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Despite accounting only for 5% of forms, reports of adult-onset KD cases are increasingly described.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A female patient manifesting KD after the age of 60\u00a0years, presenting with spastic paraplegia and cognitive decline, is described. The scientific literature of KD with onset\u2009&gt;\u200910\u00a0years has been extensively reviewed to refine the spectrum of later-onset KD manifestations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Including ours, we identified 84 KD adolescent\/adult-onset patients (mean age at onset 28.7\u2009\u00b1\u200914.2\u00a0years). Most patients had limb spasticity as main characterizing neurological feature (58\/84, 70.2%), followed by polyneuropathy (11\/ 84, 13.1%), both upper and lower motor neuron signs (2\/84, 2.4%), and epilepsy (2\/84, 2.4%). Five out of 84 patients (6.0%) were asymptomatic. Most patients had cortico-spinal tracts involvement at brain MRI. The most common pathogenic GALC variants were the c.1901\u00a0T\u2009&gt;\u2009C (18 patients), the c.857G\u2009&gt;\u2009A (13 patients), and the c.1161\u2009+\u20096532_polyA\u2009+\u20099kbdel (13 patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Complicated spastic paraplegia is the most common manifestation in later-onset KD, rarely with normal brain MRI. KD should be always considered also in cases with very late-onset spastic paraplegia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-026-08836-5","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T04:18:20Z","timestamp":1770956300000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Very late-onset Krabbe disease with concomitant dementia: case description and a critical review of the literature"],"prefix":"10.1007","volume":"47","author":[{"given":"Salvatore","family":"Rossi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Tessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Gabriella","family":"Vita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosellina","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Parisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorella","family":"Piemonte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmarco","family":"Dalla Zanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Maria","family":"Santorelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Silvestri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"8836_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neulet.2021.135841","volume":"752","author":"AM Bradbury","year":"2021","unstructured":"Bradbury AM, Bongarzone ER, Sands MS (2021) Krabbe disease: new hope for an old disease. 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