Understanding Very Late-Onset MS (VLOMS)
Most people associate multiple sclerosis with young to middle-aged adults, but it can affect individuals at any stage of life. A diagnosis after age 50 is known as late-onset MS (LOMS), while a diagnosis after 60 is considered very late-onset MS (VLOMS). While only a small percentage of total MS cases fall into this category, with meta-analysis showing around 5% of diagnoses occurring after 50, the increasing longevity of the population means clinicians are encountering more of these cases. This rise is also partly attributed to greater awareness and improved diagnostic technologies.
Why VLOMS is Often a Progressive Disease
Those who develop MS later in life are more likely to present with a progressive form of the disease, rather than the relapsing-remitting form more common in younger adults. In the progressive form, neurological function gradually declines without periods of remission. This may be linked to the normal aging of the immune system, a process called immunosenescence, which alters the inflammatory and repair processes in the body. As people age, the central nervous system's capacity for repair decreases, which can contribute to a steady accumulation of disability.
Diagnostic Challenges in Older Adults
Diagnosing MS at any age can be difficult, but it is particularly challenging in older adults. The primary reason is that many MS symptoms overlap with common age-related conditions, making misdiagnosis or delayed diagnosis a significant concern. For instance, motor dysfunction and gait imbalance in a 70-year-old could be attributed to arthritis or normal aging, rather than MS.
To overcome these hurdles, a comprehensive diagnostic process is necessary. Doctors must rule out other potential causes for symptoms, which may include cerebrovascular disease (stroke), cervical spondylotic myelopathy (a spinal cord problem), peripheral neuropathy, or vitamin deficiencies. Diagnostic tools used to differentiate VLOMS include:
- Magnetic Resonance Imaging (MRI): Imaging of the brain and spinal cord is crucial. Certain MRI findings, like lesions around a central vein, can be more specific to MS. Spinal cord lesions are also a strong indicator, as they are rarely incidental in healthy older adults.
- Cerebrospinal Fluid (CSF) Analysis: A lumbar puncture to analyze the CSF for oligoclonal bands is another important test. A positive result can confirm inflammatory processes consistent with MS.
- Evoked Potentials: These tests measure electrical activity in the brain in response to specific stimulation and can reveal demyelination that might not be clinically obvious.
Contrasting Early-Onset and Very Late-Onset MS
| Feature | Early-Onset MS | Very Late-Onset MS (VLOMS) |
|---|---|---|
| Typical Age at Diagnosis | 20s to 40s | 60 and older |
| Most Common Phenotype | Relapsing-Remitting MS (RRMS) | Primary Progressive MS (PPMS) |
| Common Initial Symptoms | Optic neuritis, numbness, weakness | Motor dysfunction, sensory problems, balance issues |
| Symptom Progression | Slower accumulation of disability, with relapses followed by remission | Faster accumulation of disability, often without remission |
| Diagnostic Delay | Shorter delay from first symptom to diagnosis | Longer delay, due to misattribution of symptoms to aging |
Managing VLOMS: The Evolving Approach
Management of MS in older adults presents its own set of challenges, distinct from those faced by younger patients. Treatment goals for VLOMS often shift from preventing relapses and new lesions (which become less frequent with age) toward managing disability progression and chronic symptoms. Treatment decisions must also account for a person's overall health and the presence of other comorbidities like high blood pressure or diabetes, which are more common in this age group and can impact the disease course.
There remains a significant knowledge gap concerning treatment efficacy and safety in older populations, as many clinical trials have historically excluded individuals over 55. However, emerging research and real-world data are helping to inform best practices for VLOMS. The focus is on finding therapies that can address the neurodegenerative aspects of the disease, while also managing symptoms through physical therapy, occupational therapy, and cognitive rehabilitation.
The Path Forward
As more people with MS live longer and diagnosis becomes more precise, a greater understanding of VLOMS is crucial. It is important for older individuals and their healthcare providers not to dismiss neurological symptoms as simply a consequence of aging. Early and accurate diagnosis is key to starting a management plan that can help slow disability progression and improve quality of life. Continuing research and collaborative care are vital for better outcomes.
The medical community is continuously working to better understand VLOMS and how it differs from MS that presents earlier in life. The Multiple Sclerosis Trust offers insights and support for those navigating MS at any age.
Conclusion
It is certainly possible for an individual to develop MS at 70 years old, a condition known as VLOMS. It differs significantly from early-onset MS, often presenting as a progressive disease with motor and sensory symptoms that can easily be mistaken for normal aging. Timely diagnosis is critical and relies on a combination of clinical evaluation, advanced imaging, and specialized lab tests. A comprehensive management approach, considering comorbidities and shifting treatment priorities, can significantly improve a senior's quality of life. Awareness of VLOMS is growing, ensuring more accurate diagnosis and specialized care for older adults affected by this condition.
