Living with multiple sclerosis in old age presents a unique challenge in understanding how the disease interacts with the natural aging process. This special ECTRIMS Review delves into groundbreaking studies exploring aging with MS, focusing on topics such as cognitive health, inflammation, brain changes, and diagnostic tools like OCT. Whether you are gaining insights into how MS develops in older age or looking for ways to proactively manage your health, this episode is packed with valuable information to help you navigate your path with confidence and knowledge.
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Table of Contents
1. Aging in People with Multiple Sclerosis: Cognitive Characteristics
by María Bárbara Eizaguirre et. al
Aging with Multiple Sclerosis: What You Should Know About Cognitive Health
Growing older comes with natural changes, and for those living with MS, cognitive challenges like memory, focus, or processing speed can sometimes feel more noticeable. A recent study explored how aging might affect cognitive abilities in people with MS, comparing older and younger individuals. Let’s break it down and see what this research means for you!
Why Was This Study Done?
Cognitive problems (like memory lapses, slower thinking, or attention difficulties) are common in MS, affecting up to 40% of people. While we know aging naturally impacts cognitive function, this study wanted to find out:
- How aging influences cognitive function in people with MS.
- What differences exist between older MS patients (OPMS) and younger MS patients (YPMS).
The goal? To better understand the challenges so healthcare providers can offer more targeted support as you age with MS.
How Did the Study Work?
The study looked at 138 people with MS:
- 68 were older (average age 59 years, OPMS).
- 70 were younger (average age 36 years, YPMS).
Participants completed tests that measured:
- Cognitive abilities: memory, information processing, and attention.
- Clinical factors: fatigue, depression, and disability levels (EDSS).
The results were compared to see how aging might influence these areas for people with MS.
Key Findings: Cognitive Differences Between Age Groups
Processing Speed and Memory Decline with Age:
- The older group (OPMS) had greater challenges with processing speed and short-term memory compared to the younger group.
- For example, 54% of older MS patients had cognitive issues compared to 29% of younger MS patients.
Fatigue and Depression Play a Role:
- Higher levels of fatigue and depression were associated with poorer cognitive performance in both groups.
Disability Levels Were Higher in Older Patients:
- As expected, older MS patients showed slightly higher levels of disability (EDSS scores), which might also impact cognitive performance.
What Does This Mean for You?
While aging is a natural process, it’s important to know that changes in cognitive function are common and not a reason to feel discouraged. This study helps to highlight a few key takeaways:
- You’re Not Alone: Cognitive changes happen to many people with MS as they age, but recognizing them early can help you manage them better.
- Fatigue and Mood Matter: Addressing fatigue and depression can have a positive effect on cognitive function, so don’t hesitate to talk to your doctor about strategies to manage these symptoms.
- There’s Hope for Cognitive Support: By staying active, both mentally and physically, and working with your healthcare team, you can protect and improve your cognitive abilities as you age.
How Reliable Are These Findings?
This study used a solid method, with a good number of participants and well-validated cognitive tests. However, it’s an observational study, which means it looked at patterns rather than testing specific treatments. On the Cochrane scale of evidence, this type of research provides moderate-level reliability—useful for understanding real-world experiences, though more studies are needed to confirm the findings.
Tips for Managing Cognitive Health as You Age with MS
- Stay Mentally Active: Challenge your brain with puzzles, reading, or learning new skills.
- Manage Fatigue and Mood: Talk to your doctor about managing energy levels and addressing any signs of depression or anxiety.
- Exercise Regularly: Physical activity is proven to support brain health and overall well-being.
- Connect Socially: Staying connected with friends, family, or MS support groups can help keep your mind engaged.
- Speak to Your Doctor: If you notice changes in memory or focus, bring it up during your appointments to discuss helpful strategies or tools.
Takeaway Message
Aging with MS may bring cognitive changes, but it’s important to remember that you have the tools and support to manage them. This study reinforces the importance of caring for your mind, body, and emotional health as you navigate life with MS. You’re not alone, and small, proactive steps can make a big difference in how you feel and function every day.
