BACKGROUND: Alzheimer disease (AD) is a leading cause of mortality in the United States; yet, population-level mortality trends and disparities remain underexplored. OBJECTIVE: This study aimed to evaluate AD-related mor...BACKGROUND: Alzheimer disease (AD) is a leading cause of mortality in the United States; yet, population-level mortality trends and disparities remain underexplored. OBJECTIVE: This study aimed to evaluate AD-related mortality trends from 1999 to 2020 and assess disparities by demographic and geographic factors. METHODS: Data were obtained from the CDC WONDER database. Deaths were identified using ICD-10 codes for AD (F01, F03, G30, G31.1) among individuals aged 45 years and older. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression analysis was used to assess trends, and disparities were analyzed by sex, race/ethnicity, age, urbanization, census region, and state. RESULTS: From 1999 to 2020, 6,697,209 deaths were attributed to AD (AAMR: 90.727). Mortality rates increased significantly (AAPC: 3.18). Females had higher AAMRs (94.31) than males (83.23). Non-Hispanic Black individuals had the highest AAMR (94.53), followed by non-Hispanic White (93.73), non-Hispanic American Indian (66.80), Hispanic (66.33), and non-Hispanic Asian individuals (46.16). Individuals aged 85 years and older had the highest CMR (3574.928). Rural areas had higher AAMRs (95.080) than urban areas (89.772). The Midwest had the highest AAMR (96.131), whereas the Northeast had the lowest (78.564). States such as South Carolina (119.789) and Tennessee (113.624) had higher AAMRs compared with New York (64.16) and Florida (68.677). CONCLUSIONS: Significant disparities exist in AD-related mortality across demographic and geographic groups. These findings highlight the need for targeted public health interventions, improved health care access, and early diagnostic efforts.
BACKGROUND: MicroRNAs, as key regulators in gene expression, may hold the key to understanding Alzheimer disease (AD) pathogenesis and diagnosis. AIMS: To explore the expression level of miR-106b-3p in the serum of AD pa...BACKGROUND: MicroRNAs, as key regulators in gene expression, may hold the key to understanding Alzheimer disease (AD) pathogenesis and diagnosis. AIMS: To explore the expression level of miR-106b-3p in the serum of AD patients, and evaluate its diagnostic value for AD. METHODS: A total of 250 AD patients and 200 healthy controls were enrolled. Real-time quantitative PCR with fluorescence detection was used to determine the relative expression level of miR-106b-3p. Correlation was analyzed by the Pearson linear correlation analysis. The receiver operating characteristic was used to evaluate the diagnostic efficacy of serum miR-106b-3p for AD. In vitro AD cellular models were established to explore the potential mechanism of miR-106b-3p in AD. RESULTS: The expression of miR-106b-3p in the serum of AD patients is significantly elevated, and its level is negatively correlated with the MMSE score. ROC curve analysis shows that it has certain diagnostic value. miR-106b-3p is a risk factor associated with AD. In addition, miR-106b-3p targets BDNF, affects the functions of SH-SY5Y cells, and promotes the occurrence and development of AD. CONCLUSION: Serum miR-106b-3p is significantly elevated in AD and may serve as a diagnostic biomarker. Preliminary evidence suggests it promotes AD progression by targeting BDNF, highlighting its potential as a therapeutic target for early intervention.
Vodovozov S, Pederson AM, Meyer OL
… +6 more, Al Hazzouri AZ, Peterson RL, Meunier CC, Whitmer RA, Kuiper C, Glymour MM
Alzheimer Dis Assoc Disord
· 2026 Jan-Mar 01 · PMID 41773882
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INTRODUCTION: Evidence on cognitive aging differences across immigrant generations is limited. METHODS: Kaiser Healthy Aging and Different Life Experiences (KHANDLE) participants reported immigrant generation, categorize...INTRODUCTION: Evidence on cognitive aging differences across immigrant generations is limited. METHODS: Kaiser Healthy Aging and Different Life Experiences (KHANDLE) participants reported immigrant generation, categorized as adulthood immigrants (immigrated ≥18 y of age, n=294, 14.51%), childhood immigrants (immigrated <18, n=105, 5.18%), second-generation (US-born with ≥1 foreign-born parent, n=553, 27.29%), and third-generation or later (reference, n=1074, 53.01%). Verbal episodic memory (VEM), executive function (EF), and everyday cognition (12-item Ecog) were assessed up to 4 times. Level and change in cognition were modeled with linear mixed-effects regressions. RESULTS: Compared with third-generation participants, adulthood immigrants had worse VEM [(β = -0.19; 95% CI: -0.30, -0.08); EF (β = -0.61; -0.72, -0.50); and Ecog (β = 0.29; 0.19, 0.40)]; childhood immigrants had lower EF [β = -0.21 (-0.36, -0.05)]; and second-generation participants had worse VEM [β = -0.11 (-0.20, -0.02)], EF [β = -0.10 (-0.19, -0.01)], and Ecog [β = 0.10 (0.009, 0.18)]. Cognitive change did not differ by immigrant generation. CONCLUSIONS: Individuals who immigrated in adulthood averaged worse cognitive scores and self-reported everyday cognition.
