as donanemab and lecanemab, are currently pending pricing and reimbursement decisions by the National Health System and are therefore not yet publicly funded.

Non-pharmacological therapies, such as cognitive stimulation, and long-term care services, including day centres and residential care, are not funded through the health system. Instead, they are provided through Spain’s separate social care system under the Dependency Law (Ley de Dependencia), which requires a means-tested co-payment based on the individual’s financial circumstances, including their pension. The law is implemented by Spain’s autonomous communities, resulting in regional variation in eligibility criteria, benefit levels, and application procedures. For example, in the Community of Madrid, individuals may receive up to €747.25 per month, depending on their degree of dependency (Grades I, II, or III) and the specific support programme for which they qualify.

Indirect support for carers is primarily structured around the Dependency Law. State financial assistance includes the PECEF benefit for family care (up to €180–€455.40/month depending on the degree of dependency), PEVS to help cover accredited private care services (up to €313.50–€747.25/month), and PEAP for personal assistants (up to €313.50–€747.25/month). Available services include Home Help (Servicio de Ayuda a Domicilio, SAD), with the intensity of support determined by the degree of dependency and varying across Spain’s autonomous communities, as well as Day and Night Centres, Residential Care, and Telecare.

Specific support for carers includes the state-funded Convenio Especial, which enables non-professional caregivers receiving PECEF to maintain Social Security contributions for future pensions. Employment legislation also provides rights to unpaid caregiving leave (excedencia), reduced working hours, and the possibility of requesting flexible working arrangements. Tax support includes state income tax (IRPF) allowances and deductions for caring for older or disabled dependants, complemented by additional regional tax benefits (for example, the Community of Madrid offers a €515.50 deduction for the care of ascendants).

However, these support mechanisms are not available to everyone who needs them. Strict eligibility criteria, lengthy administrative delays in processing Dependency Law applications, and significant regional disparities often leave many people living with Alzheimer’s disease and their caregivers waiting months or even years for adequate support.

Patient and family associations, including CEAFA (through its local Alzheimer’s associations) and the Fundación Alzheimer España (FAE), together with organisations such as the Fundación Pasqual Maragall, provide specialised training, psychological support, peer networks, and respite care. Additional education and training are also available through IMSERSO’s CRE Alzheimer, which offers free online courses for carers and professionals.

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 provide an important policy framework, their implementation has been limited by the absence of dedicated funding and uneven execution across Spain’s autonomous communities. Stakeholders are therefore calling for an updated National Dementia Plan, accompanied by a specific budgetary allocation, to ensure more consistent implementation and reduce regional disparities in dementia 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.

Blood-based biomarker testing has rapidly evolved from a research tool to routine clinical practice in specialised centres across Spain. Hospital Clínic Barcelona was among the first centres in the country to formally integrate the highly accurate p-tau217 blood test into its diagnostic pathway for cognitive impairment. Following the CE marking of two p-tau217 assays in 2026 (Roche/Lilly’s Elecsys® pTau217 and Fujirebio’s Lumipulse G pTau217 Plasma), implementation is expected to expand further across the Spanish healthcare system.

Researchers at the Barcelonaβeta Brain Research Center (BBRC) are part of an international collaboration validating blood-based biomarkers that measure phosphorylated tau, including p-tau217, which closely reflects Alzheimer’s disease pathology and correlates with cognitive decline. This work represents an important step towards the biological staging of Alzheimer’s disease, enabling more accurate and accessible diagnosis and supporting earlier therapeutic intervention.

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.