Is multiple sclerosis common in the elderly? Understanding MS in older age

While multiple sclerosis (MS) is most often diagnosed between the ages of 20 and 40, a growing body of evidence shows that its prevalence is increasing among older individuals. Many people with MS are now living longer thanks to improved treatments, meaning clinicians are increasingly managing the disease in elderly populations. The question, is multiple sclerosis common in the elderly?, highlights the complex nature of aging with this neurological condition.

Quick Summary

The prevalence of multiple sclerosis is rising in older adults, though most diagnoses occur at a younger age. For those with late-onset MS, the disease often follows a more aggressive progressive course. Symptoms and management are complicated by age-related changes, comorbidities, and reduced treatment effectiveness.

Key Points

• Prevalence is Rising in Older Adults: Although MS is most commonly diagnosed in younger adults (20s-40s), the number of people living with MS into their later years is increasing significantly due to longer life expectancies and better treatments.

• Late-Onset MS is Rare but Distinct: Onset after age 50 (late-onset MS, or LOMS) is uncommon but tends to follow a more aggressive, progressive disease course from the beginning.

• Progression Shifts with Age: In older individuals, the disease often transitions from inflammatory relapses to a more consistent, neurodegenerative decline, with less inflammatory activity seen on MRI.

• Diagnosis is Often Delayed: Symptoms in older adults can be mistaken for normal aging or other conditions, leading to significant delays in diagnosis.

• Management is More Complex: Older MS patients often have multiple comorbidities, and the risk-benefit profile of disease-modifying therapies can be less favorable, requiring careful, individualized treatment decisions.

• Holistic Care is Essential: Effective management involves more than just MS treatment. It includes addressing comorbidities, supporting physical and cognitive function, and maintaining social connections to improve overall quality of life.

Understanding the Changing Demographics of Multiple Sclerosis

Historically, multiple sclerosis (MS) was primarily considered a disease affecting young adults, but the demographic landscape is changing. Due to increased life expectancy and more effective treatments, there has been a significant rise in the number of older people living with MS. Population studies in Canada and the UK show a shift in peak prevalence to older age groups. While late-onset MS (LOMS), after age 50, and very-late-onset MS (VLOMS), after age 60, are less common than diagnoses at younger ages, these groups are expanding.

Distinct Clinical and Pathological Features in Older MS Patients

As MS patients age, both the clinical presentation and disease processes evolve. The inflammatory relapses seen in earlier stages often decrease, and a more steady neurodegenerative process becomes dominant.

Clinical presentation in older adults

• Progressive Disease Course: A higher percentage of older adults, particularly those with LOMS, are diagnosed with or transition to progressive forms like primary progressive MS (PPMS) or secondary progressive MS (SPMS).
• Faster Disability Accumulation: Disability often progresses more rapidly in those with LOMS compared to younger individuals. This can result in a higher disability score at the time of diagnosis.
• Symptom Overlap: Symptoms such as balance problems, bladder issues, and cognitive difficulties can overlap with other age-related conditions, making diagnosis more challenging and potentially causing delays.

The role of immunosenescence

Immunosenescence, the aging of the immune system, impacts how MS progresses in the elderly. This process shifts the immune response from an inflammatory attack to chronic inflammation and neurodegeneration, contributing to the slower, degenerative disease course often observed in older MS patients.

Management Challenges for Multiple Sclerosis in the Elderly

Managing MS in older adults involves unique considerations related to treatment effectiveness, safety, and the presence of other health conditions.