INTRODUCTION: Neuropsychiatric symptoms are integral features of Alzheimer disease (AD) and may precede cognitive impairment. Appetite and eating disturbances are common across the AD spectrum. METHODS: We analyzed 7223...INTRODUCTION: Neuropsychiatric symptoms are integral features of Alzheimer disease (AD) and may precede cognitive impairment. Appetite and eating disturbances are common across the AD spectrum. METHODS: We analyzed 7223 participants from the National Alzheimer Coordinating Center with Uniform Data Set assessments and MRI. Appetite and eating disturbances were assessed using the Neuropsychiatric Inventory Questionnaire. Cross-sectional associations with brain volumes were examined using multivariable regression. Longitudinal analyses among participants without baseline appetite disturbance used discrete-time survival models. RESULTS: Appetite disturbances were present in 9.4% of participants and were associated with greater neuropsychiatric burden and disease severity. Cross-sectionally, lower global gray matter volume showed the most robust association, while regional effects were attenuated after neuropsychiatric adjustment. Longitudinally, baseline brain structure predicted incident appetite disturbance only among cognitively normal participants (OR per SD decrease=0.87). DISCUSSION: Appetite disturbances may reflect diffuse neurodegenerative vulnerability and represent early behavioral markers of Alzheimer-related brain aging.
BACKGROUND: While REM-sleep behavior disorder (RBD) is a robust prodromal marker of Parkinson disease (PD), little is known about the RBD's interaction with striatal dopamine transporter binding, a key neurobiological me...BACKGROUND: While REM-sleep behavior disorder (RBD) is a robust prodromal marker of Parkinson disease (PD), little is known about the RBD's interaction with striatal dopamine transporter binding, a key neurobiological mechanism in PD. This study used a large-scale dataset of PD to examine the potential interaction between positive screening on probable RBD (pRBD) and striatal dopamine on cognition. METHODS: Sample included 1120 individuals (mean age 62.83±9.48, 38.0% female, 32.32% with pRBD) with PD. pRBD was screened using the RBD Screening Questionnaire. Dopamine transporter (DaT) single-photon emission computed tomography values were extracted for the putamen and the caudate. Cognitive performance was measured using neuropsychological tests. RESULTS: Regression analyses indicated that pRBD was significantly associated with the Symbol Digit Modalities Test (SDMT, B=-1.8, P =0.01), after adjusting for covariates. While there was no significant interaction between pRBD and striatal DaT measures on SDMT, pRBD's association with SDMT remained significant after adding DaT in the analytic model. CONCLUSION: In a large, early-stage PD cohort, a positive screen for probable RBD was significantly associated with a measure of processing speed and cognitive control. This association was not explained by dopamine transporter activity. Early screening of RBD would be important for treatment planning managing cognitive changes in PD.
Hexanucleotide repeat expansion in the chromosome 9 open reading frame 72 ( C9orf72 ) gene has been identified as the most common genetic cause of both frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS...Hexanucleotide repeat expansion in the chromosome 9 open reading frame 72 ( C9orf72 ) gene has been identified as the most common genetic cause of both frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). While large pathogenic expansions can reach hundreds to thousands of repeats, the lower limit for the number of pathogenic repeats remains controversial. Pathogenic threshold ranges from 30 to >60 repeats. Here, we report a rare case of behavioral variant frontotemporal dementia (bvFTD) associated with a C9orf72 repeat expansion of 49 units, a size that falls within the intermediate-length range. The patient presented with progressive neuropsychiatric decline, which progressed to include emotional blunting and memory impairment. Neuroimaging demonstrated bilateral temporal and hippocampal atrophy, with a reduction in glucose metabolism observed in the left fronto-parieto-temporal cortex and thalamus. This study may provide crucial clinical evidence for the ongoing debate on the pathogenicity of intermediate-length alleles in C9orf72 .
