St. Kitts and Nevis

No national guideline specifies which cognitive screening tools should be used for dementia assessment in Saint Kitts and Nevis. Clinicians may use internationally recognized instruments such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Mini-Cog, Clock Drawing Test, verbal fluency tests, or informant-based questionnaires, but no local source confirms the routine nationwide use of any specific tool. Dedicated public neuropsychological testing services were not identified, and cognitive assessment may be influenced by educational, cultural, and language factors. No locally validated cognitive screening instrument for Saint Kitts and Nevis was identified.

CT scanning is the primary structural imaging modality currently available in Saint Kitts and Nevis for evaluating causes of cognitive impairment such as stroke, tumour, hydrocephalus, or head injury. In 2024, the government announced the procurement of a 128-slice CT scanner for the Joseph N. France General Hospital, intended to expand diagnostic capabilities, including advanced cardiac imaging. The government has also invested in a dedicated MRI facility at the hospital, with installation of the country’s new MRI system planned for early 2025, representing a significant enhancement of local diagnostic capacity.

Despite these investments, publicly available information does not confirm routine access to dementia-protocol MRI, FDG-PET, amyloid PET, tau PET, or other functional neuroimaging specifically used in Alzheimer’s disease diagnosis. Likewise, the availability of dementia-specific neuroradiology interpretation has not been documented. Patients requiring advanced molecular imaging, including amyloid or tau PET, would therefore likely need referral to overseas specialist centres.

No national dementia-genetics service was identified. Testing for rare familial Alzheimer genes such as APP, PSEN1 and PSEN2, frontotemporal-dementia genes or APOE genotype does not appear to form part of routine public dementia assessment.

No evidence was found that Alzheimer’s disease biomarkers are routinely processed locally in Saint Kitts and Nevis, including cerebrospinal fluid (CSF) amyloid-beta, total tau, phosphorylated tau, plasma phosphorylated tau, amyloid-beta blood ratios, or neurofilament light (NfL). Although lumbar puncture may be technically available in hospital settings, samples requiring specialized dementia biomarker analysis would likely need to be sent to overseas laboratories. As a result, while the country has general laboratory infrastructure, a publicly documented pathway for Alzheimer’s biomarker testing has not been identified.

Joseph N. France General Hospital in Basseterre is the Federation’s principal public referral hospital and the main centre for specialist diagnostic services. Although it is not a dedicated dementia centre and no multidisciplinary memory clinic has been identified, the hospital provides many of the services involved in dementia assessment and management, including internal medicine, emergency care, mental health services, diagnostic imaging, laboratory medicine, and visiting specialist clinics. Recent government investment has further strengthened diagnostic capacity through the installation of a 128-slice CT scanner and construction of a dedicated MRI facility, improving local access to neuroimaging for patients with cognitive impairment.

Alexandra Hospital is the main public hospital serving Nevis and provides inpatient care, emergency services, laboratory diagnostics, and general medical care for the island’s population. It represents the primary point of access for older adults with suspected dementia living on Nevis. Patients requiring more complex investigations or specialist neurological assessment may be referred to Joseph N. France General Hospital or overseas when services are unavailable locally.

Saint Kitts and Nevis operates a network of approximately 17 community health centres and health posts, which form the foundation of the country’s primary healthcare system. Although these facilities do not provide specialist dementia services, they play an important role in early recognition of cognitive decline, chronic disease management, medication monitoring, caregiver education, home visits, and referral to secondary care. Effective management of vascular risk factors such as hypertension and diabetes through primary care may also contribute to reducing dementia risk and supporting patients after diagnosis.

The Dr. Arthur W. L. Lake Mental Health Day Treatment Centre provides community-based psychiatric rehabilitation and supports the transition from inpatient treatment to community living. While it is not a dementia-specific service, its multidisciplinary mental health team may become involved in the management of dementia patients experiencing depression, anxiety, psychosis, agitation, or other behavioural and psychological symptoms of dementia (BPSD).

Residential care for older adults is provided through a combination of public, charitable, and private facilities, although a comprehensive national network of dementia-specific residential services has not been identified. Recognizing the need to strengthen quality assurance, the Government of Saint Kitts and Nevis has begun developing regulatory standards for institutions providing elder care in collaboration with Windsor University School of Medicine. These reforms are intended to improve oversight, safeguarding, and standards of care for older adults, including those living with dementia.

No national estimate of the annual cost of dementia treatment or long-term care was identified for Saint Kitts and Nevis. While public primary care and hospital services help reduce some direct medical costs, the financial burden of dementia varies depending on disease severity, the need for long-term support, and whether services are obtained locally or overseas. Families may incur out-of-pocket expenses for prescription medicines, home-care aides, live-in caregivers, transportation, continence products, home adaptations, day supervision, respite services, private residential care, overseas specialist treatment, and the indirect cost of lost caregiver income.

For low-income residents, the Social Assistance programme includes a means-tested Medical Assistance benefit that can contribute toward the cost of medical procedures performed locally, regionally, or internationally, subject to a lifetime financial limit. While this may help offset some healthcare expenses, no dementia-specific funding mechanism or long-term care benefit was identified, and ongoing costs associated with home care, supervision, and residential care continue to fall largely on patients and their families.

