The challenge of learning to accompany memory

Barcelona wants to stop wondering how to live with Alzheimer's and start living better.. The Barcelona Alzheimer's and Dementia Strategy 2025-2030, promoted by the City Council and the Barcelona Alzheimer's Roundtable, stems from this perspective: acknowledging that the number of people with cognitive impairment will continue to grow as the city ages, and that the response can no longer be limited to specific services. It must be integrated into how the city, its neighborhoods, municipal services, and even daily life are understood.

Catalonia has more than 100,000 people with dementia, and that number could double by 2050. "With our demographic trends, this will happen if we don't find a way to intervene," explains Laia Ortiz, director of the social services department at the Pasqual Maragall Foundation. The warning goes beyond the statistics: Spain is one of the countries that invests the least in long-term care, and 86% of the cost of the disease falls on families. "Clearly, we are not prepared. We now know that there are ways to intervene, extend the autonomy of these individuals, and improve their quality of life, but we are not providing that support."

Meanwhile, 21% of Barcelona's population is over 65, a group for whom prevalence studies range from 5% to 14.9%. These figures do not include undiagnosed cases. Ortiz warns that many diagnoses are made late and that, after a certain age, symptoms that are clear signs of decline are normalized. "Ageism and territorial inequality in access to specialists hinder early detection, which could change the course of many people's lives."

To address this situation, the strategy revolves around five key areas: awareness-raising, prevention through accessible facilities, early diagnosis, inclusive cities, and research. "Clear leadership is essential, because cities change, but we have to work to make them easier to navigate," says Marta Villanueva, Barcelona's Health Councillor.

The aim is to support people from the first sign of need to the final stage, coordinating Health, Social Services, and Urban Planning so that the response doesn't depend solely on the individual initiative of families. Because "there's a lot of talk about dependency, but a fundamental aspect is autonomy." Beyond cases where this lack of autonomy exists, the focus is on supporting people in the early stages when they may need assistance. At this point, technology offers new opportunities. "There's a whole range to explore, because the development of AI-powered resources can offer solutions that make life easier in the early stages." From solutions that provide personalized reminders to robots that can detect emergency situations.

However, the city can also intervene in very simple but crucial ways to extend people's active lives. For example, Ortiz points out that "in a sports facility where all the lockers are the same, people get disoriented and stop doing an activity they always did. With a little intervention, that person can continue going to the pool."

This shift in perspective is what inspires the concept of a "dementia-friendly city": an environment that doesn't exclude anyone when the first symptoms appear. This involves training for municipal professionals, clear signage, quiet spaces, more accessible transportation, and facilities designed so that disorientation doesn't mean abandoning routines.

The roadmap

The Strategy has a total budget of €6.3 million until 2030. More than half will be allocated to social, community, and public health projects, while a third will go towards strengthening research and the remainder towards raising awareness. Twenty-six actions have been planned and will be implemented progressively, such as the creation of an information and advice point at Barcelona Cuida, co-managed by organizations from the Barcelona Alzheimer's Roundtable. "We must put all our knowledge to use to transform facilities, raise awareness, and train professionals. If this strategy is implemented, it can bring about many changes, but it won't come without a price: we need to get moving at full speed," Ortiz asserts.

One of the first initiatives already underway is the Alzheimer's HUB Barcelona, ​​which brings together hospitals, scientific centers, and social organizations to promote research, training, and innovation. "One of the Hub's objectives is to position Barcelona globally, which would include establishing links with other cities that have pioneered initiatives," explains Villanueva.

Another initiative that is being worked on is the improvement of the content ofAlzheimer Chatbot, now accessible on the municipal website, to offer truthful information and answer questions from citizens, especially caring families.

The rollout schedule is still being finalized, and "we want the strategy to be territorialized, but we know that the postal code determines health as much as or more than the genetic code, so we will try to prioritize neighborhoods with less access to information, resources and less willingness to cope with brain health programs," Villanueva explains.

All of this entails a constant effort in coordination and monitoring. The strategy will be evaluated using specific indicators, such as the number of trained professionals, the volume of users accessing stimulation programs, the new adapted facilities, and the use of the Barcelona Cuida point. The goal is to ensure that the city makes real and measurable progress.

Learning to care through training and prevention

The strategy also focuses on the role of the community, with a clear consensus that families are still too often left to fend for themselves. According to a study by the Pasqual Maragall Foundation, 67% of professionals in nursing homes, day centers, or home care had not received dementia training. "And we're talking about professionals," Ortiz points out. "Imagine the rest of the people in jobs that involve the general public." The city wants to reverse this with cascading training: for the municipal police, bus drivers, staff at markets, libraries, and sports centers. "An initial intervention in training professionals on the ground who can identify people in the early stages of dementia or who may not yet have been diagnosed," Villanueva explains. The entire city network can detect a sign and provide support through more structured channels, communicating with greater empathy and effectiveness.

Another crucial aspect, and one that presents an opportunity, according to Villanueva, is the prevention and promotion of healthy living, which has traditionally been more closely associated with heart disease and cancer. Recent studies conclude that 45% of dementia cases could be prevented through individual and social changes. Physical activity, social life, the Mediterranean diet, lifelong learning, addressing hearing loss, and reducing urban noise can all have direct effects on the rate of cognitive decline. "People don't realize this. Everyone assumes that Alzheimer's is inevitable, and that's not the case. We must incorporate brain health into public policies, just as we have done with cardiovascular health," explains Ortiz.

A public space that accompanies

Another fundamental pillar is the adaptation of public spaces and facilities. The Strategy plans to adapt streets, urban routes, and signage, as well as libraries, community centers, and museums, to make them more understandable and easier to navigate. Villanueva emphasizes that urban planning must consider cognitive impairment just as it considers reduced mobility. But the challenge is complex: "It's very difficult to find the balance between progress and the need for more green spaces and accessible areas," she acknowledges. Therefore, accessible routes will be created, landmarks will be reinforced, and work will be done with general facilities to reduce invisible barriers.