Table of ContentsView AllTable of ContentsCausesTypesDiagnostic ChallengesDisease ProgressionTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Causes
Types
Diagnostic Challenges
Disease Progression
Treatment
Frequently Asked Questions
When it comes to age,multiple sclerosis (MS)doesn’t discriminate. Although most people are between 20 and 50 when they’re diagnosed, the disease can strike folks who are older. This is called late-onset MS and it’s commonly defined as the occurrence of the first MS symptoms after age 50.
Verywell / Nusha Ashjaee
The way the disease manifests in late-onset MS can be different from what normally happens in adult-onset MS, which most commonly affects people in their mid-20s and 30s.
4:133 MS Patients Share Their Experiences Facing Mobility Challenges
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3 MS Patients Share Their Experiences Facing Mobility Challenges
MS is a chronic disease of the central nervous system (CNS), which includes your brain, spinal cord, and optic nerves, located in your eyes. In MS, your immune system attacks your nerve cells and the fatty myelin sheath surrounding them, causing scarring.
The myelin scar tissue essentially jams communication between your brain and your body. The resulting distortion and blocking of messages between the brain and spinal cord lead to the symptoms and disability that are recognized as MS.
It’s not yet known what turns on the immune system response when you have MS. However, this appears to occur in people with a genetic susceptibility to the disease who are exposed to one or more environmental triggers, including smoking, stress, and vitamin D deficiency.
It’s also unknown why some people develop MS later than others. Further research needs to be done to understand the causes and onset of MS more clearly.
What Causes Multiple Sclerosis?
There are three kinds of MS.
Relapsing-Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Secondary progressive MSoccurs when RRMS takes on a progressive form. Within 25 years of having RRMS, an estimated 90% of untreated patients gradually transitioned to SPMS.
Primary Progressive MS (PPMS)
Withprimary progessive MS, there’s a slow and steady decline in function due to permanent damage to nerves. Relapses and plateaus may occur in some people. PPMS usually starts with problems walking, such as foot-dragging or stiffness in one or both legs. Over the course of months and years, the degree of disability increases.
This type affects around 15% of people with MS. Older adults are more likely to be diagnosed with PPMS than younger adults.
Types of Multiple Sclerosis
Unfortunately, MS may be harder to diagnose in this population for a variety of reasons. One of the main barriers is that MS has not been studied in the older adult population as much as in younger adults.
Symptoms of late-onset MS are also often mistaken for signs of normal aging. These include fatigue,balance problems,vision changes, andcognitive impairmentthat healthcare providers may presume are aging-related.
Even some diagnostic tests may be incorrectly interpreted if steps are not taken to explore immune-mediated diseases.
In late-onset MS, symptoms can easily mimic those of other disorders including:
Steps to Getting an MS Diagnosis
While the initial symptoms of late-onset MS develop later in life, research suggests that physical disability and loss of motor function occur faster and more frequently when MS develops later.
Studies differ on which type of MS is diagnosed more often in late-onset MS; some say PPMS, while others say RRMS. PPMS does tend to be diagnosed when people are in their 40s and 50s though, around the same time that the majority of people with RRMS transition into secondary progressive MS (SPMS).
A 2016 study published in the journalPLoS Oneconcluded that people with late-onset MS reached a higher disability level faster—a median time of 6.5 years—compared to a median of 12.8 years for people with adult-onset MS. Males were also found to progress significantly faster to disability than females.
Delayed diagnosis and treatment are among the reasons why people with late-onset MS tend to have a worse outcome. The effects of aging, more rapid physical disability, and having PPMS are other factors.
Your treatment plan will depend on the type of MS you’ve been diagnosed with, other medical conditions you may have, and how severe your disease is. Your neurologist will go over the strategies for managing MS that will be most effective for you and your individual situation.
Medications
If you’ve recently found out you have MS and you’re over 50, your medication options may be more limited than they are for a younger adult.
This is partly because many past clinical trials on medications for MS purposely excluded people over 50, so it’s not always clear what’s most effective or safe for those in this age group.Thankfully, many newer studies have expanded the age of participants to 60 or 65.
As with any powerful medication, Ocrevus and Ocrevus Zunovo have side effects, including some that could be especially problematic for older people, such as increasing the risk of respiratory infections and causing abnormal tissue growth.
For RRMS, patients who are over the age of 50 may not respond as well as younger patients to Novantrone (mitoxantrone), one of the DMTs that’s FDA-approved to treat both RRMS and secondary progressive MS.
