In 2025, all of the baby boomer is to be 75 years and older. Estimate number of death would be 1.6 million, twice as much as total number of birth, and 90% of them are projected to be older people. Increasing number of Alzheimer type dementia is becoming burden of the family member or care taker, but it is difficult to know their preferences due to lower cognitive function. So that nutrition method or medical treatment is decided by medical staff and family without consent from patient themselves in most cases. In Japan, there is no national consensus on using nasal-tube feeding or on indication of percutaneous endoscopic gastrostomy for end stage of degenerative dementia patients. The older people who have made advance directives with their will might be healthier. Advance care planning is a process of discussion regarding end of life care with family, care taker and medical staff to share patient’s values and preferences. Process itself is vital and essential for better end of life care rather than making advance directives and living wills. Advance care planning might decrease the psychological burden of care and promise better quality of life of patients themselves.

High incidence of motor neuron disease was known in West Papua, Indonesia, since 1960’s, but this was not confirmed during 1990’s. We clarified the prevalence of ALS in Papua has decreased over the past ∼30–35 years, it remains higher than the global average. There was a high prevalence of overlapping ALS, parkinsonism and cognitive impariment which has also been previously reported in Guam and Kii.