Late onset MS and treatment

Typically multiple sclerosis is diagnosed between the ages of 20-40 years old. Late onset MS – diagnosis post 40 – is still possible but less common; symptoms can be mistaken for other age-related health issues.

Article medically reviewed by Karen Vernon an MS Nursing Specialist at Salford Royal Foundation Trust, UK.

Multiple sclerosis is most typically diagnosed in younger people - aged between 20 and 40 years old, usually. But, a multiple sclerosis diagnosis can come in later life, too, outside the average age for MS diagnosis.

Some people only discover they have multiple sclerosis in their 50s or 60s, although they might have been living with it for some time before an official diagnosis. In older people, MS symptoms could be mistaken for age-related conditions, which can lead to a delay in being diagnosed.

An MS diagnosis in people who are older than the 20-40 years average age range is often classed as late-onset MS. It’s rare to be diagnosed with multiple sclerosis after the age of 50, and rarer still to be 60 or older. Some studies have shown that people over the age of 60 years old, diagnosed with relapsing remitting multiple sclerosis, account for only 1% of MS cases.

“Awaiting a diagnosis but confident I have MS… late onset as I am 65. From reading it seems late onset is primary progressive MS and it feels progressive as my legs weaken and I developed foot drop.” @Cassy

MS symptoms in older adults

“I am 61 and have had noticeable symptoms for about a year and a half now… but looking back I have had some recognisable traits as I call them for some time.”

Reaching an MS diagnosis isn’t a simple process. There isn’t a one-off test to come to a conclusion. So, it can be more challenging to diagnose multiple sclerosis in older adults. Why is this? Well, it’s often because some symptoms are associated with age-related conditions, primarily fatigue, vision or eyesight issues, problems with balance and cognitive impairment. 

As we age, it’s common to experience some of these issues so it’s easy to confuse the onset with some of these as part of the ageing process and not necessarily a condition such as multiple sclerosis.

On top of this, common MS symptoms can be similar to other conditions that can manifest in older age, including stroke, which affects balance and vision, and Parkinson’s disease, which has a similar impact. Cognitive impairment, affecting memory and brain function, could be mistaken for dementia or Alzheimer’s. For older people in particular, getting a diagnosis of multiple sclerosis can be a process of elimination and take time while other neurological conditions that present with similar symptoms are ruled out.  

Does MS progress more quickly in older people?

The way multiple sclerosis is treated in older people might differ compared to those of a younger age – though everyone’s journey is different, and a treatment management plan is always based on the individual.

As we covered in this guide, there are different types of multiple sclerosis. While relapsing remitting MS is the most frequently diagnosed type in the 20-40 age range, in adults aged 40 and older, it’s more common to see primary progressive MS (PPMS). 

With PPMS, your multiple sclerosis is classed as progressive, so symptoms can gradually worsen. This means that, in some cases, MS can progress at a quicker rate in older people. That said, PPMS symptoms can be mild over a long period of time.

Compared to RRMS, there are fewer disease modifying therapy (DMT) treatment options if you have PPMS. A DMT called Ocrevus, or ocrelizumab, is one option. Older people, especially those of a senior age, may have lower immune systems and so any kinds of drug treatment will need to be carefully considered and discussed with your MS support team, of course. How medication may affect the body as someone ages will be a consideration, as it is for any condition.

Living with multiple sclerosis always provides challenges in some form. An MS diagnosis later in life can further impact mobility issues and mental health. Although everyone is different, it can be more challenging to stay physically active as you age and a diagnosis of multiple sclerosis is likely to throw up other hurdles in that regard.

Regardless of age though, there are still mechanisms you can put in place and help you can turn to when living with MS. Read about our advice for living with MS here, and tips for managing your mental health here.

A diagnosis of multiple sclerosis in your senior years may prompt you to change any plans you might have had in mind – including working, retirement and lifestyle – but this doesn’t need to be a bad thing!

“For me at this age (I’m in my 50s), me and my husband did a massive restructure last year, effectively enabling a state of semi-retirement and it was the best thing we ever did.” @Vixen

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