USA

The U.S. currently does not have a national screening program for asymptomatic older adults, a position guided by the U.S. Preventive Services Task Force, which finds insufficient evidence to weigh the benefits against the harms of such screening. Update on this decision is currently in progress. Cognitive assessment is prompted by clinical concern. A key opportunity for this is the Medicare Annual Wellness Visit, which mandates an assessment for cognitive impairment. If this initial check raises concerns, a more detailed, reimbursed Cognitive Assessment & Care Plan Service can be performed.

Commonly used tests include the Mini-Cog, the MMSE, the Montreal Cognitive Assessment (MoCA), and the General Practitioner Assessment of Cognition (GPCOG). Informant-based questionnaires like the Ascertain Dementia 8 (AD8) and The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are also used to gather perspectives from family members. However, the Alzheimer’s Association does not recommend that home screening tests be used as a substitute for a thorough examination by a skilled doctor.

Structural brain imaging with MRI and CT is available across the U.S. and is considered a standard part of a medical workup for dementia. The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging have jointly published Appropriate Use Criteria for both amyloid and tau PET imaging. While the first tau-PET tracer was approved by the Food and Drug Administration (FDA) in 2020, these scans are still primarily used in specialty academic centres and research settings. Widespread clinical availability and insurance reimbursement for tau-PET are still evolving. Fluorodeoxyglucose (FDG)-PET scans are more established than tau-PET and are generally available at major medical centres.

Testing for early-onset familial Alzheimer’s disease genes (APP, PSEN1, PSEN2) is a specialised medical service, typically ordered by a neurologist or genetic counsellor within a memory disorders clinic or an academic medical centre. Apolipoprotein E (APOE) genotyping is also available. It can be ordered as a clinical test through major laboratories and is also offered directly to the public through direct-to-consumer genetic testing companies. All major professional guidelines emphasize that testing should only occur in the context of formal genetic counselling. The joint practice guidelines from the American College of Medical Genetics and Genomics and the National Society of Genetic Counsellors provide a robust framework for this process.

Cerebrospinal fluid (CSF) Alzheimer’s disease biomarker testing is available through specialised laboratories and memory clinics. Outside of specialist centres, CSF Alzheimer’s disease biomarker testing may be underused. In May 2025, the U.S. FDA granted clearance for the first blood test, Lumipulse, to be marketed as an aid in the diagnosis of Alzheimer’s disease. The test is approved for adults aged 50 years old and older who have early memory or thinking problems, and is not a standalone diagnostic tool, nor is it intended for screening asymptomatic individuals. Rather, it is meant to be used by specialists as part of a comprehensive clinical evaluation to help determine if a person’s cognitive impairment is due to Alzheimer’s disease pathology. To guide the responsible integration of these blood tests, the Alzheimer’s Association released its first-ever evidence-based clinical practice guideline for the use of blood-based biomarkers.

The U.S. provides different forms of Alzheimer’s disease care, including in-home assistance and adult day centres to specialized residential facilities and end-of-life support. At the highest level of clinical practice are the public and private memory clinics and the National Institute on Aging’s Alzheimer’s Disease Research Centers (ADRCs), which are congressionally designated Centers of Excellence at major medical institutions across dozens of states.

Rural residents living with dementia face disparities in access to neurologists, with one study finding rural Washington state residents lived an average of 100 miles from a neurologist, compared to nine miles for urban residents. The care system is further strained by high turnover among direct care workers and a severe shortage of specialists, with estimates showing a need to more than double the current number of geriatricians by 2050 just to care for those with Alzheimer’s disease. The care system is further strained by a severe shortage of specialists, with a projected shortfall of nearly 27,000 geriatricians by 2025, and high turnover among direct care workers. One study found a geographic variation in dementia specialists’ shortfalls, with an estimated 34% to 59% of the older adult population (aged 65 years and older) living in areas with an inadequate supply of expert clinicians, a crisis that disproportionately affects rural communities where over 78% of the elderly reside in these underserved regions.

To address gaps in dementia care and better support families, the Centers for Medicare & Medicaid Services introduced the Guiding an Improved Dementia Experience (GUIDE) Model. This initiative is designed to provide comprehensive, coordinated care for individuals living with dementia while actively addressing the heavy burden placed on their unpaid caregivers. Through the GUIDE Model, participating Medicare providers offer a standardised package of care management and coordination services, which includes the development of personalised care plans, 24/7 access to a support line, and assistance from a dedicated care navigator. The model also recognises the vital role of caregivers by providing them with evidence-based education, training, and a respite care benefit, ultimately aiming to improve the quality of life for both patients and their families while delaying the need for nursing home placement.

