Wales

Initial cognitive screening in primary care commonly uses validated tools such as the General Practitioner Assessment of Cognition (GPCOG), 10-Point Cognitive Screener (10-CS), 6-Item Cognitive Impairment Test (6CIT), Mini-Cog, and Test Your Memory (TYM) to identify individuals requiring specialist assessment. Following referral, Memory Assessment Services undertake more comprehensive cognitive evaluation, commonly using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) alongside tests of verbal episodic memory and formal neuropsychological assessments where diagnostic uncertainty remains.

Structural neuroimaging forms a routine part of the Alzheimer’s disease diagnostic pathway in Wales. MRI is the preferred imaging modality because it can identify patterns of cerebral atrophy while excluding alternative causes of cognitive impairment such as stroke, tumours, hydrocephalus, and other structural abnormalities. CT is also widely available and is used when MRI is contraindicated or unavailable. Both MRI and CT are readily accessible through National Health Service (NHS) hospitals following referral from specialist memory services. When diagnostic uncertainty remains after clinical assessment and structural imaging, more advanced functional imaging techniques such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) or perfusion single photon emission computed tomography (SPECT) may be considered. However, these investigations are available only through specialist centres and are reserved for selected complex or atypical cases rather than routine clinical diagnosis.

Genetic testing is not routinely performed as part of the diagnostic pathway for Alzheimer’s disease in Wales. Although genetic variants such as the apolipoprotein E (APOE) ε4 allele are recognised as important risk factors for late-onset Alzheimer’s disease, NICE specifically recommends not using APOE genotyping to diagnose Alzheimer’s disease, as it indicates susceptibility rather than confirming disease. Genetic testing is therefore generally reserved for individuals with suspected familial or young-onset Alzheimer’s disease, particularly where there is a strong family history suggestive of an inherited dementia syndrome. Access is consequently limited to specialist NHS Clinical Genetics Services or research settings following referral from neurology or memory specialists and is not part of routine dementia assessment.

NICE recommends considering CSF analysis to measure amyloid-beta (Aβ42/Aβ40), total tau, and phosphorylated tau (p-tau) in people with diagnostically uncertain, atypical, or early-onset presentations, where it can improve diagnostic accuracy. However, despite these recommendations, CSF testing is not widely used across the NHS because it requires lumbar puncture, specialist laboratory analysis, and appropriate clinical expertise, limiting its availability to selected specialist centres. Blood-based biomarkers, including plasma phosphorylated tau (p-tau181 and p-tau217) and neurofilament light chain (NfL), have shown considerable promise as less invasive diagnostic tools. However, they are not yet routinely available within NHS Wales and are currently being evaluated through national research initiatives, including the UK Blood Biomarker Challenge, before wider implementation in clinical practice.

Wales has a well-established, nationwide network of Memory Assessment Services (MAS) embedded within every NHS Wales Health Board as part of the All-Wales Dementia Care Pathway. These multidisciplinary services provide comprehensive assessment, diagnosis, post-diagnostic support and care planning for people with suspected dementia. Memory clinics are available across the country, including urban and rural areas.

Local authorities provide dementia day centres, respite care, home care and community support, while organisations such as Alzheimer’s Society Cymru and Age Cymru offer dementia advisers, support groups, cognitive stimulation programmes and carer support throughout the country. Many Health Boards also operate specialist older people’s mental health day units for people living with dementia, such as the Tonteg Day Unit in Cwm Taf Morgannwg, and similar services are available in other regions.

Wales has a comprehensive palliative care system delivered through the NHS and an extensive network of hospices. Specialist palliative care is available in all Health Boards through hospital palliative care teams, community palliative care services and hospices. Although these services are not dementia-specific, national guidance promotes palliative and end-of-life care for people living with advanced dementia, with care delivered through community teams, care homes, hospitals and hospices according to patient needs.

