Clinical and functional profile of very old people with multiple sclerosis: a cross-sectional study in the genoa area

People with multiple sclerosis (pwMS) are rapidly aging, yet the clinical and functional profile of older individuals remains poorly characterized.

Our study aimed to describe the demographic, clinical, cognitive, functional, and psychosocial features of pwMS aged ≥ 60 years in the Genoa province, and identify predictors of cognitive and motor decline.

In this cross-sectional study, 109 pwMS aged 60-89 years were evaluated via structured telephone interviews. Collected variables included demographics, disability (SRDSS), mobility, comorbidities, dysphagia (DYMUS), pain (NRS, DN4), fatigue, urinary and fecal dysfunction, spasticity, cognitive function (Telephone-MoCA), depressive symptoms, and the level of independence. Multivariate logistic and ordered logistic regressions examined predictors of cognitive, motor, and clinical outcomes. An exploratory regression model estimated age-related cognitive and motor trajectories.

Of the 109 participants (median age 71 years), 43 subjects were < 70 and 66 ≥ 70 years old. Participants showed high disability, widespread mobility limitation, fatigue (96%), urinary dysfunction (78%), and cognitive impairment (median MoCA 10). Older age was associated with worse cognition, greater dependence on instrumental activities of daily living, and higher dysphagia. In multivariate models, education predicted MoCA performance, and pain was independently associated with female sex and comorbidity burden. The age-trajectory model revealed a nonlinear acceleration of decline after 72-73 years, with cognition deteriorating earlier and faster than mobility.

Aging pwMS exhibit a substantial multidimensional burden. Cognitive decline accelerates in advanced age and precedes motor deterioration, underscoring the need for early cognitive monitoring and integrated, geriatric-informed care strategies.