Research suggests that it’s common for the pattern of MS to change as you age. For both women and men with MS, getting older is associated with a switch from a relapsing pattern to one of progression and increasing disability.
Here we explore why ageing may affect the changing pattern of MS seen in later life.
The ageing brain
As we age, our brain’s ability to adapt and reroute messages around areas of MS nerve damage (known as neuroplasticity) gradually reduces. This can contribute to reduced recovery from relapses and the increasing disability we see in progressive MS.
Your body’s ability to repair damage to the nerve covering (myelin) also seems to decline over time. When nerve cells are left completely exposed, they may begin to die (neurodegeneration). This loss of nerve cells is what can lead to more permanent disability.
Everyone’s brain shrinks as we get older as cells and the connections between them are slowly lost. However, this seems to happen faster in people with MS than in the general population, particularly those with progressive MS. Brain shrinkage (atrophy) is associated with worsening physical disability and cognitive decline.
The weakening immune system
Our immune system also changes as we age and certain immune cells gradually decline. The declining function of white blood cells (these are the cells that cause the inflammation seen in MS) may explain why less inflammatory activity is seen in older people with MS. Older people tend to have fewer relapses and fewer active lesions (or none at all).
However, these changes mean that your immune response may not be as good as when you were younger. This can leave you at an increased risk of infections and with reduced protection from any vaccinations you have. (It’s still important to keep up with vaccinations as they can reduce the severity of a potential infection.)
This weakening immune system can have a knock-on effect on your MS. Your MS symptoms may worsen while your body is fighting off an infection. Dealing with more frequent infections can add extra challenges to managing your MS day to day. Older people with MS are particularly at increased risk of recurrent urinary tract infections (UTIs), skin infections and chest infections.
Chromosome changes
It’s not just our immune cells that change as we age. Chromosomes are the long, thread-like structures made up of DNA that carry our genetic information. The ends of our chromosomes are protected by a region of DNA called telomeres. Telomeres work a bit like the cap you get on the ends of shoelaces to stop them fraying.
Over our lifetime, as cells divide, these telomeres get shorter. This shortening can happen more quickly in people with MS than it does in normal ageing, especially if you have progressive MS. Shorter telomeres have been linked to higher disability levels and a reduction in brain volume (atrophy).
Increased risk of living with more than one health condition
The risk of living with multiple health conditions (comorbidities) increases as you age, whether you have MS or not. Living with more than one health condition can make MS management and treatment more complex. Having comorbidities is linked to higher levels of disease activity and can impact on relapse rates and physical disability. People with multiple conditions may also end up being on a variety of medications (known as polypharmacy). These have the potential to interact and have a negative impact on MS symptoms.
Changes in your sex hormones
In both women and men, the sex hormone oestrogen protects nerve cells against damage and degeneration. This is known as neuroprotection. As we age there is a change in the levels of our sex hormones. For women going through the transition to menopause, there is a dramatic drop in the levels of oestrogen. Men also see a decline in sex hormones at around the same age as women experience menopause, but it’s more gradual.
It’s possible that the reduction in oestrogen (particularly for women), and the neuroprotective effect it provides, may play a role in the transition to a more progressive disease course as you get older. But high-quality research is needed to explore this possibility further as the results of small studies looking into this are mixed.
Impact of the menopause
The impact of the menopause on MS symptoms seems to vary from person to person. Some women report a worsening of symptoms after the menopause, whereas others see no difference at all.
For many perimenopausal or menopausal women, it can be very confusing when MS symptoms and menopause symptoms overlap (for example, sexual problems, bladder issues, mood changes and cognitive problems which can be caused by both). To try and work out the cause, it’s common for overlapping symptoms to be treated as menopausal symptoms initially and then investigated further if there’s no improvement.
The risk of osteoporosis – a condition where your bones weaken – increases in all women post-menopause, but it’s more common in women with MS than the general population. Weight bearing exercise can help to improve your bone health. Ask for a referral for bone density screening (DEXA scan) if you’re concerned.
Whilst ageing is inevitable, there are various lifestyle and wellbeing choices you can make to keep your body as healthy as possible and lessen the impact of ageing on your MS.
- Manage your MS (and any other health conditions) well by taking medication as prescribed and following any rehabilitation therapies as recommended.
- Reduce your risk of comorbidities by attending any health screening appointments, keeping up with vaccinations and looking after your bone health.
- Boost your brain health by maintaining a healthy weight, reducing alcohol, avoiding smoking, and doing creative activities (like reading, puzzles, crafting and playing an instrument).
- Make healthy food choices. Read more about what’s considered a healthy diet.
- Keep active and take part in exercise where you can. Learn more about how different types of exercise are beneficial for MS.
- Look after your mental health by managing stress, anxiety and low mood.
- Practise good sleep hygiene to ensure you’re getting enough sleep.
- Stay in touch with people to maintain relationships and reduce your risk of loneliness and social isolation.