BACKGROUND: Understanding the relationship between specific behavioral and psychological symptoms of dementia (BPSD) clusters and improvements in activities of daily living (ADL) supports effective interventions for deme...BACKGROUND: Understanding the relationship between specific behavioral and psychological symptoms of dementia (BPSD) clusters and improvements in activities of daily living (ADL) supports effective interventions for dementia. This study identified BPSD clusters and examined their association with ADL improvement in patients with dementia in subacute rehabilitation settings. METHODS: This prospective cohort study included 137 patients with dementia, aged 65 years or older, admitted to a subacute rehabilitation ward in Japan. ADL and BPSD were assessed using the Functional Independence Measure (FIM) and Neuropsychiatric Inventory-Nursing Home Version, respectively. Exploratory factor analysis explored the BPSD clusters. Linear mixed models identified the factors associated with FIM score changes between admission and discharge. RESULTS: Five BPSD clusters were identified: psychosis, behavioral disorders, affective syndrome, hyperactivity, and apathy. In the linear mixed model, higher cognitive functions were associated with greater ADL independence (β=2.136, P <0.001). A significant interaction between mini-mental status examination and time (β=-0.919, P <0.001) indicated greater improvements in participants with lower baseline cognition. Conversely, higher hyperactivity scores were associated with less ADL improvement (β=-0.454, P =0.048). CONCLUSIONS: Cognitive function and hyperactivity-related BPSD significantly influenced the functional outcomes in patients with dementia undergoing subacute rehabilitation.
INTRODUCTION: The joint associations of physical activity (PA) and sleep quality with cognitive function remain unclear. METHODS: The study was an observational analysis of an 8-week clustered randomized controlled trial...INTRODUCTION: The joint associations of physical activity (PA) and sleep quality with cognitive function remain unclear. METHODS: The study was an observational analysis of an 8-week clustered randomized controlled trial with a 24-month follow-up in rural older Chinese. The trial took place from May 2021 to May 2023, in Sichuan, China. The participants' cognitive function was evaluated using the Telephone Interview for Cognitive Status. Linear mixed effects models and stratified analysis were performed. RESULTS: The study population comprised a total of 498 older adults. The average age was 70.96, and 55.4% were female. The interaction between PA and sleep quality was significant on global cognition ( P =0.04) and memory ( P =0.04). Compared with the low-PA and poor sleep quality group, any category of PA combined with sleep quality had better global cognition function, and the high-PA and good sleep quality group had the best global cognition function ( β =0.58, 95% CI: 0.29-0.92) and memory ( β =0.43, 95% CI: 0.23-0.64). CONCLUSION: Both higher levels of PA and better sleep quality are important for cognitive health, supporting the need for dual-behavior interventions in aging populations.
Frontotemporal dementia (FTD) comprises neurodegenerative syndromes causing progressive deterioration in behavior, language, and executive function, with relative preservation of memory early on. Overlap between the beha...Frontotemporal dementia (FTD) comprises neurodegenerative syndromes causing progressive deterioration in behavior, language, and executive function, with relative preservation of memory early on. Overlap between the behavioral variant (bvFTD) and nonfluent/agrammatic primary progressive aphasia (nfvPPA) reflects shared frontotemporal network pathology but remains rarely documented in Sub-Saharan Africa, where Alzheimer disease predominates. We describe a 61-year-old Tanzanian man who initially presented with effortful, halting speech, agrammatism, and impaired syntax consistent with nfvPPA. Over 4 years, he developed mutism, apathy, loss of initiative, and pica-like behaviors, indicative of bvFTD progression. MRI showed asymmetric frontotemporal atrophy, predominantly in the left hemisphere, with relative posterior sparing. Laboratory tests were unremarkable. This case highlights the evolution from language-predominant to behavioral FTD, illustrating the clinical continuum of frontotemporal lobar degeneration. It underscores the need for awareness, longitudinal assessment, and accessible neuroimaging to improve FTD recognition and management in resource-limited settings.