Palliative care is widely available for people living with Alzheimer’s disease in the U.S., but access depends heavily on where and how care is delivered. Hospice programs, which offer a form of palliative care typically for patients expected to live six months or less, are nearly universal in their support for people living with dementia. As of 2017, there were more than 4,200 hospice providers, and nearly all served individuals living with Alzheimer’s disease or other forms of dementia. Beyond hospice, specialty palliative care services have expanded across hospitals. As of 2024, about 84% of U.S. hospitals with more than 50 beds offer palliative care, a number that climbs to 96% in hospitals with 300+ beds. Yet access remains uneven. Only 49% of for-profit hospitals and just 34.5% of rural hospitals offer palliative care programs, revealing significant gaps in access.

Medicare Part D plans are private insurance plans that cover outpatient prescription drugs. This includes medications used to manage the symptoms of Alzheimer’s disease. All Part D plans are required to cover at least two cholinesterase inhibitors. However, each plan has its own formulary (a list of covered drugs) and cost structure, including deductibles and tiered copayments. As for disease-modifying drugs, both Leqembi and Kisunla have been approved by the FDA and are covered under Medicare Part B for seniors and by many private insurance plans for people under age 65. People are usually responsible for coinsurance on the cost of the drug, which can amount to several thousands of dollars per year in out-of-pocket costs, although most seniors have private supplemental insurance policies to pay for most or all of it.

Palliative care is often covered by Medicare, Medicaid, and private insurance. When the person is in the final stage of the disease (typically with a prognosis of 6 months or less), hospice care is available and covered under Medicare Part A. Long-term custodial care for daily activities is not covered by Medicare or standard private health insurance. Consequently, families face immense out-of-pocket expenses, averaging over $10,000 annually, which is more than four times the amount spent for adults who do not live with dementia. The average annual cost of nursing home care is more than $100,000.

Medicaid is the primary payer for long-term care but acts as a safety net of last resort, requiring families to first spend down their life savings to meet strict poverty-level eligibility criteria. Private long-term care insurance can provide coverage, but it is a product that must be purchased years before a diagnosis is made. On average, total health care, long-term care, and hospice payments for a senior living with dementia are more than three times higher than those for a senior without the condition.

State-level support varies significantly. Medicaid home and community-based services waivers are critical programs that partially fund at-home care to prevent nursing home placement, and many states allow these funds to be used to pay family members as carers. Specific examples include California’s HCBA Waiver, Texas’s STAR+PLUS Waiver, and New York’s Nursing Home Transition and Diversion Waiver. Some states have unique programs, like Pennsylvania’s Caregiver Support Program, which directly reimburses carers for out-of-pocket expenses. A growing number of states, including California and New Jersey, offer Paid Family Leave, which provides a partial wage replacement for carers who need to take time off work. Additionally, caregivers who financially support their care recipient may qualify for the federal Credit for Other Dependents, a broad $500 tax credit designed for taxpayers supporting qualifying adult relatives or non-minor dependents.

Social Security programs like Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide income to the person living with dementia, not directly to the carer, but these funds can be used to pay for care expenses. For veterans’ families, the Department of Veterans Affairs offers the most direct financial aid through the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which provides a monthly stipend, health insurance, and respite care to a designated carer. The Veteran Affairs also offers an indirect benefit through the Aid and Attendance (A&A) Pension, which is paid to the veteran and can be used to hire a carer.

A key carer resource is education and support. The Alzheimer’s Association is the largest non-profit provider of care and support for dementia in the U.S., offering a free 24/7 Helpline, website, education programs and support groups for carers. Additional resources are available through local and county Area Agencies on Aging, community-based non-profits, health care systems, and web-based programs.

