Aging with MS: Everything you need to know!

Multiple sclerosis is an autoimmune disease. The defense system supposed to protect the patient from external aggression turns on his or her own cells and attacks them. The reasons for this remain unknown to this day.

>> To find out more about multiple sclerosis and its diagnosis, have a look at our MS fact sheet! <<

Multiple sclerosis is the leading cause of severe non-traumatic disability in young adults. It's onset is around the age of 30 and it affects women more than men (1 man for 3 women).

In the US,nearly one million people are living with multiple sclerosis.

It is difficult to predict the course of multiple sclerosis in the short or long term because each patient is affected in a different way. However, depending on the progression of the disease, multiple sclerosis is classified into 3 types.

What are the different types of MS? 

Depending on the way the disease progresses, it is divided into 3 types:  

• Relapsing-remitting MS: exacerbations are followed by periods of remission. This type of multiple sclerosis affects about 85% of patients. During relapses, the symptoms appear within hours or days and are often associated with extreme and unusual fatigue. The symptoms then disappear completely or partially within a few weeks. Periods of remission are more or less long and, during the first years of the disease, the recovery after each attack is most often complete.
• 5 to 20 years after the onset of the first symptoms, 50% of multiple sclerosis cases develop into a "secondary progressive” form. Patients experience gradual worsening of neurological functions, without flare-ups. Recent epidemiological studies suggest that immunomodulators / immunosuppressants are able to delay the onset of this phase.
• Finally, so-called “primary progressive” multiple sclerosis progresses slowly and gradually from the start, patients do not experience exacerbations and there are no periods of remission. This form accounts for 15% of cases and is usually seen in older patients, aged over 40, and affects both women and men.

How does multiple sclerosis progress? 

Multiple sclerosis is an extremely heterogeneous disease. In fact, it does not progress in the same way from patient to patient, and its symptoms can be very different as well.

This is because the symptoms of MS vary a lot from patient to patient and can also change throughout the life of a patient. They depend on the area of ​​the brain or spinal cord affected by the lesions.

They can be isolated or form a combination. Here are the most common symptoms:

• Motor impairments related to muscle weakness which can affect the upper and / or lower limbs and thus impair the patient's ability to walk.
  
• Sensory disorders such as numbness, tingling, pain ...
  
• Visual impairments: double vision or reduced visual acuity.
  
• Problems with balance and coordination, or dizziness.
  
• Urinary and sexual disorders.
  
• Cognitive problems: difficulty paying attention and concentrating, memory loss.
  
• Anxiodepressive disorders.

In addition, patients with multiple sclerosis whose cerebellum is affected by the disease, may have trouble articulating and are prone to tremors.

Moreover, swallowing disorders, though often underestimated, can have serious consequences. These impairments have different causes: lack of tongue mobility, weakness in muscles of the soft palate or the mouth, sensory disorders… The most dangerous consequence of swallowing problems is that food can go down the wrong way, ending up in the respiratory tract.

Symptoms can go away spontaneously, especially at the onset of the illness. The consequences can sometimes remain, or even turn into a disability, especially if they have been developing for several years. In this case movement, balance, sensitivity or the ability to control urine can be affected. This is different for primary-progressive MS, where symptoms persist from the onset of the disease.

The risk of disability remains significant. However, this risk is not inevitable, and disability can vary both in nature and intensity, as well as in the speed of its progression.

How do we age when we have MS? 

Care plan and the management of the disease should be adjusted for patients over 60, especially due to such comorbidities, linked to aging, as osteoporosis or cardiovascular diseases.

Plus, treatments are usually validated in younger population and rarely in patients over 60 years old.

Although myelin repair becomes less efficient as we age, the severity of the disease decreases after the age of 60, except for patients with primary progressive MS. This happens because autoimmune mechanisms become less active, so patients have less flare-ups, and probably because of other factors, for example, of hormonal nature, such as the onset of menopause in women.

Immunomodulators or immunosuppressants are prescribed to treat MS. The choice of treatment depends on the severity of the disease. These medications modulate, more or less intensively, the activity of the patient's immune system.

In fact, the age of the patient should be taken into account. The benefit-risk ratio of treatments is not the same for older patients as for the younger ones. In older patients the immune system becomes more fragile with time, and as the treatments aim at modulating it, there is a greater risk of complications, especially due to opportunistic pulmonary infections.

When a physician prescribes a treatment, he or she should know the age group in which the clinical trial was carried out. The risk of the disease progressing must be greater than the risk of complications from treatment.

In older patients, treatment is reduced or even stopped because the disease usually stabilizes on its own. In this case, the care plan is mainly based on ensuring their daily comfort, rehabilitation and physical activity as well as providing psychological and social care.

What's new in clinical research on MS and aging? 

A study began in 2018 on subjects with a more advanced stage of the disease. The main complication in patients with multiple sclerosis is pneumonia (infections of the lungs). This study, conducted on 70 patients with a high level of disability (wheelchair or walking aid) aims at determining the criteria for evaluating their respiratory capacities, which would make it possible to improve the assessment of the benefit-risk ratio of the treatments.

In addition, certain clinical trials are and will be conducted to test the effectiveness of molecules promoting remyelination, so that it would be possible to repair the lesions and not just limit their development.