Self-perceptions of delay of gratification in MCI have not been examined longitudinally and we know nothing about brain volume changes that might be linked to them. For the first time, amnestic MCI patients' reports of d...Self-perceptions of delay of gratification in MCI have not been examined longitudinally and we know nothing about brain volume changes that might be linked to them. For the first time, amnestic MCI patients' reports of delay of gratification were measured with the Delaying Gratification Inventory (DGI) money subscale at baseline, 6, and 12 months. Results revealed statistically significant differences in aMCI and matched healthy controls regarding their DGI money subscale scores, with lower delay of gratification in aMCI. Correlations between brain volumes and delay of gratification reports at all 3 time points support the importance mainly of the left and right medial frontal cortices. These preliminary findings show that self-reports may be useful in psychological assessment in older adults as they differentiate MCI from healthy individuals. Future studies should further investigate personality and sociocultural factors in the formation of such statements in healthy as well as clinical populations.
Houlihan H, Guzman D, Smith A
… +6 more, Sanchez T, Johnson A, Kreisl WC, Cosentino S, Noble JM, Lao P
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41288284
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Alzheimer disease and its clinical variants have characteristic spatial and temporal progression patterns of amyloid and tau driving symptomatology, but the distribution of microglia density, as measured by 18kDa translo...Alzheimer disease and its clinical variants have characteristic spatial and temporal progression patterns of amyloid and tau driving symptomatology, but the distribution of microglia density, as measured by 18kDa translocator protein (TSPO) PET, is unknown. Baseline TSPO, amyloid, and tau PET as well as T1 MRI from the longitudinal imaging of microglial activation in different clinical variants of Alzheimer disease study were adjusted for age, sex, body mass index, APOE4 status, TSPO genotype, and intracranial total volume. Imaging outcomes were standardized against controls, visualized across the brain, and placed along a pseudo-longitudinal timeline using disease duration. Microglia density follows the spatial distribution of tau in amyloid-positive individuals and that of neurodegeneration in amyloid-negative individuals. The magnitude, location, and timing of elevated microglia density relative to amyloid, tau, and neurodegeneration is specific to different clinical subtypes of Alzheimer disease.
INTRODUCTION: Education and premorbid intelligence have been used to predict disease trajectory in dementia. However, there is conflicting evidence regarding their independent predictive ability. This study aims to inves...INTRODUCTION: Education and premorbid intelligence have been used to predict disease trajectory in dementia. However, there is conflicting evidence regarding their independent predictive ability. This study aims to investigate whether education and premorbid intelligence predict cognitive and functional decline in rural dementia patients over 1 year. METHODS: Data from 614 rural patients was analyzed for the association between (a) years of education and (b) premorbid intelligence [Premorbid Verbal IQ] and cognitive function [MMSE, CDR-SB, NPI, FAQ] through linear regression analysis as an overall group sample, and stratified into Subjective Cognitive Impairment, Mild Cognitive Impairment, Alzheimer Disease, and Non-Alzheimer Disease dementia groups. Premorbid verbal IQ was estimated using the Wechsler Test of Adult Reading & Wide Range Achievement Test 4th Edition, after norming each was scored on a scale of 100. RESULTS: Higher Premorbid Verbal IQ score predicted a smaller decline in cognition in the overall group sample and reduced caregiver dependence in the non-AD dementia group 1-year post-diagnosis. Education was not a statistically significant predictive factor of cognition 1-year post-diagnosis. CONCLUSION: Higher premorbid intelligence may be a better 1-year prognostic indicator of cognition and function than education level in rural populations.
OBJECTIVE: A growing body of research has outlined the adverse outcomes which may occur for those providing informal care in the context of visual hallucinations for those with Lewy Body Disorder (LBD). However, there is...OBJECTIVE: A growing body of research has outlined the adverse outcomes which may occur for those providing informal care in the context of visual hallucinations for those with Lewy Body Disorder (LBD). However, there is a lack of first-person, subjective perspectives from those providing informal care in this area. METHOD: Interpretative phenomenological analysis (IPA; Smith et al 2009) was deemed the most appropriate qualitative method to answer the research question: "What is the lived experience of individuals providing informal care to those experiencing visual hallucinations in the context of Lewy body dementia?" IPA is dedicated to understanding participants' experiences by accessing the meaning they impart on the phenomenon. RESULTS: Six caregivers of persons with LBD took part in semistructured interviews. All participants had experience providing informal care to individuals with visual hallucinations in the context of Lewy Body Disorder (LBD). IPA was conducted to get close to participants' experiences. Five superordinate themes were identified, including (1) duty and devotion. (2) How do you make sense of something surreal? (3) Moving to a position of adjustment. (4) The horrible shape the illness takes. (5) Preservation and survival: "Easier said than done, but you just have to get through it." Findings revealed that visual hallucinations shocked most caregivers, which was related to the appraisals attached to the phenomenon and cultural beliefs. All caregivers highlighted the importance of considering the broader context around the illness, which resulted in an inescapable subsuming awfulness. CONCLUSIONS: The identified themes illustrate how caregiving within the context of LBD was marked by continual loss and ongoing psychosocial difficulties, both of which required ongoing work to manage. Although formal and informal support was crucial to helping caregivers during their experiences, this was only sometimes available and resulted in a more arduous journey. Participants provided valuable insights that may be helpful for professional practice, especially in terms of illustrating how important it is for a program of psychoeducation to be offered alongside better access to support services more broadly. Further research is needed to understand the nuances around caregiving within this context from a cross-cultural perspective.