2. Inflammaging and multiple sclerosis: inevitable partners in aging?
by Andrea Iribarren-López et. al
Aging, Inflammation, and MS: What This Research Means for You
As we get older, our immune system naturally changes, a process called immunosenescence. For people with MS, this aging process can interact with the disease in ways that affect inflammation, nerve health, and overall symptoms. A recent study explored these connections, providing new insights that help us understand how aging impacts the immune system in MS.
Let’s break down the findings and what they mean for your MS journey.
Why Was This Study Done?
Inflammation is a big part of MS progression and aging. This study wanted to investigate:
- How inflammation changes as we age in people with MS compared to healthy individuals.
- How markers of neurodegeneration (nerve damage) relate to aging and inflammation.
By identifying these patterns, researchers hope to improve how MS is managed as we age.
How Did the Study Work?
Researchers compared blood samples from:
- People with MS across different ages.
- Healthy individuals of similar ages.
They measured the levels of:
- Cytokines (inflammatory molecules like IL-1ß, IL-6, IL-10, and TNF-α) that signal inflammation.
- CRP (C-reactive protein): A marker of overall inflammation.
- NfL (Neurofilament light chain): A marker of nerve damage and neurodegeneration.
These measurements gave a clear picture of how inflammation and neurodegeneration differ in MS as people age.
Key Findings: Aging, Inflammation, and MS
Inflammation Is Higher in People with MS:
- Inflammatory molecules like IL-6 and TNF-α were significantly higher in people with MS compared to healthy individuals.
Inflammation Increases with Age:
- In both groups, inflammation levels increased with age, but the effect was stronger in people with MS.
Signs of Nerve Damage Are Linked to Aging:
- The marker NfL, which reflects nerve damage, was higher in people with MS and increased as they aged.
- The correlation between aging and nerve damage was much stronger in MS patients.
CRP and IL-10 Were Unique to MS:
- CRP (a general marker of inflammation) and IL-10 (an anti-inflammatory molecule) increased with age only in people with MS.
Why Is This Important for You?
This research highlights that aging and MS can interact to increase inflammation and nerve damage. But here’s the good news: understanding this connection can lead to better ways to monitor and manage MS as you get older.
- Knowledge Is Power: Knowing that inflammation naturally increases with age gives you and your healthcare provider a chance to focus on strategies to reduce it, such as exercise, nutrition, and possibly medications.
- Monitoring Nerve Health: Tracking markers like NfL could help identify changes earlier and adapt your care plan to maintain brain and nerve health.
3. Aging intervenes in relationship between OCT and clinical or MRI outcome measures
by Sezgi Kaçar
Aging and MS: How Does It Affect Your Brain and Vision?
As we age, changes naturally happen in our brain and body, but for those living with MS, it’s important to understand how aging interacts with MS progression. A recent study explored the relationship between aging, nerve layers in the eye, and brain health in people with MS, helping us gain a clearer picture of what’s happening and why it matters.
What Was This Study About?
The goal of the study was to see how aging impacts the connection between:
- Nerve thickness in the eye (measured through OCT, a type of eye scan).
- Brain health (measured through MRI scans).
- Clinical outcomes, such as disability levels.
These measurements provide important clues about how aging and MS progression might be connected.
How Did the Study Work?
Researchers compared data from two groups of MS patients:
- Project Y – Patients chosen based on their birth year.
- PrograMS – A more diverse group of MS patients with varying disease lengths.
They used advanced statistical models to measure:
- RNFL and GCIPL Thickness: Layers of nerve tissue in the eye.
- Brain Health: MRI measures, such as white matter and brain volume.
- Disability Levels: Clinical markers like the EDSS score.
Key Findings: What the Study Discovered
Changes in Eye Nerve Layers:
- MS patients had thinner nerve layers (RNFL and GCIPL) compared to healthy individuals.
