Is MS more common in the elderly? Understanding the changing demographics

Historically, multiple sclerosis (MS) has been diagnosed most often between the ages of 20 and 40. However, an increasing number of individuals are now living with and being diagnosed with MS in their later decades, challenging the perception that MS is primarily a disease of young adulthood. This article explores whether MS is more common in the elderly and the factors contributing to this trend.

Quick Summary

The prevalence of multiple sclerosis is increasing among older adults, a shift largely driven by longer life expectancies due to effective treatments. While onset is still most common in younger years, a growing number of people are living with MS into their later decades, with some cases also beginning later in life.

Key Points

• Prevalence is Increasing in Older Adults: While MS onset typically occurs in young adulthood, a growing number of people are now living with MS into their later years, driven by increased life expectancy.

• Late-Onset MS (LOMS) is More Frequent: There is a documented rise in MS diagnoses for individuals over age 50, a condition known as LOMS.

• Disease Course Shifts with Age: As people with MS age, the disease often shifts from a relapsing-inflammatory pattern to one dominated by chronic neurodegeneration.

• Symptoms Overlap with Normal Aging: Diagnosing MS in older adults can be challenging, as symptoms like balance issues and fatigue can be confused with age-related changes or other health conditions.

• Comorbidities Complicate Management: Older adults with MS often have multiple comorbidities, which increases the complexity of treatment and can worsen disease progression.

• Treatment Strategies Must Adapt: The focus of care in older MS patients may shift from controlling relapses with DMTs to managing progressive disability, with individualized risk-benefit assessments being crucial.

• PIRA is More Common with Age: Progression Independent of Relapse Activity (PIRA), a gradual worsening of neurological function without relapses, is more likely to occur as a person with MS ages.

Is MS a disease of old age?

Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system. While most diagnoses occur between ages 20 and 40, the elderly population with MS is growing. This isn't necessarily because MS is inherently more common in the elderly, but rather a combination of increased longevity due to better treatments and a rise in late-onset diagnoses.

The rise in prevalence among older adults

Studies show a rise in MS prevalence among individuals over 55. This is significantly influenced by advances in disease-modifying therapies (DMTs), which have increased life expectancy for those with MS. As a result, many diagnosed in their youth are now managing the condition into their senior years.

Late-onset multiple sclerosis (LOMS)

Late-onset MS (LOMS) occurs when the first symptoms appear after age 50. LOMS diagnoses are becoming more frequent, possibly due to improved awareness and diagnostic methods. This form of MS often presents with a more progressive course, such as primary-progressive MS (PPMS), and can lead to faster disability accumulation.

Overlapping symptoms and diagnosis challenges

Diagnosing MS in older adults can be difficult as symptoms like balance issues and weakness can be mistaken for normal aging or other conditions. This can result in delayed diagnoses, which are noted to be longer for LOMS patients. Clinicians need to distinguish MS symptoms from those of common comorbidities in the elderly.

How does MS progression differ with age?

The characteristics of MS change over a person's life. In younger individuals, inflammatory relapses are typical. With age, changes in the immune system can lead to less inflammation but more chronic neurodegeneration.

Progression independent of relapse activity (PIRA)

Older individuals with MS are more likely to experience PIRA, where neurological function worsens gradually without new relapses. This neurodegenerative process contributes significantly to long-term disability.

Impact on brain health

While brain volume decreases naturally with age, this process can be accelerated in individuals with MS. The combined effects of MS-related damage and aging can lead to more significant brain atrophy and potentially greater cognitive impairment over time.

The complex role of comorbidities

Older adults with MS often have multiple other health conditions (comorbidities). These can complicate MS management and include cardiovascular diseases, diabetes, depression, and other autoimmune conditions. Comorbidities can worsen MS symptoms, impact quality of life, and complicate treatment decisions, particularly regarding DMTs. Managing multiple conditions often involves multiple medications, increasing the risk of interactions.

Treatment effectiveness and safety in older patients

Some research suggests that DMTs that effectively control relapses in younger individuals may be less effective at preventing disability progression in older adults. Additionally, the aging immune system and certain DMTs may increase the risk of infections and side effects, requiring careful assessment for older patients. Clinical trials have often excluded older adults, leading to less evidence on optimal treatments for this group.

