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Disability measurement in Multiple Sclerosis patients 55 years and older: What is the Expanded Disability Status
Sharon Lynch1, Sara Baker1, Muhammad Nashatizadeh1
1Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, US.
Background:
The Expanded Disability Status Scale (EDSS) measures disease progression in Multiple Sclerosis (MS). EDSS changes are assumed to be due to worsening MS-related disability. Strict interpretation of this premise may include some normal findings as abnormal, inflating the disability score. Further, determining the cause of neurologic symptoms can be difficult in an older population with comorbid illness and polypharmacy.
Objective:
To examine the association between EDSS, age, comorbidities and polypharmacy.
Methods:
106 people, 55 years and older, with and without MS were administered the EDSS and a validated comorbidity questionnaire. Polypharmacy was also assessed.
Results:
Median EDSS scores were 6.0 in people with MS and 3.0 in people without MS. No participant in our cohort had an EDSS of 0. Higher EDSS scores were associated with older age and more polypharmacy. Pyramidal and cerebellar functional systems accounted for the largest percentage of unique variance between groups.
Conclusion:
Older individuals with and without MS demonstrated significant disability on the EDSS. These findings indicate that EDSS scores may be partially due to factors other than MS. Our understanding of disease course and disability may benefit from the development of normative EDSS scores to correct for these factors.
Insights
The Expanded Disability Status Scale (EDSS) may overestimate Multiple Sclerosis (MS) disability in older adults. Age and polypharmacy, not just MS, are linked to higher EDSS scores.
Area of Science:
- Neurology
- Geriatrics
- Clinical Assessment
Background:
- The Expanded Disability Status Scale (EDSS) is a primary measure of Multiple Sclerosis (MS) progression.
- Current interpretation assumes EDSS changes solely reflect MS-related disability.
- Neurologic symptom attribution is complex in older adults due to comorbidities and polypharmacy.
Purpose of the Study:
- To investigate the relationship between EDSS scores, aging, comorbidities, and polypharmacy.
- To assess potential confounding factors influencing EDSS in older populations.
Main Methods:
- A cohort of 106 individuals aged 55 and older, with and without MS, participated.
- The Expanded Disability Status Scale (EDSS) and a validated comorbidity questionnaire were administered.
- Polypharmacy status was also evaluated.
Main Results:
- Median EDSS scores were 6.0 for MS patients and 3.0 for non-MS participants; no one scored 0.
- Increased EDSS scores correlated with older age and higher levels of polypharmacy.
- Pyramidal and cerebellar functional systems showed the most significant variance between groups.
Conclusions:
- Older adults, both with and without MS, exhibit notable disability on the EDSS.
- Findings suggest EDSS scores can be influenced by factors beyond MS.
- Developing normative EDSS data is recommended to adjust for age and comorbidity influences.