OBJECTIVE: This study evaluates trends in the use of potentially inappropriate medications (PIMs) and anticholinergic drugs among older adults with and without dementia to enhance medication safety and health care qualit...OBJECTIVE: This study evaluates trends in the use of potentially inappropriate medications (PIMs) and anticholinergic drugs among older adults with and without dementia to enhance medication safety and health care quality. METHODS: This retrospective repeated cross-sectional study analyzed data from outpatients aged ≥65 years at a medical center in Taiwan from 2018 to 2022. Patients were classified annually by dementia status using ICD-10 codes. PIMs were identified according to the 2019 Beers Criteria, and anticholinergics were identified via the Anticholinergic Cognitive Burden Scale. Trends were analyzed using generalized estimating equations, adjusting for sex, age, Charlson Comorbidity Index, and polypharmacy. Adjusted odds ratios (aORs) with 95% CIs were reported, using 2018 as the reference. RESULTS: By 2022, PIM use significantly declined in both dementia (aOR 0.91, 95% CI: 0.86-0.97) and nondementia groups (aOR 0.88, 95% CI: 0.86-0.90). Anticholinergic use declined in nondementia patients (aOR 0.80, 95% CI: 0.78-0.83) but remained stable in those with dementia (aOR 0.99, 95% CI: 0.93-1.06). Use of antipsychotics and proton pump inhibitors increased in both groups, while prescribing of ergoloid mesylates, benzodiazepines, and skeletal muscle relaxants declined. CONCLUSION: PIM use declined overall, but anticholinergic use remained high in older adults with dementia. These findings highlight the need for targeted strategies to reduce inappropriate prescribing, particularly for those with cognitive impairment. Future efforts should emphasize safer deprescribing practices in this vulnerable population.
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41288279
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Cognitive dysfunction and impaired activities of daily living (ADL) in middle-aged and older adults are critical public health issues, but the links with sleep remain unclear. Using data from CHARLS, which involved 39,85...Cognitive dysfunction and impaired activities of daily living (ADL) in middle-aged and older adults are critical public health issues, but the links with sleep remain unclear. Using data from CHARLS, which involved 39,852 participants aged 45 years or older, this study explored these associations using restricted cubic spline and multivariate logistic regression models. A U-shaped relationship was found between sleep duration and cognitive performance (including information processing speed, memory, and attention) as well as the risk of ADL limitation, with 7 hours as the optimal duration. Both short (<6 h) and long (≥9 h) sleep were linked to higher cognitive decline risk (OR=1.51 and 1.72, P<0.05). Stratified analyses revealed that older males with long sleep (≥9 h) and older females with short sleep (6 to 7 h) had elevated risks of ADL limitation (OR=1.72 and 1.51, respectively). This study provides epidemiological evidence for targeted interventions.
OBJECTIVE: To assess the impact of regional white matter hyperintensity (WMH) volume on cognitive function in individuals with subjective cognitive decline (SCD) and investigate its relationship with amyloid burden. METH...OBJECTIVE: To assess the impact of regional white matter hyperintensity (WMH) volume on cognitive function in individuals with subjective cognitive decline (SCD) and investigate its relationship with amyloid burden. METHODS: A cohort study in South Korea focused on predicting progression from SCD to cognitive impairment or dementia. Demographic and clinical data were analyzed, stratified by WMH severity in SCD. Statistical comparisons were made among quartiles of WMH volume. Multiple regression analyses explored associations between regional WMH volume, standardized uptake value ratio (SUVR), and cognitive function. RESULTS: Examining 120 SCD patients, 78.3% had negative amyloid PET scans. Higher WMH volume quartiles correlated with older age, increased diabetes prevalence, and elevated SUVR in the precuneus and cuneus region. Higher WMH was linked to poorer processing speed and executive functions. Significant associations were found between posterior periventricular WMH volume and precuneus/cuneus SUVR values. Conversely, posterior deep WMH volume correlated with age and Framingham Score, not regional amyloid burden. CONCLUSION: This study suggests that WMH and amyloid burden independently influence cognitive function in SCD patients. Notably, a significant association was observed between amyloid burden and regional WMH volumes. These findings underscore the distinct roles of WMH and amyloid burden in cognitive decline among individuals with SCD.
