Multiple sclerosis and aging

Area of Science:

• Neurology
• Immunology
• Geriatrics

Background:

• Multiple sclerosis (MS) is a central nervous system inflammatory demyelinating disease typically peaking around age 30.
• An increasing number of elderly patients with MS are being observed due to improved healthcare and increased life expectancy.
• This review examines MS in the elderly, focusing on late-onset MS (onset >50 years) and aging individuals with early-onset MS.

Purpose of the Study:

• To review the epidemiologic, physiopathological, clinical, and therapeutic characteristics of MS in elderly patients.
• To differentiate between late-onset MS and aging with young adult-onset MS.
• To highlight considerations for managing MS in older populations.

Main Methods:

• Review of existing epidemiologic studies on MS in individuals over 50.
• Analysis of clinical presentations, including disability progression and cognitive function.
• Examination of therapeutic challenges and considerations for disease-modifying therapies in the elderly.

Main Results:

• Late-onset MS accounts for approximately 5% of all MS cases.
• Compared to young-onset MS, late-onset MS typically shows a progressive course, delayed diagnosis, and higher rates of motor disability.
• Cognitive impairment frequency and affected domains are similar between late-onset and young-onset MS in the elderly population.

Conclusions:

• MS in the elderly, whether late-onset or aging with early-onset, necessitates specialized care.
• Healthcare providers must address higher comorbidity prevalence and unique pharmacological considerations in older MS patients.
• Optimizing treatment requires adapting risk/benefit assessments for disease-modifying therapies in this demographic.