The National Alzheimer’s Plan, periodically updated to reflect the latest scientific understanding and societal needs, is built around six fundamental goals. These objectives provide a roadmap for a coordinated national effort to prevent future cases, enhance care for those currently affected, and lessen the overall load of these devastating neurodegenerative diseases.
1. Prevent and effectively treat Alzheimer’s disease and related dementias (ADRD) by 2025: This objective drives a significant investment in biomedical research to identify the underlying causes of ADRD, discover new therapeutic targets, and develop effective interventions to slow or halt disease progression. A key strategy within this goal is the acceleration of clinical trials and the promotion of public-private partnerships to expedite the translation of research findings into viable treatments.
2. Enhance care quality and efficiency: This involves developing and disseminating evidence-based care guidelines, improving access to timely and accurate diagnosis, and building a workforce with the specialized skills required to provide high-quality dementia care across all settings, from home and community-based services to long-term care facilities.
3. Expand support for people with Alzheimer’s disease/ADRD and their families: The plan acknowledges the immense physical, emotional, and financial toll on carers and aims to provide them with better resources, education, and support services. This includes promoting flexible and affordable long-term care options and ensuring that individuals living with dementia can remain in their communities for as long as possible.
4. Enhance public awareness and engagement: This involves launching national education campaigns to inform the public about the signs and symptoms of ADRD, the importance of early diagnosis, and the resources available to individuals living with dementia and families. The aim is to create a more dementia-friendly society that is supportive of those living with the disease.
5. Improve data to track progress: This goal underscores the importance of a robust data infrastructure to monitor the prevalence and impact of ADRD. By collecting and analyzing comprehensive data, policymakers and researchers can better understand the scope of the problem, identify disparities in care and outcomes, and evaluate the effectiveness of the national plan’s strategies and interventions.
6. Accelerate action to promote healthy aging and reduce risk factors for AD/ADRD: This is a more recent addition to the plan which encourages public health initiatives to promote brain health across the lifespan. This approach emphasizes the growing body of evidence suggesting that lifestyle modifications, such as physical activity, a healthy diet, and cognitive engagement, may reduce the risk of cognitive decline.

Public Health Approach
In 2019, the U.S. Congress passed the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act, which seeks to build and expand public health capacity across the country to address dementia using public health tools, techniques, and strategies. With about $35 million in annual funding, the initiative funds state, local, and tribal public health activities that address dementia and funds three Centers of Excellence (on risk reduction, early detection, and caregiving) to support public health action.

Examples of innovative research being conducted in the US include:

The POINTER trial is a two-year randomised clinical trial that investigates whether lifestyle modifications can protect brain health in older adults at risk for cognitive decline. It involved over 2,100 participants and compared two approaches to implementing healthy habits like physical exercise, the MIND diet, cognitive and social engagement, and cardiovascular monitoring. The results showed that while both groups experienced cognitive improvements, the participants in the structured program with higher accountability and support demonstrated a statistically significant greater improvement in overall cognitive function, highlighting that accessible, multidomain lifestyle interventions can effectively slow cognitive decline.

University of California, San Francisco (UCSF) scientists have pioneered the use of artificial intelligence in diagnostics by applying a machine learning model to the electronic health records of over 5 million patients. This approach was able to predict the future onset of Alzheimer’s disease with 72% accuracy up to seven years before a clinical diagnosis was made. For example, based on the combination of different factors hypertension, high cholesterol and vitamin D deficiency, were predictive in both men and women.

West Virginia University’s Rockefeller Neuroscience Institute is conducting clinical trials using focused ultrasound, a non-invasive technology that temporarily opens the blood-brain barrier. This method has been shown to significantly enhance the delivery of anti-amyloid antibody drugs into the brain, resulting in a greater reduction of amyloid plaques compared to the drug alone.

The University of California, Los Angeles (UCLA) is investigating low-intensity focused ultrasound as a form of non-invasive brain stimulation to improve memory. This proof-of-concept trial targets the entorhinal cortex, a key memory region of the brain, to determine if the technology can increase brain activity and enhance connectivity in memory networks for people living with mild cognitive impairment or early Alzheimer’s disease.

The University of California, San Diego (UCSD) is a primary site for a first-in-human gene therapy trial that aims to protect neurons from the damage caused by Alzheimer’s disease. Alzheimer’s disease clinical trials at UCSD have around 16 clinical trials that are in progress, with 8 which are open to eligible people. The research involves delivering the gene for Brain-Derived Neurotrophic Factor (BDNF), a protein that supports neuronal health and survival, directly into the brain to slow or prevent cell loss.

Weill Cornell Medicine and Duke University are among the clinical trial sites for a study designed to evaluate gene therapy clinical trials specifically for individuals who carry two copies of the APOE4 gene, the strongest genetic risk factor for late-onset Alzheimer’s disease. The therapy uses a harmless virus to deliver the gene for the protective APOE2 variant into the brain, with the goal of shifting the protein isoform from high-risk to protective.

Indiana University is one of two national centres developing stem-cell-based models of the human brain to explore the underlying causes of Alzheimer’s disease and related dementias. This technology allows researchers to study complex disease processes like neuroinflammation in a highly human-relevant system, aiming to improve the predictive value of preclinical research and accelerate the testing of new drug candidates.

Johns Hopkins University’s Richman Family Precision Medicine Center of Excellence is leveraging artificial intelligence and big data analytics to redefine Alzheimer’s disease as a collection of distinct biological subtypes.