Smith A, Guzman D, Lee S
… +10 more, Talmasov D, Dass D, Chikwem N, Johnson A, Houlihan H, Sanchez T, Kreisl WC, Cosentino S, Noble JM, Lao P
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41288277
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OBJECTIVE: To determine how 18kDa Translocator (TSPO) PET, which measures inflammatory alterations, is associated with domain-specific cognition in the presence and absence of elevated amyloid. METHODS: This cross-sectio...OBJECTIVE: To determine how 18kDa Translocator (TSPO) PET, which measures inflammatory alterations, is associated with domain-specific cognition in the presence and absence of elevated amyloid. METHODS: This cross-sectional study uses data collected on 46 adults aged 50 and over who underwent TSPO PET (11C-ER176 SUVR) and amyloid PET (18F-Florbetaben SUVR) as well as medical, neurological, and neuropsychological assessments. Controls (n=21) were amyloid-negative and cognitively unimpaired while individuals with Alzheimer disease or related dementias (ADRD; n=25) were cognitively impaired, regardless of amyloid positivity. Cognition was assessed using the Mini-Mental State Examination (MMSE) and domain-specific tests included in the NACC UDSv3. RESULTS: Greater TSPO is associated with lower performance in episodic memory, attention/processing speed, executive function, language, and visuospatial ability in amyloid-positive individuals, but restricted to episodic memory in amyloid-negative individuals. CONCLUSION: Targeting microglia as an additional or alternative strategy for cognitive impairment in Alzheimer disease and related dementias may provide further benefits, even in amyloid-negative individuals.
Dementia is a global health issue and its effects on family caregivers are substantial. This study investigated the relationship between cohabitation with patients and the mental health of families in South Korea. On the...Dementia is a global health issue and its effects on family caregivers are substantial. This study investigated the relationship between cohabitation with patients and the mental health of families in South Korea. On the basis of the nationwide data, 24,874 individuals with dementia within their families were included in the analysis. Multivariate logistic models were used to compare the 3 mental health issues (stress, depression, and suicidal ideation) between the cohabiting and noncohabiting groups. Approximately 15% of participants cohabited with patients with dementia. Members of the cohabiting group had a more stressful status and a higher rate of suicidal ideation than those in the noncohabiting group; however, this association remained significant only for older caregivers (≥65 y). In conclusion, the mental health of family members living with patients with dementia, particularly older caregivers, should be carefully assessed.
PURPOSE: The focus of this study was people with advanced dementia with young- and late-onset who were cared for at home, as well as their family caregivers. It was aimed to gain insight into symptoms, quality of life, t...PURPOSE: The focus of this study was people with advanced dementia with young- and late-onset who were cared for at home, as well as their family caregivers. It was aimed to gain insight into symptoms, quality of life, treatment, health care utilization, well-being of the family caregiver, and differences between young-onset and late-onset dementia (YOD and LOD). METHODS AND PATIENTS: The monocentric, prospective EPYLOGE study (IssuEs in Palliative Care for People in Advanced and Terminal Stages of Young-Onset and Late-Onset Dementia in Germany; ClinicalTrials.gov: NCT03364179) included 191 people with advanced dementia. For the current analyses data on symptoms, suffering, care, (palliative) therapy, and the burden on relatives from a subset of 88 people with advanced YOD and LOD who were cared for or at home and their caregivers were analyzed. RESULTS: Key findings were that in an advanced dementia stage, the overall levels of suffering, discomfort, and symptom burden are low, matching with an only slight to moderate impairment of quality of life. Further, the study showed that differences between LOD and YOD are only minor, with the exception of the caring constellation and health care utilization. Caregiver strain was higher in caregivers of persons with advanced YOD than LOD. CONCLUSION: Since family constellations and living situations differ for people with advanced dementia, particular emphasis on counseling and support must be placed on ensuring that the support offered is tailored to the individual case. At the same time, an improved information policy and efforts to reduce hesitations about utilizing services are necessary for optimal service use.