- These changes were seen more clearly as patients aged or had longer disease duration.
Connections to Brain Health:
- Thinner eye nerve layers were linked to changes in brain volume (like white matter and thalamus) seen on MRI scans.
- This means that changes in the eyes can reflect what’s happening in the brain as you age.
Disability and Eye Nerve Layers:
- Higher disability scores (like EDSS) were associated with thinner nerve layers in the eye, showing a connection between physical function and nerve health.
What Does This Mean for You?
This study provides important insights:
- Your Eyes Are a Window to Your Brain: Measuring the thickness of nerve layers in your eyes with OCT scans can provide valuable clues about brain health and MS progression.
- Aging Plays a Role, but It’s Not the Only Factor: While aging naturally impacts nerve and brain health, MS progression and disease duration are significant factors too.
- Early Monitoring Matters: By tracking changes in eye nerve layers and brain volume, doctors can better understand your MS journey and guide treatment strategies.
How Reliable Is This Study?
This study used large datasets and robust statistical methods to analyze how aging affects nerve and brain health in MS. While it’s not a randomized trial (the gold standard on the Cochrane scale), the findings are highly reliable because they combine clinical, MRI, and eye measurements across different groups of patients.
What Can You Do?
- Ask About Eye Scans (OCT): OCT scans are quick, painless, and can provide important information about your nerve health. They may be helpful in tracking MS changes over time.
- Keep Your Brain Healthy: Stay active, eat a balanced diet, and manage stress—these strategies can support brain health as you age.
- Monitor Your Symptoms: Share any changes in vision, memory, or physical function with your doctor to stay on top of your care.
Takeaway
This research shows that aging, MS, and nerve health are connected—but you’re not powerless. By tracking eye and brain changes early and working with your healthcare team, you can stay proactive in managing MS as you age. Remember, understanding these changes empowers you to take control of your health and feel confident about your MS journey.
4. Enlarged perivascular spaces are associated with brain microangiopathy and aging in multiple sclerosis
by François Guisset et. al
How Brain MRI Markers Help Us Understand Aging and MS
When living with multiple sclerosis (MS), understanding how aging and brain changes interact is key to managing your health. This study looks at enlarged perivascular spaces (EPVS)—tiny fluid-filled spaces in the brain seen on MRI scans—and how they might play a role in aging, neurodegeneration, and MS progression. Let’s break it down together.
What Are EPVS and Why Do They Matter?
EPVS are small spaces around blood vessels in the brain. While they’re a normal part of aging, having more EPVS can sometimes indicate issues like neuroinflammation or neurodegeneration, which are relevant for people with MS. This study aimed to see if EPVS could serve as a marker for brain health and MS progression.
What Did the Study Do?
Researchers analyzed 207 people with MS using brain MRI scans. They divided participants into two groups based on their EPVS levels:
- High EPVS (more enlarged spaces).
- Low EPVS (fewer enlarged spaces).
They compared these groups to look for connections between EPVS and other brain health markers, like:
- Brain-predicted age difference (PAD): This shows how much your brain age differs from your actual age.
- Brain volume and lesions: These are indicators of MS disease progression.
- Cerebral spinal fluid spaces: Important for brain health and inflammation.
Key Findings: What They Discovered
More EPVS Linked to Brain Changes:
People with higher EPVS levels showed more brain aging (higher PAD) and changes in brain volume, particularly in areas like the thalamus—a key region for processing information.EPVS and Neurodegeneration:
Higher EPVS levels were also linked to other signs of neurodegeneration, like increased lesions and reduced brain volume. This suggests EPVS may reflect the long-term effects of MS on the brain.EPVS as a Brain Health Marker:
EPVS could serve as a potential MRI marker for tracking brain health in MS. It might help identify early signs of aging or worsening MS, allowing doctors to intervene earlier.
What Does This Mean for You?
