Table 1.

Results of the main studies in artificial nutrition and hydration (ANH) in patients with severe dementia.

Study	Objective and methodology	Results	Conclusion
Ciocon et al. [61]	Evaluate the indications, benefits, and complications of ANH in patients using enteral tube, with serious swallowing disorders and at risk of aspiration	67% of patients were agitated when the tube was removed and 43% had aspiration pneumonia during the study	Researchers concluded that the use of ANH may lead to a high frequency of complications
Finucane et al. [10]	Review of the literature (1966 to 1999) to evaluate the use of ANH in advanced dementia	No data to suggest that the use of ANH may prevent aspiration pneumonia, reduce the risk of infections or prolong life	Most studies show that there are substantial risks in using ANH in these patients, and thus its use is discouraged
Li [62]	Review the use of ANH in patients with advanced dementia	ANH does not prevent malnutrition, reduce the occurrence of bed sores, or prevent aspiration pneumonia, nor does it prolong life	Although it may not be effective in preventing malnutrition and dehydration, this type of feeding allows a degree of maintenance and patient comfort
Pasman et al. [19]	Evaluate the discomfort of patients with serious dementia of a Dutch nursing home	The highest rates of discomfort observed in these patients were in dyspnea, acute pain, and agitation	Not choosing ANH did not correlate with the level of discomfort of the patients. ANH was identified as an individual decision
Clarfield et al. [63]	Evaluate the use of ANH in patients with advanced dementia admitted to Israeli and Canadian hospitals in order to find the main differences between ethnicities and ethical issues	24,5% patients were in if fed by ANH	These results may be explained by a combination of administrative or financial incentives and by religion and culture
Volkert et al. [43]	ESPEN Guideline developed to recommend use of ONT or ANH in elderly patients based on scientific evidence	No increase in survival associated with this use, leading the researchers to consider ANH only according to patient's or family's wishes	ANH not recommended in patients with advanced dementia
Buiting et al. [64]	To investigate the opinion of Dutch and Australian physicians on use of ANH in patients with advanced dementia	Dutch physicians based their decision on a wide-ranging evaluation, while Australian physicians tended to use scientific evidence	All are reluctant at beginning of ANH but Dutch physicians tend to take primary responsibility for the decision, while Australian physicians prefer to leave the decision to the family