How Does MS Evolve As You Age?

Multiple sclerosis (MS) is an autoimmune disease in which the body’s immune system starts attacking the protective coverings of the nerve cells. Damage to this outer cover, known as the sheath, leads to diminished functioning of the spinal cord and the brain. The symptoms of MS are known to be unpredictable and can vary in intensity. While some people experience numbness, pain, and fatigue, more severe cases of MS can also lead to vision loss, diminished brain function, and even paralysis. Multiple sclerosis (MS) is usually diagnosed during the 20s or 30s, and the disease continues to progress, moving through different symptoms over the years. Everyone experiences MS in a different way, and the manner in which the disease progresses over time also varies from person to person. Advances in MS research has now started offering unique and better treatments that are helping in slowing down the progression of the disease and also improving the outlook for people who are living with MS. Read on to find out how Multiple sclerosis (MS) evolves as you age.

How Does MS Evolve As You Age?

First Stage of MS

MS typically begins with just a single attack. It usually starts by your vision, becoming blurry suddenly or you might feel like your legs are becoming weak or numb. When these symptoms begin to last for at least 24 hours, it is considered as the first attack and is known as clinically isolated syndrome (CIS).

CIS tends to begin between the ages of 20 and 40, and it is not caused by anything else, such as an infection or a fever. It is caused by damage or inflammation to the myelin present in your central nervous system. CIS is considered to be a warning of MS to come, but it is not always the case.

Approximately 30 and 70 %(1) of people who have CIS end up developing MS, and if an MRI scan shows signs of brain lesions, then it is much more likely that you will go on to develop MS.

First Stage Diagnosis: Relapsing-Remitting MS (RRMS)

Over 80 percent(2) of all people with MS are typically diagnosed with RRMS at first. RRMS usually begins when a person is in their 20s or 30s, but it can also start later or even earlier in life.

When you have RRMS, the disease attacks the myelin sheath of the nerves followed by periods of flare-ups during which there is a worsening of your symptoms. This period is referred to as a relapse. During a relapse, some of the symptoms you may experience may include:

  • Weakness
  • Fatigue
  • Tingling or numbness
  • Double vision
  • Loss of vision
  • Problems with balance

Each flare-up or relapse can last from a couple of days to a few months. Keep in mind, though, that the exact symptoms and the severity of the symptoms differs from person to person.

After a relapse, you will notice that you enter a symptom-less period known as remission. Each remission can last from a couple of months to a couple of years. During the remission phase, the disease stops progressing.

Some people remain in the RRMS phase for many decades, while others can progress to the next stage of secondary progressive MS within just a couple of years. It is impossible to understand or predict the manner in which the disease is going to progress, but the advent of new treatments have helped slow down the progression of MS.

Next Stage: Primary Progressive MS (PPMS)

According to the National Multiple Sclerosis Society, nearly 15 percent of people who have been diagnosed with MS are diagnosed with the primary progressive form of MS. (2) PPMS usually affects a person during the mid to late 30s.

In this form of MS, the damage to the nervous system as well as other symptoms starts getting worse at a steady pace over time. There are also no proper remission periods in PPMS. The disease just continues to progress, and it can also eventually cause problems in performing your day to day activities and even in simple activities such as walking or writing.

Secondary Progressive MS (SPMS)

SPMS or Secondary Progressive MS is the next stage after RRMS. In SPMS, the damage to myelin starts worsening over time. In this type of MS, you will not have the usual long remission periods that you experienced with RRMS. In fact, the increase in the damage to your nervous system will cause a further worsening of your symptoms and also lead to more severe symptoms.

Research suggests that at least half of the people who have RRMS end up moving to the SPMS stage within a decade of first experiencing the symptoms of MS.(3)

However, the majority of people, 95 percent, transition to SPMS from RRMS within 25 years.

With the market being flooded with many new types of MS drugs in recent years, there are fewer people progressing on to SPMS today, and this transition is also happening at a much slower pace. However, experts still do not know just how long these new and innovative treatments will delay the progression of RRMS to SPMS.

Diagnosis Age and the Progression of MS

It has always been believed that MS progressed faster in people who were diagnosed at a later age. In fact, a study carried out by the University Hospital of Wales in February 2013 and published in the Journal of Neurology, Neurosurgery, and Psychiatry, found that children who were already diagnosed with MS took a longer time to progress onto secondary progressive disease (approximately 32 years) as compared to patients who were diagnosed in their adult years (18 years). Children with MS also took longer to reach any disability milestone commonly associated with MS.(4)

However, the researching team noted that patients who were diagnosed as children, ended up hitting the disability milestones at a younger age, and therefore, these patients were considered to have a poorer MS prognosis.

Meanwhile, a study published in the European Journal of Neurology in April 2015 aimed at finding whether the usage of the commonly prescribed MS medications beta interferons caused a delay in the onset of secondary progressive MS. The study concluded that beta interferons did not have any impact on disease progression.(5)

Diagnosis of MS in Children

According to the International Pediatric MS Study Group, up to ten percent of all MS cases are usually diagnosed in children and teenagers.(6) MS in children is also understood to cause more or less the same symptoms as MS does in adults.

Motor symptoms and weakness are equally as common in children as in adults. However, children do tend to experience more relapses of MS as compared to adults.

The disease also follows a slower rate of progression, and kids are likely to have less disability early on into the condition.

It is also important to note that a 30-year-old patient who had a pediatric onset of MS is likely to have more disability as compared to a 30-year-old patient who was diagnosed with MS in the adult years. This is why better treatment plans are required in children with MS.

