Does MS get better or worse with age? Understanding the course of multiple sclerosis

Oct 26, 2025 4 min read •

neurology Multiple Sclerosis Autoimmune Diseases

While Multiple Sclerosis (MS) is most commonly diagnosed in people in their 20s and 30s, the disease and its symptoms often change significantly as individuals get older. As to the question, 'Does MS get better or worse with age?', the answer is complex and depends heavily on the specific type of MS, an individual's overall health, and treatment approaches.

Quick Summary

The progression of multiple sclerosis with age varies widely, from periods of stability to a steady worsening of neurological function. As individuals with MS get older, they may transition to a progressive phase with accumulating disability, influenced by the aging immune system, hormonal changes, and comorbidities.

Key Points

Progression is Variable: How MS progresses with age is highly individual and depends heavily on the type of MS someone has, not following a single, predictable path.
Age Exacerbates Symptoms: The natural aging process, with its effect on stamina, balance, and the immune system, can cause existing MS symptoms to worsen over time.
Relapsing-Remitting May Become Progressive: Most people initially diagnosed with relapsing-remitting MS (RRMS) will eventually transition to secondary progressive MS (SPMS), where symptoms steadily worsen.
Age of Onset Influences Course: The primary progressive form (PPMS), which involves a gradual worsening from the start, typically has a later average age of onset (after 40) compared to RRMS.
Treatment is Key to Managing Progression: Early and consistent treatment with disease-modifying therapies can effectively reduce relapses and slow disability accumulation, particularly in the relapsing stage.
Lifestyle and Comorbidities Matter: Factors like diet, exercise, smoking, and other health conditions can significantly influence the pace of MS progression and symptom severity with age.
'Benign' MS is Not Guaranteed: While some people experience a mild course with minimal disability for decades, this cannot be guaranteed, as progressive symptoms can still emerge later in life.
Ongoing Research Offers Hope: Scientists are actively researching new treatments, including those targeting progressive MS and nerve repair, to improve outcomes for aging patients.

Multiple Sclerosis and the Impact of Aging

Understanding how multiple sclerosis (MS) progresses over time is crucial for managing the disease effectively. While the initial disease course is often marked by relapses and remissions, the effects of natural aging can cause symptoms to worsen. As people with MS get older, the central nervous system has less ability to compensate for accumulated nerve damage, leading to more noticeable symptoms. This gradual decline is also influenced by immunosenescence—the natural aging of the immune system—which leads to chronic, low-grade inflammation that can further damage the nervous system.

The Role of Aging in Progressive MS

Age is a major factor in the transition to progressive forms of MS. The secondary progressive stage (SPMS), where disability accumulates steadily after a period of relapsing-remitting MS, typically begins in mid-life. Similarly, the primary progressive form (PPMS), characterized by a gradual worsening of symptoms from the onset, most often begins in people over 40. The accumulation of disability is not only due to MS itself but also compounded by standard age-related changes, such as reduced stamina and balance.

Common effects of aging on MS progression:

Increased disability accumulation: The longer a person has MS, the more time there is for nerve damage to build up, leading to greater disability over time.
Hormonal shifts: Age-related hormonal changes, such as menopause in women and lower testosterone in men, can exacerbate MS symptoms and potentially accelerate progression.
Comorbidities: Older individuals with MS are at higher risk for other health conditions, including cardiovascular disease, diabetes, and bone and joint problems. These conditions can further complicate MS management and contribute to a decline in function.

Comparison of MS Progression Across Different Types

MS is a highly individual disease, and its course varies significantly depending on the type. While some people may experience a benign course with minimal disability for many years, others face a more aggressive progression. The following table highlights the key differences in how the main types of MS typically progress with age.


