Adopting an ethics and human rights lens, this paper provides a critical analysis of national dementia care guidance from countries ranked highly in providing quality of care towards the end-of-life, including Australia, Ireland, New Zealand, Switzerland, Taiwan and the United Kingdom. The aim of this paper is to determine areas of consensus and disagreement among guidance and to understand current gaps in research. Overall, studied guidances showed consensus regarding patient empowerment and engagement, promoting independence, autonomy and liberty through; establishing person-centered care plans, providing ongoing care assessment, resources and support to individuals and their family/carers. Consensus was also seen in most end-of-life care issues; re-assessing care plans, rationalizing medication, and most importantly carer support and well-being. Disagreement could be found in criteria relating to decision-making after losing capacity, i.e. through appointment of case managers or a power of attorney, reducing barriers to equitable access of care, stigma and discrimination for minority and disadvantaged groups - including younger people with dementia, medicalized care strategies such as alternatives to hospitalization, covert administration, and assisted hydration and nutrition, and also in identifying an active dying phase. Potential for future development includes a greater emphasis on multidisciplinary collaborations, financial and welfare assistance, exploring the use of artificial intelligence technologies for testing and management, while also providing safeguards against such emerging technologies and therapies.

Background Mild cognitive impairment (MCI) is a cognitive state falling between normal aging and dementia. The relation between alcohol intake and risk of MCI as well as progression to dementia in people with MCI (PDM) remained unclear. Objective To synthesize available evidence and clarify the relation between alcohol intake and risk of MCI as well as PDM. Method We searched electronic databases consisting of PubMed, EMBASE, Cochrane Library, and China Biology Medicine disc (CBM) from inception to October 1, 2019. Prospective studies reporting at least three levels of alcohol exposure were included. Categorical meta-analysis was used for quantitative synthesis of the relation between light, moderate and heavy alcohol intake with risk of MCI and PDM. Restricted cubic spline and fixed-effects dose-response models were used for dose-response analysis. Result Six cohort studies including 4244 individuals were finally included. We observed an unstable linear relation between alcohol intake (drinks/week) and risk of MCI (P linear = 0.0396). It suggested that a one-drink increment per week of alcohol intake was associated with an increased risk of 3.8% for MCI (RR, 1.038; 95% CI 1.002-1.075). Heavy alcohol intake (> 14 drinks/week) was associated with higher risk of PDM (RR = 1.76; 95% CI 1.10-2.82). And we found a nonlinear relation between alcohol intake and risk of PDM. Drinking more than 16 drinks/week (P nonlinear = 0.0038, HR = 1.42; 95% CI 1.00-2.02), or 27.5 g/day (P nonlinear = 0.0047, HR = 1.46; 95% CI 1.00-2.11) would elevate the risk of PDM. Conclusion There was a nonlinear dose-response relation between alcohol intake and risk of PDM. Excessive alcohol intake would elevate the risk of PDM.

Authors' objectives: Background: Currently, no disease-modifying treatment is available for Alzheimer disease (AD) or Parkinson’s disease dementia (PD). Professional societies in Switzerland generally recommend symptomatic treatment using non-pharmacological therapies, and to add antidementia drugs when needed. However, scientific literature is inconclusive about the clinical benefit of antidementia drugs. A health technology assessment (HTA) was requested to compare the available evidence on Acetylcholinesterase (AChE) inhibitors and memantine for the symptomatic treatment of AD and PD. Objective: This HTA examines the efficacy, effectiveness, safety and cost-effectiveness of antidementia drugs compared to treatment without antidementia drugs or placebo in AD and PD and presents the health economic impact of a potential removal of these drugs from the list of pharmaceutical specialties in Switzerland. Furthermore, ethical, legal, social and organizational aspects are considered. Research questions: Is it efficacious, effective, safe and cost-effective 1) to treat mild to moderately severe AD patients with donepezil, galantamine or rivastigmine compared to not treating them with antidementia drugs? 2) to treat moderate to severe AD patients with memantine compared to not treating them with memantine? 3) to treat mild to moderately severe PD patients with rivastigmine compared to not treating them with rivastigmine? What is the budget impact of donepezil, rivastigmine, galantamine and memantine? Are there ethical, legal, social, or organizational issues related to antidementia drugs?

Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical effectiveness and cost effectiveness of the Strategies for Relatives (START) intervention aimed at improving the mental health of carers of people with dementia?