This research shows that EPVS seen on MRI scans may provide helpful clues about brain aging and MS progression. Here’s what it means practically:
- Monitoring Brain Health: If you’re having regular MRI scans, EPVS might one day be used alongside other markers (like brain volume) to get a clearer picture of your MS progression.
- Early Detection: Understanding these changes early could help your healthcare team personalize your care and focus on ways to support brain health.
- The Role of Aging: While aging naturally impacts the brain, EPVS help us see how MS might accelerate these changes and what we can do to slow them down.
How Reliable Is This Study?
This study used MRI imaging and analyzed a large group of MS patients, which makes the findings reliable and relevant. On the Cochrane evidence scale, this study is observational—meaning it identifies connections rather than causes—but it still provides valuable insights into MS and brain health.
What Can You Do?
- Talk to Your Doctor About Brain Health: Ask how regular MRI scans are helping monitor your MS progression and brain health.
- Protect Your Brain: Staying active, eating a balanced diet, managing stress, and keeping your mind engaged can all support healthy aging.
- Be Proactive: Understanding how aging and MS interact gives you the power to take charge of your health and discuss new approaches with your healthcare team.
Takeaway
EPVS are emerging as an important marker in MS, helping researchers better understand how aging and neurodegeneration interact. While aging is a natural process, knowing more about brain changes can help you and your doctors work together to slow progression and keep you feeling your best.
Your journey with MS is unique, but with knowledge, awareness, and the right care, you can continue to live well and thrive—no matter your age.
5. Levraging immunosenescence cellular signatures to evaluate the "immune-age": moving towards precision medicine in multiple sclerosis
by Hanane Touil et. al
How Aging and the Immune System Interact in MS: What You Need to Know
Aging is a natural process, but for people living with multiple sclerosis (MS), it can come with unique challenges. This study takes a closer look at how the immune system changes as we age—something called immunosenescence—and what it might mean for brain health in MS. Let’s break it down so it’s easy to understand.
What Is Immunosenescence, and Why Does It Matter?
As we age, our immune system changes. Some cells lose their ability to fight off infections, while others become more active than they should be. This process, known as immunosenescence, is linked to inflammation and aging in the brain.
For people with MS, who already deal with an overactive immune system attacking nerve cells, this aging process may play a role in brain changes like atrophy (shrinking brain volume) and cognitive decline.
What Was the Goal of the Study?
The researchers wanted to:
- Look at how the immune system changes with age in ethnically diverse groups, including people with MS.
- Understand how these immune changes relate to brain health, particularly brain volume loss.
This focus is important because most aging studies have been done in European populations, and it’s critical to understand these processes across different ethnic backgrounds.
How Was the Study Done?
Researchers studied 239 people aged 22–88 years, including:
- People of African American (AA), Hispanic (His), and non-Hispanic White (NHW) backgrounds.
- People with MS and healthy individuals for comparison.
They measured:
- Immune cell changes using flow cytometry (a lab technique to study blood cells).
- Brain health using MRI scans to check brain volume.
What Did the Study Find?
Changes in Immune Cells With Aging:
- The study found a decrease in some immune cells (like naive T-cells) as people aged, which is normal.
- However, they identified a specific immune cell type called CD56+PD-L1+ NK cells in Hispanic individuals that becomes more active with age. These cells are linked to inflammation and may play a role in MS progression.
Brain Changes and Inflammation:
- For people with MS, the researchers saw a connection between immune cell activity and brain volume loss, particularly in regions like the entorhinal cortex and parahippocampal regions (important for memory and cognition).
- These findings suggest that immune system aging may influence how quickly brain atrophy happens in MS.
Ethnic Differences Matter:
- This study highlights that immune aging processes can vary across ethnic groups, which is an important step toward understanding how MS affects different populations.
What Does This Mean for You?
This research helps us understand how aging and the immune system interact in MS. Here’s what it means for you:
- Aging and MS Are Connected: Immune system changes may contribute to brain changes as you age, so it’s important to monitor your health regularly.
