Can MS begin in the over fifties?


14 October 2013

The study in brief

At one time, it was thought that MS rarely developed in people over 50 but opinion is changing as more cases are now being identified. This study looked at the characteristics of MS when it begins over the age of 50.

People in south-east Wales whose MS began at age 50 or above were identified from a regional database of 2654 people with MS. Some distinct differences were found compared with those whose MS began at a younger age. The researchers found that sensory and motor symptoms were more frequently found, there were fewer relapses and faster progression of disability.

The researchers comment that this makes it even more important to identity this group and to ensure that they have the support they need from MS services.

The study in more detail

Background

MS is often diagnosed when someone is in their 30s or 40s. At one time, it was thought that MS rarely developed in people over 50 but opinion is changing as more cases are now being identified.

Diagnosing MS can be difficult in a person of any age but there are additional challenges as people get older. This is because there are other age related conditions which need to be taken into consideration when deciding what the correct diagnosis might be. In addition, there is little information available on the long term pattern of MS in people who develop it late in life.

How this study was carried out

People in south-east Wales whose MS began at age 50 or above were identified from a regional database of 2654 people with MS. The over 50's group was named "late onset MS" and was compared with an adult (under age 50) onset group.

The medical notes of the late onset group were reviewed to see what diagnoses were considered apart from MS.

What was found

132 people (5.2%) had late onset MS which had begun between the ages of 50 and 72. Some distinct differences were found:

  • Over half (58%) of the late onset group were women as compared with just over two thirds (70%) of the adult onset group.
  • Almost half (47%) had primary progressive MS (PPMS) whereas less than one in ten (9%) had PPMS in the adult onset group
  • The average time from first symptoms to diagnosis was 2.7 years as compared with 4.6 years
  • People in the late onset group were more likely to test negative when cerebrospinal fluid from a lumbar puncture was analysed for oligoclonal bands (23% as compared with 16%)

In four out of ten (42%) cases of late onset MS, no other diagnosis was considered likely and so diagnosis was made more rapidly (on average after 1.8 years).

For those where other possible diagnoses were considered, it took an average of 3.2 years to come to the definite diagnosis of MS. The most common possibilities considered were cerebrovascular disease (16%), degenerative spinal disease (8%) and motor neurone disease (6%).

The most common first symptoms were sensory and cerebellar symptoms for the older age group whereas optic neuritis was most common in the adult onset group.

The late onset group had about half as many relapses in the first ten years compared with the adult onset group. However, they reached disability milestones more quickly as judged by the time taken to reach a particular EDSS score. For example they took an average of 4.8 years to reach an EDSS of 4 as compared with 15.5 years; an average of 5.7 years to reach an EDSS of 6 as compared with 20.4 years; an average of 16.8 years to reach an EDSS of 8 as compared with 39.0 years. However, as their MS had begun later in life, the late onset group were between five and 11 years older when they got to each disability milestone.

What does it mean?

When MS occurs in adults over 50 it can be difficult to diagnose as it may be quite different from MS in younger adults and because it may appear similar to other conditions which occur in older age groups. The most common differences in the older age group are that sensory and motor symptoms are more frequently found, there are fewer relapses and faster progression of disability.

Once MS has begun, disability progresses more rapidly than in younger people with MS. The researchers comment that this makes it even more important to diagnose the older group and to ensure that they have the support they need from MS services.

Harding K, Griffiths M, Wardle M, et al.
Late-onset multiple sclerosis in south-east Wales.
J Neurol Neurosurg Psychiatry. 2013 Nov;84(11):e2.

More about diagnosing MS

MS can be very difficult to diagnose and it often takes a long time to get a definite diagnosis.

All the symptoms of MS can also be symptoms of other conditions so the neurologist has to work out which of all the possibilities is the correct one. This can mean lots of tests to rule out other conditions and then more tests to see if it might be MS. It is sometimes a question of watching and waiting to see how symptoms develop as this can help distinguish MS from the other possibilities. All this can be very frustrating and worrying but it is quite a common experience.

Tests used in the diagnosis of MS

There is no simple test for MS which will say "yes" or "no" like a pregnancy test. The neurologist has to take a multi-pronged approach and use their experience to decide if it is MS or not. Sometimes, it is still impossible to be absolutely certain.

Neurologists will usually ask about any history of unexplained symptoms. The most common next step is to have an MRI scan which can detect the tiny scars caused by MS. These show up as little white patches in the brain and spinal cord and are usually called lesions. Everyone gets more white patches in their brain as they get older so the neurologist has to judge if they are all age-related or possibly due to MS. Sometimes a chemical called gadolinium is injected into a vein before the scan as it can help the radiologist and neurologist distinguish between active MS lesions and old areas of scarring.

Some people will have a lumbar puncture also known as a spinal tap. In this test, a sample is taken of the cerebrospinal fluid which bathes the brain and spinal cord. The fluid can be analysed in the laboratory and if more protein bands are seen than usual (called oligoclonal bands) this can suggest MS.

In some cases, evoked potential tests are carried out. This involves putting small electrodes on the head, arms or legs to measure the speed of messages travelling along the nerves from the eyes, ears or skin on the limbs. If the messages are slowed then this may be due to MS.

The neurologist will review all the test results alongside a person's medical history to decide if it all adds up to a diagnosis of MS.

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