Feature	Relapsing-Remitting MS (RRMS)	Secondary Progressive MS (SPMS)	Primary Progressive MS (PPMS)
Onset	Most common initial diagnosis, typically in 20s or 30s.	Follows an initial period of RRMS, often in 40s or 50s.	~15% of MS cases; gradual onset, typically begins in middle age (40s+).
Progression	Defined by clear relapses followed by periods of partial or full recovery (remission).	Disability steadily worsens over time, with or without occasional relapses.	Disability accumulates steadily from the start, with no clear relapses or remissions.
Immune Activity	Primarily inflammatory attacks targeting the central nervous system.	Shifts from inflammatory attacks to a more neurodegenerative process.	Primarily neurodegeneration with less inflammatory activity.
Treatment Response	Highly responsive to disease-modifying therapies (DMTs) that reduce relapse rates.	DMTs are less effective at slowing disability accumulation in this phase compared to RRMS.	Only a single DMT is currently approved for PPMS; treatment focuses on managing symptoms.

Factors Influencing MS Prognosis

While age is a significant determinant of MS progression, it is not the only factor. A combination of genetic, environmental, and lifestyle elements play a role in how the disease unfolds over time.

Genetics: Specific genetic variations can influence the severity and rate of MS progression, with some linked to more aggressive forms of the disease.
Lifestyle: Modifiable factors such as diet, exercise, and smoking status can significantly impact the disease course. Quitting smoking, for example, can slow progression.
Comorbidities: Pre-existing or age-related health conditions can interact with MS, making symptoms worse. For example, cardiovascular disease can complicate MS management and negatively impact brain health.
Early Intervention: Starting effective disease-modifying therapies early in the course of relapsing-remitting MS can delay or prevent the transition to the secondary progressive stage.

The Evolving Landscape of MS Care

With advancements in treatment and research, the outlook for people living with MS has improved dramatically. In the past, discussions around MS and aging were focused on managing inevitable decline. Today, the focus is on a comprehensive, long-term strategy that incorporates disease-modifying therapies with robust symptom management and lifestyle interventions. Clinics are increasingly specializing in care for older MS patients, addressing the unique challenges they face, including managing comorbidities and adapting to natural aging processes. The goal is to maximize quality of life and function throughout a person's life, regardless of their MS type or age.

Ultimately, Does MS get better or worse with age? is a question with a nuanced answer. For most, the natural progression of the disease, combined with aging, leads to accumulating disability over time, particularly for those who transition to progressive forms. However, with effective treatment, proactive management, and lifestyle choices, it is possible to mitigate symptoms and maintain a good quality of life for many years.

Disclaimer: This article provides general information and is not a substitute for professional medical advice. Always consult a healthcare professional for diagnosis and treatment.

Frequently Asked Questions

For many, the most common path is transitioning from relapsing-remitting MS (RRMS) to secondary progressive MS (SPMS). This shift often occurs in mid-life, where the disease begins to worsen steadily instead of just during relapses.

The term 'benign MS' is sometimes used for cases with mild disability over a long period, but it is no longer widely recommended. Damage can still occur silently, and the disease may become progressive later in life, meaning 'benign' is not a permanent guarantee.

As the body and immune system age naturally (a process called immunosenescence), there is a buildup of chronic low-grade inflammation. This, combined with accumulated nerve damage over time and a declining neurological reserve, can accelerate MS progression.

In younger people with MS, the immune system often launches aggressive inflammatory attacks. With age, the immune response changes to more chronic, smoldering inflammation, which contributes to neurodegeneration and ongoing disability.

DMTs are most effective at treating the inflammatory attacks of relapsing MS and are less effective at slowing the neurodegeneration seen in progressive MS. This means they are often less impactful for older patients in the progressive stage.

Other health conditions, or comorbidities, like cardiovascular disease, diabetes, and joint problems become more common with age and can have a magnified impact on people with MS. They can worsen overall function and complicate MS management.

While it's impossible to halt the disease entirely, proactive management can make a significant difference. This includes using appropriate therapies, adopting a healthy lifestyle, managing comorbidities, and engaging in rehabilitation to maintain function.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.