Older people do less well


Guillemin F, Baumann C, Epstein J, Kerschen P, Garot T, Mathey G, Debouverie M; LORSEP Group.Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study.Neuroepidemiology. 2017 Aug 10;48(3-4):179-187.
BACKGROUND:Late-onset multiple sclerosis (LOMS) frequently features a primary progressive (PP) course, strongly predicting severe disability. In this population-based cohort, we estimated the prognostic role of age at multiple sclerosis (MS) onset, independent of PP course, on disability progression.
METHODS:The association of age at disease onset (adult, <50 years [AOMS], vs. late, ≥50 years [LOMS]) and time to Expanded Disability Status Scale (EDSS) score 4 and 6 was estimated by Cox regression modelling.
RESULTS:Among 3,597 patients, 245 had LOMS. Relapsing-remitting (RR) disease was less frequent with LOMS than AOMS (51.8 vs. 90.8%, p < 0.0001). PP course, LOMS and male gender predicted short time to EDSS 4 and 6. Worse outcome with LOMS (time to EDSS 4 and 6, HR 2.0 [95% CI 1.7-2.4] and 2.3 [1.9-2.9]) was independent of PP course or male gender. LOMS had greater impact on RR than PP disease (time to EDSS 4 and 6, HR 3.1 [2.3-4.0] and 4.0 [2.9-5.6]). Only LOMS predicted time from EDSS 4 to 6 (p < 0.0001).
CONCLUSIONS:Late onset MS was strongly associated with poor prognosis, independent of initial disease course, in predicting the disability progression along time.

ProfG has often said that “Age Matters” especially when it relates to brain health. As we age our repair and protective capabilities wane. This study supports this view and the the older you are there less well you do. However this is at a population level and there will be older people who do very well and younger people who do very badly.

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  • I believe "late-onset" just means that the MS was there for many years. Just that it wasn't severe enough or active enough to draw attention.

    Ie late-onset MS has probably been around for thirty-forty-fifty years, simmering beneath the surface

  • I agree with anon 9.36 LOMS often means MEMS (missed earlier MS). So not sure too much should be read into these comparison studies. Would be interesting to repeat the study using 'date of probable earliest symptoms' instead of diagnosis date. As historically no dmt at least people were spared the knowing.

    Different story nowadays, we hope. Sooner the treat early message is taken on board by all the better. Generic cladribine for CIS (as well as PP and SP of course). Safe, effective, convenient… …and cheap 🙂

  • Researchers should focus on improving a progressive or elderly MS patient's reserve through remyelination, neuroprotection and neurorestoration. Instead, we continue to "beat a dead horse" and focus solely on the pharma driven inflammation model which has failed progressive MS patients miserably time and again as bluntly pointed out in MD's other thread "Are MS drugs a waste of time".

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