Multiple sclerosis (MS) is a chronic disease that affects the central nervous system. It often begins between the ages of 20 and 50, but it can also develop later in life. Let’s take a closer look at how common MS is among older adults over 60.
What is MS?
MS is an autoimmune condition where the immune system attacks the protective covering around nerve fibers called myelin. This causes communication problems between the brain and the rest of the body. Some of the most common symptoms include:
- Vision problems or vision loss
- Numbness and tingling
- Weakness and fatigue
- Mobility problems
- Pain
- Cognitive changes
The symptoms of MS are different for everyone and can come and go in episodes called relapses or flare-ups. Over time, relapses can lead to permanent neurological damage and disability. There is no cure for MS, but treatments are available to manage symptoms and modify the course of the disease.
Prevalence of MS in older adults
Most people are diagnosed with MS between the ages of 20 and 50, but the disease can occur at any age. According to estimates from the National MS Society:
- About 4% of cases are diagnosed in childhood (before age 18)
- 3-5% of cases are diagnosed after age 50
So while MS is less common in older adults, it’s certainly not unheard of. Let’s look at some key statistics on the prevalence of MS after age 60:
Prevalence by Age
| Age Range | Estimated MS Prevalence |
|---|---|
| 60-64 years | 47 per 100,000 |
| 65-69 years | 36 per 100,000 |
| 70-74 years | 30 per 100,000 |
| 75-79 years | 30 per 100,000 |
| 80-84 years | 28 per 100,000 |
| 85+ years | 24 per 100,000 |
As shown in the table, the prevalence of MS declines steadily with increasing age. It peaks between ages 60-64 at 47 cases per 100,000 people, then drops to 24 cases per 100,000 people over age 85.
Sex Differences
MS is about 3 times more common in women than men. This gender gap persists in older age groups as well:
| Sex | Prevalence After Age 60 |
|---|---|
| Women | 39 per 100,000 |
| Men | 13 per 100,000 |
So among adults over 60, MS prevalence is approximately 39 cases per 100,000 women compared to 13 cases per 100,000 men.
Symptoms of Late-Onset MS
The symptoms of MS that develops later in life after age 60 can be similar to those that occur in younger patients. Common symptoms include:
- Numbness and tingling in extremities
- Weakness, balance issues, and problems walking
- Bladder dysfunction
- Optic neuritis causing vision changes or loss
- Fatigue and cognitive problems
- Depression
However, some studies have found that late-onset MS may be more likely to cause certain symptoms compared to early-onset MS, such as:
- More mobility impairments – Late-onset MS is associated with more problems with gait, balance and coordination.
- Severe fatigue – Debilitating fatigue occurs more frequently in late-onset MS.
- Visual problems – Optic neuritis and vision loss are more prominent in late-onset MS.
- Sensory issues – Numbness, tingling, and other sensory disturbances are common.
Late-onset MS may also progress somewhat faster than early-onset MS. Older people tend to experience more rapid accumulation of disability and transition into the secondary progressive phase.
Causes and Risk Factors
The causes of MS are not fully understood, but believed to involve a combination of genetic susceptibility and environmental exposures. Some factors that may influence MS risk later in life include:
- Genetics – Having certain genes makes people more prone to abnormal immune responses.
- Vitamin D deficiency – Low vitamin D is linked to increased MS risk.
- Epstein-Barr virus infection – Exposure to EBV may trigger autoimmunity in at-risk individuals.
- Smoking – Smoking cigarettes is associated with more severe MS.
- Obesity – Higher BMI may increase susceptibility to MS.
The risk of MS rises steadily with age until about age 50, then progressively declines. It’s not clear why fewer cases develop after midlife. Possible explanations include:
- Age-related changes in the immune system make autoimmunity less likely.
- The brain’s myelin becomes less vulnerable or susceptible to damage from MS.
- People with an inherent predisposition may already develop MS at a younger age.
Diagnosis of MS in Older Adults
Diagnosing MS in seniors can be challenging because it resembles many other age-related conditions. Some key points about MS diagnosis after 60:
- There is no single test to diagnose MS – it’s based on a combination of clinical history, MRI, and lab tests.
- MRI results in older adults can be difficult to interpret due to age-related changes.
- Late-onset MS diagnosis requires excluding disorders like vitamin B12 deficiency, compressive myelopathy, NMOSD, and CADASIL syndrome.
- Neurologists may be less likely to consider MS as a diagnosis in older patients.
- Misdiagnosis rates for MS may be higher in seniors.
Experts recommend having a high index of suspicion for MS in older adults with typical symptoms. Early specialist referral for diagnostic workup can help confirm or rule out MS more accurately.
Treating MS After Age 60
Many of the same MS treatment options can be used in older and younger patients. But special considerations for seniors may include:
- Avoiding immunosuppressants that increase infection risk.
- Using lower medication doses due to reduced kidney/liver function.
- Monitoring for drug interactions with other conditions.
- Treating common comorbidities like hypertension, diabetes, and depression.
- Addressing mobility impairment and fall risks.
- Providing rehab services to maximize independence.
Older patients may need more frequent symptom assessments and medication adjustments to keep up with their disease activity. The treatment plan should be tailored to the individual based on their health status and quality of life goals.
Prognosis of Late-Onset MS
The prognosis of MS diagnosed after age 60 can vary quite a bit depending on the individual. Some general observations about late-onset MS outcomes:
- It may progress faster disability milestones like needing ambulation assistance.
- Older age at onset is linked to shorter time to reach Expanded Disability Status Scale (EDSS) 6.0.
- However, life expectancy is typically not reduced compared to the general public.
- With treatment, many patients over 60 can maintain a good quality of life.
- Comorbid health conditions often have more impact than MS itself in older adults.
Much more research is needed into long-term outcomes for late-onset MS patients. The data currently available indicates that many seniors can live productive lives with proper disease management.
Key Takeaways
- About 3-5% of MS cases are diagnosed after age 50.
- Prevalence declines with older age but still affects about 24 per 100,000 adults over 85.
- Women have 3 times higher risk than men, even in later life.
- Late-onset MS may differ in symptoms and be harder to recognize initially.
- With treatment, patients can often maintain independence and quality of life.
MS remains a possibility on the differential diagnosis even in older adults. Increasing awareness and research on late-onset MS will help improve outcomes in this population.