Diagnosis of MS After 50

There is only a small percentage of people who have received their MS diagnosis after the age of 50. In some cases, these patients have had late-onset MS, but for many, the diagnosis only represented a delayed identification of symptoms that went unrecognized for years, sometimes even decades.

The physical and mental changes that are commonly associated with aging are usually similar or even overlap, with the symptoms of MS. These symptoms may include balance issues, visual changes, weakness, cognitive impairments, and even sleep disturbances.

Older people with MS are also at a high risk of developing pneumonia, urinary tract infections, cellulitis (a type of bacterial skin infection), and septicemia (infection of the blood), as compared to older adults who do not have MS.

The fact is that the combination of aging, along with MS symptoms, is going to aggravate any health problems that a person has. For example, if a person is having mobility problems due to MS, then they are going to experience difficulty in traveling to and from their medication appointments. Due to this, they are more likely to skip these trips and also miss the care that they would have gotten during the appointment. This will prove to be harmful not just for their MS, but also for any other medical condition they might be having.

Reduced mobility is also going to make it difficult for you to maintain good heart health. After all, being less active is a well-known risk factor for heart disease.

Research on what emotional effect MS has on elderly patients remains few and conclusions are also mixed. For example, a study carried out by the Group Health Research Institute in the US and published in the September 2015 issue of the Psychology, Health and Medicine journal, found that older people who have MS tend to experience less psychological distress in response to disrupted physical functioning as compared to younger people who have MS.(7)

However, in April 2014, a study carried out by the University of Calgary in Canada and published in the Journal of Psychosomatic Research found that people of ages 65 and above who have MS are nearly four times more likely to have suicidal thoughts as compared to younger people affected by MS.(8)

Regardless of what age your MS gets diagnosed at, depression and suicidal thoughts should never be ignored. If you or someone you know with MS is experiencing signs of depression, and =they might be thinking of suicide, then you should immediately seek help from a mental health professional or from a doctor without delay.

Does MS Have Any Effect On Life Span?

At the end of the day, MS is a chronic and progressive disease, but not a terminal one. Nevertheless, MS can shorten the life span of patients, but there are many MS patients who go on to live up to 70 or 80 years of age.

A research study published in the journal Neurology in May 2015 made use of healthcare statistics from the province of Manitoba in Canada to confirm that people with MS had an average life span of 75.9 years(9), while people without MS had a median life span of 83.4 years. So as can be seen, there is not much of a difference between the two life spans.

According to the same study, the most common cause of death amongst people who had MS were diseases of the circulatory system and the nervous system. It was also noticed that mortality rates due to diseases of the respiratory system and infectious diseases were also higher in people who had MS.

Conclusion

MS is a progressive disease that begins early in life but steadily progresses as you age. Most people first experience the disease in the relapsing-remitting form at first, with alternating periods of symptoms known as relapses with remissions, which are the symptom-free periods. Without treatment, though, MS continues to progress to the secondary progressive form.

With new and more effective medications and treatments, doctors have been able to slow down the progression of MS, sometimes even for decades. Leaving the disease untreated is not a good idea, and your symptoms will only keep worsening, and the severity of the symptoms will also increase at a rapid rate.

References:

  1. MS Trust. (2019). Clinically isolated syndrome (CIS). [online] Available at: https://www.mstrust.org.uk/a-z/clinically-isolated-syndrome-cis [Accessed 16 Aug. 2019].
  2. National Multiple Sclerosis Society. (2019). Types of MS. [online] Available at: https://www.nationalmssociety.org/What-is-MS/Types-of-MS [Accessed 16 Aug. 2019].
  3. National Multiple Sclerosis Society. (2019). Secondary progressive MS (SPMS). [online] Available at: https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS [Accessed 16 Aug. 2019].
  4. Harding, K.E., Liang, K., Cossburn, M.D., Ingram, G., Hirst, C.L., Pickersgill, T.P., Naude, J.T.W., Wardle, M., Ben-Shlomo, Y. and Robertson, N.P., 2013. Long-term outcome of paediatric-onset multiple sclerosis: a population-based study. J Neurol Neurosurg Psychiatry, 84(2), pp.141-147.
  5. Zhang, T., Shirani, A., Zhao, Y., Karim, M.E., Gustafson, P., Petkau, J., Evans, C., Kingwell, E., van der Kop, M., Zhu, F. and Oger, J., 2015. Beta‐interferon exposure and onset of secondary progressive multiple sclerosis. European journal of neurology, 22(6), pp.990-1000.
  6. Ipmssg.org. (2019). International Pediatric Multiple Sclerosis Study Group. [online] Available at: http://www.ipmssg.org/ [Accessed 16 Aug. 2019].
  7. Jones, S.M. and Amtmann, D., 2015. The relationship of age, function, and psychological distress in multiple sclerosis. Psychology, health & medicine, 20(6), pp.629-634. Viner, R., Patten, S.B., Berzins, S., Bulloch, A.G. and Fiest, K.M., 2014. Prevalence and risk factors for suicidal ideation in a multiple sclerosis population. Journal of psychosomatic research, 76(4), pp.312-316.
  8. Marrie, R.A., Elliott, L., Marriott, J., Cossoy, M., Blanchard, J., Leung, S. and Yu, N., 2015. Effect of comorbidity on mortality in multiple sclerosis. Neurology, 85(3), pp.240-247.

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