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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Bibliographic Details
Published in:Nature reviews. Neurology Vol. 15; no. 6; pp. 329 - 342
Main Authors: Vaughn, Caila B, Jakimovski, Dejan, Kavak, Katelyn S, Ramanathan, Murali, Benedict, Ralph H B, Zivadinov, Robert, Weinstock-Guttman, Bianca
Format: Journal Article
Language:English
Published: England Nature Publishing Group 01.06.2019
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:1759-4758
1759-4766
1759-4766
DOI:10.1038/s41582-019-0183-3