- The Role of Inflammation: Managing inflammation may help slow brain changes and protect cognitive function. Talk to your doctor about strategies, including diet, exercise, and medication, that may help reduce inflammation.
- Diverse Perspectives Matter: This study’s inclusion of diverse populations is a big step forward in making research more relevant and inclusive for everyone with MS.
How Reliable Is This Study?
This study used well-established techniques like flow cytometry and MRI imaging to analyze immune cells and brain health, which adds to its reliability. On the Cochrane evidence scale, this would be considered observational research, meaning it identifies connections but doesn’t prove cause and effect. However, with a large, diverse group of participants and strong methods, these findings provide valuable insights into aging and MS.
Takeaway
This study sheds light on the link between aging, the immune system, and brain health in MS. By understanding how these processes interact, researchers are getting closer to finding ways to slow brain changes and improve quality of life as you age with MS.
Stay positive and proactive—maintaining a healthy lifestyle and working with your healthcare team can help you take charge of your MS journey at every stage of life.
6. Durable efficacy of cladribine tablets in an aging (> 50 years of age) MS patient population- A Real-World Experience
by Donald Negroski et. al
What Was the Study About?
The study looked at people with relapsing MS (RMS) who switched to cladribine tablets from other treatments. It aimed to understand how well cladribine works in real-world conditions, particularly for patients under and over the age of 50. Researchers analyzed how it affected relapses, MRI activity, and lymphocyte levels (important for the immune system).
Why Cladribine?
Cladribine tablets are unique because they are a short-course treatment, taken over two years. Unlike continuous medications, cladribine works by selectively targeting immune cells that drive MS progression. This makes it especially appealing if you’re looking for a treatment that’s low-maintenance but effective.
Key Findings
Well-Tolerated and Effective:
- Most patients showed stable or improved MRI results and fewer relapses after starting cladribine.
- This includes people both under and over 50 years old, showing that it works effectively regardless of age.
Reduced Relapses:
- The average annual relapse rate was significantly lower for patients on cladribine compared to their previous treatments.
Lymphocyte Dynamics:
- While cladribine lowers certain immune cells (lymphocytes), these levels mostly remained stable and manageable. This is important for monitoring immune function over time.
Reasons for Switching Treatments:
- Patients switched to cladribine for various reasons, including:
- Worsening MRI activity
- Relapses or disease progression
- Desire for a shorter, more convenient treatment schedule
- Side effects from previous therapies
- Patients switched to cladribine for various reasons, including:
What Does This Mean for You?
If you’re living with MS and navigating the challenges of aging, this study offers encouraging news:
- Cladribine is an effective option that’s particularly easy to manage because it’s taken for a short time each year.
- It works well for older adults and those with long-standing MS, showing stable results in real-life conditions.
- For people tired of continuous treatments or side effects, cladribine offers a simpler path to managing your MS while maintaining quality of life.
How Reliable Is the Data?
This was a real-world observational study, meaning it looked at how cladribine performed in everyday clinical practice rather than in tightly controlled trials. On the Cochrane scale, this type of study provides moderate-level evidence: it reflects real experiences, which are valuable, but more controlled research can further confirm these findings.
Takeaway Message
If you’re considering your options for managing MS, especially as you get older, cladribine might be a treatment worth discussing with your doctor. Its combination of effectiveness, low treatment burden, and tolerability makes it a strong choice for many people with MS. Remember, age doesn’t have to limit your options—there are therapies designed to keep you living well and staying active.
Aging with MS can bring changes, but it also brings opportunities to refine the way you manage your disease. From understanding cognitive changes to taking advantage of new treatments and monitoring brain health, it’s important to stay informed and proactive. Remember: knowledge is power, and with the right strategies and support, you can continue to live a full life, regardless of your age. If any of these insights resonate with you, don’t hesitate to discuss them with your medical team and see how they can be applied to your treatment.
See you soon and try to make the best out of your life,
Nele
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