Treatment for Alzheimer’s disease is fully funded by NHS Wales. Consultations with GPs and specialists, diagnostic assessments, memory clinic services, and clinically recommended Alzheimer’s disease medicines (including donepezil, rivastigmine, galantamine, and memantine) are provided free at the point of use. Allied health therapies (e.g. occupational therapy, physiotherapy, speech and language therapy, and psychological support), when clinically indicated and provided by the NHS, are also covered without patient charges. Therefore, there are no copayments for NHS-funded Alzheimer’s disease medicines or therapies, and families generally do not bear direct treatment costs, although they may incur costs related to non-medical long-term care or private services.

Although there is no dementia-specific caregiver allowance, unpaid carers may be eligible for Carer’s Allowance (a UK-wide benefit), and under the Social Services and Well-being (Wales) Act 2014, care partners have a legal right to a carer’s needs assessment. If eligible, carers can receive support through direct payments, which are intended to meet their assessed support needs, such as funding respite, wellbeing activities, or other services that help them continue caring.

People living with Alzheimer’s disease may also receive financial support through benefits such as Attendance Allowance, Personal Independence Payment (PIP) (if under State Pension age), and local authority-funded social care. In addition, direct payments can be provided to people living with eligible care needs to arrange their own care, including employing personal assistants or purchasing home care services.

Wales has also adopted a dedicated Strategy for Unpaid Carers, recognising care partners of people living with conditions such as Alzheimer’s disease as a priority group. The strategy commits the Welsh Government to improving access to respite care, psychological support, information, and flexible services. Welsh Government funding supports projects such as the Dementia Integration and Links (DIAL) service, which provides wellbeing programmes, counselling, and community support specifically for unpaid carers of people living with dementia.

In addition to government support, charities including Alzheimer’s Society Cymru, Age Cymru, and Carers Wales provide information, benefits advice, caregiver education, peer support, and assistance navigating health and social care services. Social Care Wales also maintains guidance on financial entitlements for people living with Alzheimer’s disease and their carer partners, including access to benefits, local authority support, and care planning resources. While these organisations do not generally provide direct financial payments, they play a central role in helping families access available statutory support.

Wales is currently developing a new 10-year Dementia Strategy for Wales (2026–2036), which will replace the previous Dementia Action Plan (2018–2022) and its 2021 companion document. The draft strategy was published for public consultation between 16 December 2025 and 6 April 2026, with priorities co-produced alongside people living with dementia, carers and other stakeholders. It focuses on seven key areas: prevention and risk reduction, awareness, diagnosis and care, support for unpaid carers, workforce development, research and innovation, and strengthened governance and accountability. The consultation has now closed and the Welsh Government is reviewing responses before publishing the final strategy; at present, the new national dementia strategy has not yet been formally adopted and the outcome of the consultation is still awaited.

At the UK Dementia Research Institute (UK DRI) at Cardiff University, researchers investigate the genetic mechanisms underlying Alzheimer’s disease. Their work focuses on identifying disease-causing genes, understanding how immune cells (microglia) contribute to neurodegeneration, and discovering new therapeutic targets. By combining genetics, computational biology, DNA repair research, and machine learning, the Cardiff team aims to develop precision medicine approaches and novel disease-modifying treatments for Alzheimer’s disease.

Researchers in Wales are developing innovative methods for the early detection of Alzheimer’s disease using combinations of blood biomarkers, genetic testing, neuroimaging, and artificial intelligence. Current projects such as the SANDBOX study evaluate whether blood-based biomarkers and AI can speed dementia diagnosis and reduce waiting times in routine clinical practice. These efforts aim to identify Alzheimer’s disease before significant brain damage occurs, allowing earlier intervention and improved patient outcomes.

Alongside laboratory research, Wales has become a leader in person-centred dementia care through the Centre for Ageing and Dementia Research (CADR) and the Dementia Services Development Centre (DSDC Wales) at Bangor University. Researchers develop and evaluate psychosocial interventions, caregiver support programmes, dementia-friendly communities, and healthy ageing initiatives. Their interdisciplinary work integrates biological, psychological, social, and environmental factors to improve quality of life for people living with dementia and their families while informing national policy and clinical practice.