Late-Onset MS: Discover What's Different

MS Onset After Age 50 May Mean More Motor Symptoms

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Do you or someone you care about have multiple sclerosis (MS)? If so, at what age was it diagnosed? Late-onset MS is commonly defined as the occurrence of the first symptoms after age 50. (Adult-onset MS is most often diagnosed in people who are in their mid-20s to 30s.)

MS “Basics”

MS is a chronic disease of the central nervous system (CNS), which includes your brain, spinal cord, and optic (eye) nerves.

In MS, your immune system attacks nerve cells and the fatty myelin sheath surrounding them, causing scarring.

The myelin scar tissue “jams” communication between your brain and your body. The resulting distortion and blocking of messages between the brain and spinal cord leads to the symptoms and disability that occur in MS.

It’s not yet known what “turns on” the immune system response in a person who gets MS. However, this appears to occur in people with an inherited (genetic) susceptibility to the disease who are exposed to one or more environmental “triggers.”

Late-Onset MS: Challenges with Diagnosis

People over the age of 50 are diagnosed with MS in an estimated 4 to 9 percent of cases, according to older studies in Journal of the American Geriatrics Society and Neurology, respectively. Unfortunately, the disease is harder to diagnose in people over 50, for a variety of reasons, and this is why the diagnosis is often delayed.

MS has not been studied in the older adult population as much as in younger adults. This is important because the disease may vary in a number of ways between younger and older people, including different symptoms. So symptoms of late-onset MS may not suggest the diagnosis to doctors who are more familiar with MS symptoms in younger adults.

In late-onset MS, the person’s symptoms can easily mimic those of other disorders. Common conditions in older people can cause MS-like symptoms that can make it harder to diagnose MS. Some of these disorders include:

Symptoms of late-onset MS can be mistaken for signs of normal aging. For example, on a magnetic resonance imaging (MRI) scan of the brain (an important diagnostic test for MS), a doctor may mistake the white-matter brain damage caused by MS for brain changes due to blood vessel (vascular) disease.

Some symptoms of late-onset MS that can overlap with conditions of normal aging include:

Late-Onset MS: Different From Young-Onset MS

You may be interested to learn that a person’s age, when diagnosed with MS, also affects the course of the disease.

Although CNS damage in late-onset MS is similar to that seen in young adults, older people usually start showing signs of disability sooner. They are also more likely to be diagnosed with progressive MS, in which the symptoms are ongoing (as compared to the relapsing-remitting form of the disease) and get worse as time passes.

 

According to a study in the Journal of Neurology, which compared 52 people who developed MS after the age of 50 to people who developed MS at a younger age (less than 40 years old), motor symptoms were more common in the late-onset MS group.

On the other hand, visual symptoms, signs of optic neuritis, and dysarthria were less common in late-onset MS. Sensory symptoms (for example, numbness and tingling), ataxia, cognitive function, and fatigue did not differ between the two groups. 

In addition, according to this same study, spinal cord lesions, as seen on MRIs, were more common in people with late-onset MS, and lesions in the cerebellum were more common in people with younger-onset MS.

 

In terms of treatment, those with young-onset MS responded better to steroids than those with late-onset MS.

A Word From Verywell

In the end, the course of late-onset MS and how different it is from young-onset MS is still not entirely clear.  That being said, a prompt and accurate diagnosis is as critically important in late-onset MS as it is at any age. Why? Because promptly starting treatment with disease-modifying medications (DMDs) can reduce MS attacks and new lesions as well as slow the progress of the disease. 

Sources:

Kis B, Rumberg B, Berlit P. Clinical characteristics of patients with late-onset multiple sclerosis. J Neurol. 2008 May;255(5):697-702.

Noseworthy J, Paty D, Wonnacott T, Feasby T, Ebers G. Multiple sclerosis after age 50. Neurology. 1983 Dec;33(12):1537-44.

Pollack ML, Barak Y, Achiron A. Late-onset multiple sclerosis. J Am Geriatr Soc. 2011 Feb;49(2):168-71.

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