The proposed National Health Insurance Scheme (NHIS) aims to strengthen financial protection by introducing defined benefit packages, graduated co-payments, case management services, and coverage for approved local and overseas care through a structured referral and pre-authorization system. The Green Paper also proposes lifetime benefit limits, preferred provider networks, and coordinated follow-up for patients receiving overseas treatment. However, these reforms remain proposals and had not been implemented at the time of writing. No dementia-specific reimbursement policy or long-term care benefit has been announced, meaning that many of the ongoing social and supportive care costs associated with dementia would likely continue to fall on patients and their families.

Overall, dementia caregiver support relies largely on NGO-led and community-based initiatives rather than on a comprehensive, government-funded system of dementia-specific services. The recent studies suggest that caregiving in Saint Kitts and Nevis relies heavily on informal family networks and community support, with caregivers often facing limited access to specialized services, insufficient training, and practical support.

The Alzheimer’s Association of St. Kitts and Nevis is the country’s principal dementia-specific organization supporting people living with dementia and their families. The association provides caregiver support groups, educational seminars and workshops, caregiver training, meaningful social activities, and community awareness programmes. It also organizes initiatives such as the Fun Day for Caregivers, which offers caregivers an opportunity for respite, peer support, and recognition of their role. One of its most practical services is a respite grant programme, which provides financial assistance to help families access temporary care and reduce caregiver burden.

Additional support is available through community health centres, public health nurses, churches, social development programmes, and extended family networks, which continue to play a central role in caring for people with dementia. Means-tested Medical Assistance is also available through the Department of Social Services and Community, which may cover the cost of medical procedures provided locally, regionally, or internationally up to a lifetime maximum for eligible low-income residents.56 However, no universal caregiver allowance, dementia-specific employment leave, nationally guaranteed respite services, comprehensive publicly funded home-care programme, or formal caregiver assessment system was identified.

Saint Kitts and Nevis does not have a dedicated national dementia strategy or Alzheimer’s disease action plan. Dementia policy is instead addressed indirectly through a range of broader health, ageing, disability, and social protection frameworks. These include the National Policy on Ageing (currently under development), the National Disability Policy 2026-2030, National Social Protection Strategy and Plan of Action and ongoing reforms toward a National Health Insurance Scheme (NHIS) and universal health coverage. The government has also begun developing regulatory standards for residential elderly-care institutions in collaboration with Windsor University School of Medicine. Although these initiatives strengthen the policy environment for older adults and persons with disabilities, no formally adopted dementia strategy with dedicated funding, measurable targets, or an implementation framework had been identified as of July 2026.

The most significant forthcoming policy development is the National Policy on Ageing, announced in the 2026 Budget Address. The policy is intended to establish a comprehensive framework for supporting an ageing population, including measures related to healthy ageing, ageing in place, health and social care, protection from abuse, social inclusion, residential care, and support for older persons and their families. Although the policy is not dementia-specific, it could become an important platform for strengthening dementia care if it includes provisions on cognitive impairment, caregiver support, early diagnosis, and quality standards for dementia services.

Another important reform concerns the regulation of residential elderly-care facilities. The Ministry of Health, in collaboration with Windsor University School of Medicine, has begun developing regulatory standards for institutions providing care to older adults. The proposed framework is expected to strengthen licensing requirements, quality assurance, safeguarding, medication management, inspection, staffing standards, and complaint procedures. Although not developed specifically for dementia care, these regulations could improve the quality and safety of services for people living with cognitive impairment. At the same time, the government continues to advance plans for Universal Health Coverage (UHC) through a National Health Insurance Scheme (NHIS). Proposed reforms include expanded financial protection, structured referral pathways, case management, and improved access to healthcare services, which could benefit people with dementia if future benefit packages explicitly include cognitive assessment, specialist care, imaging, medicines, home-based support, and long-term care.

The Federation is also investing in broader health system modernization. Ongoing implementation of a national Health Information Management System (HMIS) is intended to improve digital medical records, information sharing, and continuity of care across hospitals, community clinics, and visiting specialists.

In addition, Nevis has joined the WHO Global Network for Age-friendly Cities and Communities, supporting initiatives that promote healthy ageing, accessibility, social participation, and age-friendly environments. While neither initiative is dementia-specific, both have the potential to improve care coordination and community inclusion for older adults living with dementia.

One of the most important health system innovations in Saint Kitts and Nevis is the implementation of the National Digital Health Information System (NDHIS) through the St. Kitts Health Services ICT Project. Funded by the Universal Service Fund (USF) of the National Telecommunications Regulatory Commission (NTRC), the project established a wide area network (WAN) connecting Joseph N. France General Hospital with 16 community clinics and health facilities across Saint Kitts. Officially launched in June 2024, the initiative aims to provide universal access to digital health services, improve the availability of patient information, and strengthen communication between healthcare providers. According to the Ministry of Health, the system is intended to support earlier access to clinical information, more efficient diagnosis, improved treatment decisions, and better continuity of care. For dementia, the NDHIS provides an important foundation for electronic health records, longitudinal monitoring, referral tracking, medication management, and future telemedicine links with visiting or overseas specialists, potentially improving access to specialist expertise in a small island setting.

The government also established Hospital Information System (HIS) at Joseph N. France General Hospital, developed with support from the Government of Taiwan. The system introduced electronic patient records, electronic prescribing, pharmacy and inventory management, barcode-based patient identification, and standardized operating procedures. It was designed to improve access to patient information across public health facilities, reduce administrative errors, and enhance the efficiency and quality of healthcare delivery. The introduction of a national patient medical information card further strengthened continuity of care by allowing patient records to be accessed more easily across the public health system, creating an important foundation for the later development of the National Digital Health Information System (NDHIS).