How Multiple Sclerosis Is Treated
Rehabilitation Therapies
Even though medications for PPMS are limited, there are many rehabilitation treatments available to help with MS symptoms.Your healthcare provider may recommend one or more of the following:
A Word From Verywell
In the end, the course of late-onset MS and how different it is from regular adult-onset MS is still not entirely clear, but a prompt and accurate diagnosis is as critically important in late-onset MS as it is at any age.
This is because starting treatment with disease-modifying medications as soon as possible can reduce MS attacks and new lesions, as well as slow the progression of the disease. If you think you might have symptoms of MS, be sure to see your healthcare provider.
Frequently Asked QuestionsThere’s no limit. Although MS typically occurs in people between 20 and 40 years old, cases of late onset (also called later-onset) multiple sclerosis have been documented in people in their 80s and older.Womenin general are more susceptible to multiple sclerosis, regardless of age.The early symptoms of MS are basically the same regardless of a person’s age. When you’re older, some of them, such as fatigue, problems with balance, andchanges in visionand cognition can easily be mistaken for normal aging. If you’re having any symptoms that seem out of place for your age and general health and well-being, let your healthcare provider know.Learn MoreCauses of Memory Loss
There’s no limit. Although MS typically occurs in people between 20 and 40 years old, cases of late onset (also called later-onset) multiple sclerosis have been documented in people in their 80s and older.
Womenin general are more susceptible to multiple sclerosis, regardless of age.
The early symptoms of MS are basically the same regardless of a person’s age. When you’re older, some of them, such as fatigue, problems with balance, andchanges in visionand cognition can easily be mistaken for normal aging. If you’re having any symptoms that seem out of place for your age and general health and well-being, let your healthcare provider know.Learn MoreCauses of Memory Loss
The early symptoms of MS are basically the same regardless of a person’s age. When you’re older, some of them, such as fatigue, problems with balance, andchanges in visionand cognition can easily be mistaken for normal aging. If you’re having any symptoms that seem out of place for your age and general health and well-being, let your healthcare provider know.
Learn MoreCauses of Memory Loss
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Multiple sclerosis.McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238Olek MJ, Mowry E.Treatment of progressive multiple sclerosis in adults.National Multiple Sclerosis Society.Primary progressive MS (PPMS).Lotti CBC, Oliveira ASB, Bichuetti DB, Castro I, Oliveira EML.Late onset multiple sclerosis: concerns in aging patients.Arq Neuropsiquiatr. 2017;75(7):451-456. doi:10.1590/0004-282x20170070Arias M, Dapena D, Arias-Rivas S, et al.Late onset multiple sclerosis.Neurologia. 2011;26(5):291-6. doi:10.1016/j.nrl.2010.09.008Guillemin F, Baumann C, Epstein J, et al.Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study.Neuroepidemiology. 2017;48(3-4):179-187. doi:10.1159/000479516Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-hashel J.Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis?.PLoS ONE. 2016;11(11):e0165846. doi:10.1371/journal.pone.0165846Shirani A, Zhao Y, Petkau J, et al.Multiple sclerosis in older adults: the clinical profile and impact of interferon beta treatment.Biomed Res Int. 2015;2015:451912. doi:10.1155/2015/451912Pzizer.Mitoxantrone-mitozantrone injection, solution, concentrate.National Multiple Sclerosis Society.Rehabilitation.Haselkorn JK, Hughes C, Rae-grant A, et al.Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Neurology. 2015;85(21):1896-903. doi:10.1212/WNL.0000000000002146Cleveland Clinic.Vocational rehabilitation services.Schultheiss T, Reichmann H, Ziemssen T.Rapidly progressive course of very late onset multiple sclerosis presenting with Parkinsonism: case report.Mult Scler. 2011;17(2):245-249. doi:10.1177/1352458510384306Merck Manual Professional Version.Multiple Sclerosis (MS).
