Epidemiology and treatment of multiple sclerosis in elderly populations

The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their...

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Vydáno v:	Nature reviews. Neurology Ročník 15; číslo 6; s. 329 - 342
Hlavní autoři:	Vaughn, Caila B, Jakimovski, Dejan, Kavak, Katelyn S, Ramanathan, Murali, Benedict, Ralph H B, Zivadinov, Robert, Weinstock-Guttman, Bianca
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Nature Publishing Group 01.06.2019
Témata:	Aged Aging Aging - immunology Aging - physiology Brain - immunology Brain - physiopathology Disease Progression Epidemiology Humans Immune system Immunosenescence Multiple sclerosis Multiple Sclerosis - epidemiology Multiple Sclerosis - immunology Multiple Sclerosis - physiopathology Multiple Sclerosis - therapy Population
ISSN:	1759-4758, 1759-4766, 1759-4766
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Abstract	The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition.
AbstractList	The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition.The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition. The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition. The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition.Vaughn et al. review the challenges facing elderly patients with multiple sclerosis (MS). They describe the complex, evolving relationship between ageing and MS pathophysiology, highlight the lack of evidence for the safety and efficacy of disease-modifying therapies in elderly patients, and discuss treatment discontinuation and wellness strategies.
Author	Zivadinov, Robert Jakimovski, Dejan Vaughn, Caila B Weinstock-Guttman, Bianca Benedict, Ralph H B Kavak, Katelyn S Ramanathan, Murali
Author_xml	– sequence: 1 givenname: Caila B orcidid: 0000-0001-8155-3501 surname: Vaughn fullname: Vaughn, Caila B organization: Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA – sequence: 2 givenname: Dejan orcidid: 0000-0001-7114-4958 surname: Jakimovski fullname: Jakimovski, Dejan organization: Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA – sequence: 3 givenname: Katelyn S surname: Kavak fullname: Kavak, Katelyn S organization: Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA – sequence: 4 givenname: Murali surname: Ramanathan fullname: Ramanathan, Murali organization: Department of Pharmaceutical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA – sequence: 5 givenname: Ralph H B surname: Benedict fullname: Benedict, Ralph H B organization: Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA – sequence: 6 givenname: Robert surname: Zivadinov fullname: Zivadinov, Robert organization: Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York (SUNY), Buffalo, NY, USA – sequence: 7 givenname: Bianca orcidid: 0000-0001-6732-151X surname: Weinstock-Guttman fullname: Weinstock-Guttman, Bianca email: bw8@buffalo.edu organization: Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA. bw8@buffalo.edu
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Snippet	The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the...
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StartPage	329
SubjectTerms	Aged Aging Aging - immunology Aging - physiology Brain - immunology Brain - physiopathology Disease Progression Epidemiology Humans Immune system Immunosenescence Multiple sclerosis Multiple Sclerosis - epidemiology Multiple Sclerosis - immunology Multiple Sclerosis - physiopathology Multiple Sclerosis - therapy Population
Title	Epidemiology and treatment of multiple sclerosis in elderly populations
URI	https://www.ncbi.nlm.nih.gov/pubmed/31000816 https://www.proquest.com/docview/2232671354 https://www.proquest.com/docview/2211946115
Volume	15
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