The Shifting Landscape of MS: A Focus on Older Onset

For years, multiple sclerosis (MS) has been considered a disease that primarily strikes young adults. However, recent research is revealing a significant shift in this pattern, with more people experiencing their first symptoms later in life. A new study, conducted in Italy, has shed light on this trend, raising important questions about how we understand and manage this complex neurological condition.

Key Findings from the Study
The study, which looked at data from 4,345 patients with relapsing-onset MS, revealed some compelling trends. Here's a breakdown of the key findings: * Increased Onset Age: The average age at which people are experiencing the first symptoms of MS is increasing. This was a clear trend across the study periods (< 1991, 1991–2000, 2001–2010, 2011–2021). There was a significant increase in the number of MS onsets in the older age groups of 40-49, 50-59 and ≥60 years over time.

* Shorter Time to Diagnosis: Despite the older age at onset, the time it takes to get a diagnosis of MS is decreasing. This is likely due to advances in diagnostic criteria and the availability of MRI technology.

* More Late-Onset MS: The proportion of people experiencing their first MS symptoms after the age of 50 has increased significantly, jumping from 1% before 1991 to almost 10% after 2010.

* Shifting Onset Locations: In people who experience MS onset at 40 years or older, the study found more frequent spinal cord involvement and less frequent supratentorial onset.

* Female to Male Ratio: The study found an increased female to male ratio in MS patients with an onset at the age of 40 or older.

Why is This Happening?
While the study doesn't pinpoint the exact causes of this shift, the authors suggest that it could be due to a combination of factors:

* Environmental Factors: Changes in lifestyle habits such as obesity, smoking, sun exposure, and infections may play a role. * Advanced Diagnostic Tools: The increased use of MRI and updated diagnostic criteria have led to more accurate and earlier diagnosis, which may be influencing the age at diagnosis.

What Does This Mean for People with MS?
These findings have significant implications for how MS is managed, particularly for older individuals:

* Treatment Considerations: Many current disease-modifying treatments (DMTs) were primarily tested on younger populations. More data is needed to understand how these medications work in older individuals.

* Risk-Benefit Assessment: Some studies suggest that the benefits of DMTs may decrease in those over 53 years of age and that certain treatments may pose an increased risk of side effects, such as neoplasms, for older patients.

* Comorbidities: Older individuals are more likely to have other health issues, which can affect the safety and effectiveness of MS treatments.

* Immunosenescence: The aging immune system can increase the risk of infections in people treated with DMTs.

The Road Ahead
This study highlights the need for further research to better understand the changing patterns of MS onset and to develop more personalized treatment strategies for patients of all ages. The authors emphasize that if their findings are confirmed in larger studies, there will be a need to re-evaluate the current treatment standards of care for older people with MS.

The shift in MS onset age is a reminder that this disease is not static, and the medical community needs to continue adapting its approach to provide the best possible care for everyone affected by MS. This will require not only further research but also a greater focus on the specific needs of an aging population living with MS.

Disclaimer: This blog post is based on the provided research article and is intended for informational purposes only. It is not intended to provide medical advice. Please consult with a healthcare professional for any health concerns.

Reference:
Prosperini, L., Lucchini, M., Ruggieri, S., Tortorella, C., Haggiag, S., Mirabella, M., ... & Gasperini, C. (2022). Shift of multiple sclerosis onset towards older age. Journal of Neurology, Neurosurgery & Psychiatry, 93(10), 1137-1139.