{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:49:38Z","timestamp":1782755378016,"version":"3.54.5"},"reference-count":85,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pakistan faces a rapidly growing dementia crisis with an estimated 374,060 cases, projected to rise substantially as the older adult population triples to 38.3 million by 2050. Yet no provincial-level assessment of service readiness has been published. To our knowledge, this study provides the first structured literature-based provincial assessment of dementia-relevant geriatric mental health infrastructure across Pakistan\u2019s four provinces and two administrative territories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an integrative review synthesizing peer-reviewed literature, grey literature, and government reports. Drawing on the conceptual structure of WHO-AIMS (2007), we developed a novel six-criteria framework to categorize provincial readiness across three dimensions: governance, infrastructure, and specialized care. Findings were contextualized through comparison with India, Bangladesh, and Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our framework stratified Pakistan into three tiers. Tier 1 provinces (Punjab, Sindh) demonstrated partial system maturity; Tier 2 provinces (Khyber Pakhtunkhwa, Balochistan) exhibited foundational but inactive governance structures; and Tier 3 territories (Gilgit-Baltistan, Azad Jammu and Kashmir) showed absent legislative frameworks and no identifiable dementia services. Validated Urdu screening instruments exist (MMSE-Urdu, 10\/66 battery) but are not systematically used. Pakistan\u2019s psychiatric workforce (0.24 per 100,000) lags significantly behind regional comparators such as Sri Lanka (0.47) and India (0.30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dementia care in Pakistan remains structurally dependent on urban tertiary centers in Punjab and Sindh; four of six jurisdictions have no identifiable dedicated dementia-specific services. Post-18th Amendment devolution created coordination gaps without capacity transfer. We propose a tiered implementation roadmap and multi-channel service delivery model leveraging primary care, community health workers, and telemedicine to bridge the specialist gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1837649","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:40:13Z","timestamp":1782754813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dementia service readiness in Pakistan: a provincial health systems assessment using a novel WHO-AIMS aligned framework"],"prefix":"10.3389","volume":"14","author":[{"given":"Syed Ali","family":"Bokhari","sequence":"first","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Qassem","sequence":"additional","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services","place":["Dubai, United Arab Emirates"]},{"name":"Maudsley Health","place":["Dubai, United Arab Emirates"]},{"name":"Mohammed Bin Rashid University of Medicine and Health Sciences","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Fahad","family":"Javaid","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the lancet standing commission","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1159\/000543578","article-title":"Global burden of Alzheimer\u2019s disease and other dementias during 1990\u20132021: a global burden of disease and risk factors study 2021-based study","volume":"60","author":"Wang","year":"2025","journal-title":"Neuroepidemiology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1241927","DOI":"10.3389\/frdem.2023.1241927","article-title":"Advancing dementia care in Pakistan: challenges and the way forward","volume":"2","author":"Ali","year":"2023","journal-title":"Front Dement"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1212\/WNL.0000000000001018","article-title":"Dementia: challenges of practice in Pakistan","volume":"83","author":"Khan","year":"2014","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s13033-024-00646-6","article-title":"Evaluating Pakistan\u2019s mental healthcare system using World Health Organization\u2019s assessment instrument for mental health system (WHO-AIMS)","volume":"18","author":"Dayani","year":"2024","journal-title":"Int J Ment Health Syst"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1016\/S0140-6736(13)60019-7","article-title":"Pakistan\u2019s health system: performance and prospects after the 18th constitutional amendment","volume":"381","author":"Nishtar","year":"2013","journal-title":"Lancet"},{"key":"ref8","year":"2020"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/978-981-96-7469-5_5","volume-title":"Geriatric Psychiatry in South Asia: Current Status and Ways Ahead. 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