How MS symptoms present in older age

Symptom presentation can vary with age and MS subtype. Below is a comparison of typical symptom patterns.

Symptom	Presentation in Younger Onset MS	Presentation in Older Age MS (including LOMS)
Disease Course	More often relapsing-remitting (RRMS), with distinct attacks and periods of recovery.	Higher likelihood of primary-progressive (PPMS) or a quicker transition to secondary-progressive (SPMS).
Inflammatory Activity	High rates of relapses and new lesions visible on MRI.	Lower rates of new relapses and active inflammatory lesions, but with more chronic neurodegeneration.
Primary Symptoms	Initial symptoms often include visual disturbances, numbness, or weakness.	More likely to present with motor dysfunctions, progressive gait issues, and sensory problems from the start.
Cognitive Changes	Can occur early in the disease, affecting processing speed and memory.	Often more severe and pervasive, compounded by natural age-related cognitive decline.
Diagnosis Challenges	Easier to identify based on hallmark inflammatory attacks.	Complex due to overlap with normal aging and other comorbidities.

Navigating care in the later years

Managing MS in older adults requires a comprehensive, individualized approach that considers MS-specific issues alongside aging, comorbidities, and psychosocial factors. For more information on aging with MS, the National Multiple Sclerosis Society is an excellent resource.

Optimizing treatment strategies

In older patients, the focus may shift from preventing inflammatory attacks to managing progression and improving quality of life. Discontinuing certain DMTs may be considered if inflammation has stopped, weighing potential risks against reduced efficacy in this population. Decisions should involve the patient, considering their age, disease stage, and overall health.

Multidisciplinary care teams

A team approach involving neurologists, therapists, social workers, and other professionals is vital to address the wide range of symptoms and age-related concerns. Managing comorbidities and medications is a key part of this care model.

Lifestyle and supportive care

A healthy lifestyle, including exercise, diet, and stress management, is important. Support systems are crucial for improving quality of life for older adults with MS. Addressing mental health, such as depression and anxiety, is also a critical component of care.

Conclusion

While MS typically starts in young adulthood, more elderly individuals are living with the condition due to increased life expectancy and improved treatments. Diagnosing and managing MS in older adults is complex due to symptom overlap with aging and comorbidities. The disease course often shifts towards chronic neurodegeneration. An individualized, multidisciplinary approach is essential for providing optimal care to this growing population.

Frequently Asked Questions

Does MS typically begin later in life?

No, multiple sclerosis typically begins between the ages of 20 and 40. However, some individuals are diagnosed with late-onset MS (LOMS) after age 50, and the number of these cases is rising.

Why is the prevalence of MS increasing in the elderly?

The rise in prevalence is largely due to two factors: improved life expectancy for people with MS because of effective treatments and an increase in the number of late-onset diagnoses.

What are the challenges of diagnosing MS in older adults?

Diagnosis can be challenging because MS symptoms, such as weakness, balance issues, and fatigue, often overlap with other age-related conditions. This can lead to diagnostic delays or misdiagnosis.

Is the course of MS different in older individuals?

Yes, for many, the disease course shifts over time. While younger patients often have inflammatory relapses, older patients more commonly experience chronic neurodegeneration and a higher likelihood of progressive MS (PPMS or SPMS).

Are treatments for MS less effective in the elderly?

Some research suggests that disease-modifying therapies (DMTs) focused on reducing inflammation may be less effective at slowing disability progression in older adults. Treatment decisions are based on the individual's disease activity and overall health.

What is Progression Independent of Relapse Activity (PIRA)?

PIRA is a gradual worsening of neurological symptoms and disability in a person with MS that occurs independently of relapses. This process is more common in older individuals with MS and is linked to chronic neurodegeneration.

How can an older person with MS manage their symptoms?

Management for older adults with MS often involves a multidisciplinary approach focused on managing symptoms, addressing comorbidities, and maintaining quality of life. Regular physical activity, a healthy diet, and cognitive exercises are often recommended.

Does aging make MS symptoms worse?

As people with MS age, accumulated disability from previous disease activity can cause symptoms to become more pronounced. While the rate of inflammatory relapses may decrease, progressive disability may accelerate, especially for those with progressive forms of the disease.