Introduction: Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers. Methods: The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed. Results: The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models and care coordination; (iii) pharmacological interventions for cognitive symptoms; (iv) non-pharmacological interventions for cognitive symptoms; (v) non-cognitive symptoms, intercurrent illnesses and palliative care. The multidisciplinary panel discussed and approved 167 clinical practice recommendations and 39 research recommendations. Commentary: Italy’s first National Guideline on dementia and MCI addresses diagnosis, treatment and care within the National Healthcare System. It includes recommendations on pharmacological and non-pharmacological approaches, and emphasises tailored interventions, comprehensive cognitive assessment, staff training and palliative care. The guideline also underlines the need to involve PwD in decision-making and supporting caregivers throughout the entire course of the disease. Conclusions: Structured strategies for the dissemination and implementation of the guideline will be defined within the Italian Fund for Alzheimer and other Dementias 2024–2026. An interactive care pathway and a leaflet dedicated to PwD and their carers are already available. The guideline will be updated starting January 2027, but early updates may be planned in case of breakthrough advancements.

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers’ outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers’ outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

Acetylcholine signaling is attenuated in early Alzheimer’s disease (AD) and other dementias. A significant reduction in the expression of nicotinic acetylcholine receptors (nAChRs) in the brain of AD patients has also been reported in several molecular biological and in situ labeling studies. The modulation of the functional deficit of the cholinergic system as a pharmacological target could therefore have a clinical benefit, which is not to be neglected. This systematic review was conducted to identify clinical trials, which evaluated the safety and efficacy of nicotinic acetylcholine receptor agonists using Clinicaltrial (CT) and EudraCT databases. Structured searches identified 39 trials, which used 15 different drugs designed to increase the function of the nAChRs. Most of the identified clinical trials were phase II trials, with some of them classified as ongoing for several years. The systematic screening of the literature led to the selection of 14 studies out of the 8261 bibliographic records retrieved. Six trials reported detailed data on adverse events associated with the intervention, while twelve trials reported data on efficacy measures, such as attention, behavior and cognition. Overall, smost of the physical side effects of cholinergic agonists were reported to be well tolerated. Some trials also reported improvements in attention. However, the efficacy of these drugs in other cognitive and behavioral outcomes remains highly controversial.

Introduction: Dementia is a growing global public health priority, with the WHO Global Action Plan (GAP) calling for coordinated efforts worldwide. Italy, one of the oldest nations globally, faces a significant challenge with approximately 2 million individuals living with dementia or mild cognitive impairment. In response, the Italian Fund for Alzheimer’s and other Dementias (IFAD) was established in 2020 to align national efforts with the WHO GAP’s objectives. This study analyses IFAD activities from 2021 to 2023, offering insights into Italy’s public health response to dementia and its relevance to global strategies. Methods: We conducted a structured, iterative review of all activities coordinated by the Italian Dementia Observatory (OssDem-Istituto Superiore di Sanità (ISS)) within IFAD 2021–2023. Global, regional and national documents on dementia prevention, care and support were retrieved from official websites, institutional repositories and targeted web searches using the keywords ‘dementia’, ‘brain health’ and ‘ageing’. Two reviewers independently screened and extracted data with a predefined matrix mapped to the seven WHO GAP Action Areas. Human-subject studies cited had independent ethics approval and informed consent; no new data were collected for this review. Results: IFAD activities led to substantial progress in dementia care services, with memory clinics, residential care facilities and daycare centres mapped, revealing regional disparities in service provision. Modifiable risk factors accounted for 39.5% of dementia cases in Italy, with an estimated 67 000 cases preventable through risk reduction. National guidelines were developed to standardise dementia care pathways, and training programmes addressed gaps in HP and caregiver preparedness, particularly highlighted by the COVID-19 pandemic. Discussion: Italy’s experience provides valuable lessons for countries facing similar demographic challenges. The IFAD extension to 2024–2026 aims to address persistent regional disparities and further implement national guidelines and prevention strategies. By integrating Italy’s progress with broader international frameworks, the Italian model can inform global efforts to enhance dementia care, highlighting the importance of scalable, regionally adapted strategies for addressing the growing global burden of dementia.

Background: Increasing life expectancy will lead to more people living with dementia (PLwD) and, consequently, more caregivers experiencing burden. Caregivers burden is influenced by characteristics of both PLwD and caregivers themselves, as well as healthcare services organisation. The COVID‐19 pandemic and lockdown measures implemented in Italy worsened PLwD and their caregivers' well‐being. Recognising the importance of understanding the profiles and care needs of PLwD and their caregivers, a national survey was conducted within the Italian Fund for Alzheimer's and Dementias to investigate the sociodemographic characteristics of PLwD caregivers and their care recipients in Italy. This study aimed to describe the characteristics of Italian caregivers of PLwD, their use of services, and satisfaction with the latter. Methods: A cross‐sectional national survey was conducted. A self‐administered questionnaire was developed consisting mainly of multiple‐choice questions. Results: A total of 2369 caregivers participated in the survey. Most of them resided in Northern Italy (60.1%), were females (73.4%) and care recipients' children (74.1%). Median diagnostic delay ranged from 7 to 36 months. Diagnosis was formulated mainly by a physician from a Centre for Cognitive Disorders and Dementia. Caregiver training was poorly reported (34.1%). PLwD clinical condition worsened during the pandemic. The mean degree of satisfaction with services dedicated to dementia was “acceptable”. Negative/very negative degree of satisfaction was associated with not living in the North, increased caregiver's age, not having received training, severe degree of disease, having received the diagnosis suspicion from a private doctor, and not having used day care centres or Centres for Cognitive Disorders and Dementia. Conclusions: Differences in the sociodemographic profile of caregivers and disparity in services across Italy emerged. The establishment of a comprehensive, accessible, and well‐integrated network of services across all stages of the disease progression is needed.