Multiple Sclerosis & Aging
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More than once I’ve wondered to myself and questioned others about the aging population of people with MS and what adjustments to our care might need to be made. The current state of medical treatments make it possible to live longer, and although that is a very good thing it also complicates our medical care.

Mary Anne Picone, MD, presented Aging in MS at the annual Consortium for MS Centers meeting in May, and it appears there are still many unanswered questions about how those two conditions fit together. We’ve all heard that MS is a young person’s disease, but there are now a lot of us with many years of experience with MS who are no longer considered young. She cites “there are approximately 225-350,000 patients older than 65 living with MS worldwide.” I am slowly approaching the age to join that group.

Dr. Picone challenges us to think if we are aging with disability instead of gaining disability as we age. Yes, I hear you wonder, is there really a difference? Those of us in the advanced aging category have to figure it out along with our doctors. What are our health problems caused by – is it our MS or is it just part of aging?

Here’s a quick quiz. Let’s start with some clinical signs – what do you think could be the cause of these symptoms:

Through my experience with elderly parents I have seen their aging has caused each and every one of these problems, but my MS has also checked quite a few of these on this list. So what’s the difference besides 30 years and how do our doctors approach our treatment differently? Do you want to see your neurologist for treatment or will your primary care physician be able to provide the right care?

Perhaps there are tests we could use to determine which it might be – Dr. Picone covers the idea that MRIs might yield clues, but it seems normal aging and MS ‘both have demyelination and gray matter atrophy. Widespread gray matter loss is seen consistently in MS and age related dementia.” She does share there are some distinct differences, particularly how the MS lesions appear vs the ones from aging.

Aging vs MS looks pretty similar in cognitive function, too. That might include slowed information processing, difficulty with concentration, short term memory problems and trouble with executive functioning including planning and organizing. Fatigue in MS and in aging is equally troublesome and both groups need medical attention on ways to have more energy.  Aging and MS fatigue can both be caused by depression, pain, physical deconditioning, poor sleep, and more.

The ‘is it MS or age?’ question gets clearly answered when looking at our eyes and ophthalmology problems. People with MS are more susceptible to optic neuritis and nystagmus while the elderly face cataracts, presbyopia (needing reading glasses), macular degeneration and glaucoma. I already have the start of cataracts, even though I have a few more years before I hit that magical over 65 age, and I know those aren’t blamed on the MS. However, extended use of steroids to treat MS can lead to the early development of cataracts, so perhaps it isn’t quite as clearly defined as we would think.

Aging bladders can cause problems with urinary frequency, incontinence, hesitancy, retention and nocturia and this is the same irritating list for the MS neurogenic bladder. Way too many of us with MS begin in our earlier years with the bladder problems we wouldn’t expect until we get much older.

Heat sensitivity is a problem for both groups, too. The elderly have problems with overheating, and a decline in the autonomic nervous system which regulates body temperature, including being able to sweat. Heat sensitivity in MS is common as well.

The elderly as well as people with MS have a higher incidence of falls than younger people living without chronic disease, and the complications that can happen from those falls, such as broken bones and the loss of independence while healing, can be equally hard to recover from. We also are just as likely as the non-MS person to have diabetes, cancer and cardiac conditions.

“It’s paradoxical that the idea of living a long life appeals to everyone, but the idea of getting old doesn’t appeal to anyone.” ― Andy Rooney

Andy Rooney sure had that right and it is even less appealing to age while having a chronic disease to contend with along with the complications of normal aging. As the number of us with multiple sclerosis over the age of 65 continues to increase, there will be new challenges for our medical providers to look closer at the cause of our problems and to choose the right treatment options. Aging isn’t easy and simple for any of us, but then again, what stage of life is?

Wishing you well,

Laura

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