Comparison of MS management in younger vs. older adults

Feature	Management in Younger Adults (20-40s)	Management in Older Adults (55+)
Disease Focus	Primarily driven by inflammation and relapses.	Shift towards neurodegeneration and steady progression.
Treatment Efficacy	Disease-modifying therapies (DMTs) are most effective at reducing relapses and inflammation.	Efficacy of DMTs for preventing disability progression diminishes with age.
Side Effect Risk	Generally lower risk of severe side effects from DMTs.	Increased risk of severe side effects, including infections and malignancies, due to aging immune system and other health issues.
Comorbidities	Fewer co-existing medical conditions typically present.	Higher burden of comorbidities (e.g., cardiovascular disease, arthritis), which can complicate MS management and diagnosis.
Symptom Management	Focus often on treating individual symptoms like fatigue or vision changes.	Requires careful management to distinguish between MS-specific symptoms and age-related issues.
Decision-Making	More straightforward approach to initiating and maintaining treatment.	Complex decisions about whether to start, continue, or discontinue DMTs, balancing risks and benefits.

Lifestyle and Support for Aging with Multiple Sclerosis

Comprehensive care for older adults with MS includes managing other health conditions and supporting overall well-being. A holistic approach can significantly improve quality of life.

• Physical Activity: Regular exercise, particularly with guidance from a physiotherapist, can help maintain strength and balance and can positively influence cognitive function and mood.
• Cognitive Support: Cognitive impairment may be more pronounced in older MS patients. Engaging in mentally stimulating activities can help support brain health.
• Social Connection: Maintaining strong social ties is important for mental health and addressing potential feelings of isolation.
• Caregiver Support: As both individuals with MS and their caregivers age, their needs change. Planning and seeking support are important for managing the long-term demands of the disease.

Conclusion

While a diagnosis of multiple sclerosis is uncommon after age 60, the number of older people living with MS is increasing due to longer life expectancies and better treatments. However, aging with MS presents distinct challenges, including a greater likelihood of progressive disability, symptom overlap with other age-related conditions, and complex treatment decisions. Effective management requires an individualized approach that considers the MS itself, overall health, comorbidities, and quality of life.

For more information on aging with multiple sclerosis, you can visit the National Multiple Sclerosis Society.

Frequently Asked Questions

Is it possible to be diagnosed with MS in your 60s or 70s?

Yes, while rare, it is possible. MS with onset after age 60 is known as very-late-onset MS (VLOMS). However, delays in diagnosis are common in this age group, as early symptoms can be mistaken for other conditions that typically affect older individuals.

Why is MS more challenging to diagnose in the elderly?

Diagnosing MS in older adults is often difficult because symptoms can overlap with common age-related conditions. For example, balance issues, cognitive decline, and bladder dysfunction are symptoms of both MS and normal aging or other disorders, which can lead to misdiagnosis or delayed diagnosis.

Do MS symptoms change as you get older?

Yes. The nature of MS changes with age. The frequency of inflammatory relapses typically decreases, and the disease often shifts toward a more gradual, progressive accumulation of disability. Over time, nerve damage and neurodegeneration become the dominant factors.

How do comorbidities affect MS in older adults?

Older adults with MS have a higher burden of comorbidities such as cardiovascular disease, arthritis, and diabetes. These conditions can complicate MS management, worsen disability progression, and increase the risk of side effects from MS medications.

Are disease-modifying therapies (DMTs) effective for elderly MS patients?

The effectiveness of DMTs in preventing disability progression tends to decrease with advancing age. Some evidence suggests that for average patients over 55, the benefits may be limited, while risks of side effects, such as infections, may increase. Decisions to continue or stop DMTs must be made individually, balancing risks and benefits.

What is immunosenescence and how does it relate to MS in the elderly?

Immunosenescence is the natural age-related decline of the immune system. In the context of MS, it contributes to a shift from early-stage inflammatory attacks to a more chronic, low-grade inflammation and neurodegeneration seen in older patients. This change in immune function impacts disease progression and the response to therapy.

What kind of support is available for aging with MS?

Support for aging with MS includes physical and occupational therapy, lifestyle modifications (such as exercise and cognitive activities), and maintaining social connections. Resources are available from organizations like the National Multiple Sclerosis Society to help with disease management and well-being.