Evidence-based care pathways for people with dementia and neurodegenerative disorders in Europe: a systematic review of models, integration of digital technologies, and quality indicators.

Dementia and other neurodegenerative disorders place growing pressure on European health systems, yet evidence on how care pathways are structured, implemented, and evaluated remains fragmented. This systematic review synthesizes European evidence on dementia and neurodegenerative care pathways and develops an evidence-informed conceptual synthesis capturing core functions, domains of care delivery, and cross-cutting implementation principles. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251020962). Five databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library) and gray literature sources were searched for studies published in the last 10 years (to June 2025) examining structured care pathways. Risk of bias was assessed using design-specific tools (RoB-2, ROBINS-I, MMAT), and findings were synthesized narratively due to substantial heterogeneity. Eighty-one studies from 11 European countries and multinational initiatives were included. Reported pathways varied widely in scope, structure, and implementation. Most focused on early-stage processes (referral, diagnosis, and initial post-diagnostic support), while later-stage elements (long-term management, advance care planning, and palliative care) were less frequently represented in the literature. Across studies, a consistent functional core was recurrently reported, including care coordination, multidisciplinary teamwork, case management, caregiver involvement, and structured follow-up. Surrounding domains, such as workforce training, digital and assistive technologies, and quality measurement, were described with variable levels of formalization. Findings reflect patterns reported in the literature rather than a direct representation of routine care across European health systems. Substantial heterogeneity in study designs, reporting practices, and pathway descriptions limited comparability across contexts. This review identifies common organizational functions underlying dementia care pathways and proposes an evidence-informed conceptual framework to support interpretation, comparison, and future development of more integrated and person-centered care models.