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Multiple sclerosis.McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238Olek MJ, Mowry E.Treatment of progressive multiple sclerosis in adults.National Multiple Sclerosis Society.Primary progressive MS (PPMS).Lotti CBC, Oliveira ASB, Bichuetti DB, Castro I, Oliveira EML.Late onset multiple sclerosis: concerns in aging patients.Arq Neuropsiquiatr. 2017;75(7):451-456. doi:10.1590/0004-282x20170070Arias M, Dapena D, Arias-Rivas S, et al.Late onset multiple sclerosis.Neurologia. 2011;26(5):291-6. doi:10.1016/j.nrl.2010.09.008Guillemin F, Baumann C, Epstein J, et al.Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study.Neuroepidemiology. 2017;48(3-4):179-187. doi:10.1159/000479516Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-hashel J.Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis?.PLoS ONE. 2016;11(11):e0165846. doi:10.1371/journal.pone.0165846Shirani A, Zhao Y, Petkau J, et al.Multiple sclerosis in older adults: the clinical profile and impact of interferon beta treatment.Biomed Res Int. 2015;2015:451912. doi:10.1155/2015/451912Pzizer.Mitoxantrone-mitozantrone injection, solution, concentrate.National Multiple Sclerosis Society.Rehabilitation.Haselkorn JK, Hughes C, Rae-grant A, et al.Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Neurology. 2015;85(21):1896-903. doi:10.1212/WNL.0000000000002146Cleveland Clinic.Vocational rehabilitation services.Schultheiss T, Reichmann H, Ziemssen T.Rapidly progressive course of very late onset multiple sclerosis presenting with Parkinsonism: case report.Mult Scler. 2011;17(2):245-249. doi:10.1177/1352458510384306Merck Manual Professional Version.Multiple Sclerosis (MS).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cleveland Clinic.Multiple sclerosis.McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238Olek MJ, Mowry E.Treatment of progressive multiple sclerosis in adults.National Multiple Sclerosis Society.Primary progressive MS (PPMS).Lotti CBC, Oliveira ASB, Bichuetti DB, Castro I, Oliveira EML.Late onset multiple sclerosis: concerns in aging patients.Arq Neuropsiquiatr. 2017;75(7):451-456. doi:10.1590/0004-282x20170070Arias M, Dapena D, Arias-Rivas S, et al.Late onset multiple sclerosis.Neurologia. 2011;26(5):291-6. doi:10.1016/j.nrl.2010.09.008Guillemin F, Baumann C, Epstein J, et al.Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study.Neuroepidemiology. 2017;48(3-4):179-187. doi:10.1159/000479516Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-hashel J.Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis?.PLoS ONE. 2016;11(11):e0165846. doi:10.1371/journal.pone.0165846Shirani A, Zhao Y, Petkau J, et al.Multiple sclerosis in older adults: the clinical profile and impact of interferon beta treatment.Biomed Res Int. 2015;2015:451912. doi:10.1155/2015/451912Pzizer.Mitoxantrone-mitozantrone injection, solution, concentrate.National Multiple Sclerosis Society.Rehabilitation.Haselkorn JK, Hughes C, Rae-grant A, et al.Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Neurology. 2015;85(21):1896-903. doi:10.1212/WNL.0000000000002146Cleveland Clinic.Vocational rehabilitation services.Schultheiss T, Reichmann H, Ziemssen T.Rapidly progressive course of very late onset multiple sclerosis presenting with Parkinsonism: case report.Mult Scler. 2011;17(2):245-249. doi:10.1177/1352458510384306Merck Manual Professional Version.Multiple Sclerosis (MS).
Cleveland Clinic.Multiple sclerosis.
McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238
Olek MJ, Mowry E.Treatment of progressive multiple sclerosis in adults.
National Multiple Sclerosis Society.Primary progressive MS (PPMS).
Lotti CBC, Oliveira ASB, Bichuetti DB, Castro I, Oliveira EML.Late onset multiple sclerosis: concerns in aging patients.Arq Neuropsiquiatr. 2017;75(7):451-456. doi:10.1590/0004-282x20170070
Arias M, Dapena D, Arias-Rivas S, et al.Late onset multiple sclerosis.Neurologia. 2011;26(5):291-6. doi:10.1016/j.nrl.2010.09.008
Guillemin F, Baumann C, Epstein J, et al.Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study.Neuroepidemiology. 2017;48(3-4):179-187. doi:10.1159/000479516
Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-hashel J.Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis?.PLoS ONE. 2016;11(11):e0165846. doi:10.1371/journal.pone.0165846
Shirani A, Zhao Y, Petkau J, et al.Multiple sclerosis in older adults: the clinical profile and impact of interferon beta treatment.Biomed Res Int. 2015;2015:451912. doi:10.1155/2015/451912
Pzizer.Mitoxantrone-mitozantrone injection, solution, concentrate.
National Multiple Sclerosis Society.Rehabilitation.
Haselkorn JK, Hughes C, Rae-grant A, et al.Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Neurology. 2015;85(21):1896-903. doi:10.1212/WNL.0000000000002146
Cleveland Clinic.Vocational rehabilitation services.
Schultheiss T, Reichmann H, Ziemssen T.Rapidly progressive course of very late onset multiple sclerosis presenting with Parkinsonism: case report.Mult Scler. 2011;17(2):245-249. doi:10.1177/1352458510384306
Merck Manual Professional Version.Multiple Sclerosis (MS).
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