Disease Comorbidity and Age-Related Changes in MS Patients
As people with MS live longer, they’re now also faced with the consequences of normal aging. It can be difficult, though, to know if the cause of worsening symptoms in older MS patients are due to conditions commonly brought on by aging such as Alzheimer’s disease, Parkinson’s disease, an intensified degenerative/inflammatory process directly related to MS progression, or a combination of these factors. Here are some of the more common complications of age and MS.
Difficulties with mobility
As people age, mobility becomes more of a concern. Last year it was reported that from 2004 and 2012, the number of American adults over the age of 65 who used canes and other mobility devices increased from 16 to 24 percent.
Although MS patients of any age may require mobility aids, statistics have shown that the aging process itself may further contribute to the growing need for them. For instance, a study of 2156 people with MS, found that older persons over the age of 65 with MS had a significantly higher rate of disability compared to their younger counterparts. It also found that a higher percentage of older adults required a cane and other types of bilateral support to walk 25 feet. A higher percentage also needed a wheelchair, scooter, or were bedridden.
While falling is a concern among elderly people, it is even more so in persons with MS. In any given year, about 70 percent of people with MS aged 18 to 50 experience a fall and are more likely to sustain an injury from falling compared to healthy individuals. Fortunately, there are online videos on sites such as YouTube that effectively show older people how to improve strength, balance and reduce the risk of falls. I have done many of the exercises demonstrated during physical therapy and find that they are equally helpful for people with MS.
Emotional and cognitive problems
Psychological and cognitive problems may also occur more frequently in elderly MS patients. While roughly 45 percent of elderly residents in nursing homes reported depressive symptoms, one study of 53 elderly MS patients found that more than half reported frequently feeling depressed. Research suggests that the prevalence of anxiety decreases in older people with MS.
Cognitive impairment reportedly affects 40-60 percent of people with MS, with slowed mental processing speed and episodic memory loss being the most common symptoms. In a cross-sectional study of where 245 MS patients and 188 healthy participants were grouped by age to analyze the effects of age on MS and cognitive slowing, researchers found that the effects of aging on cognitive processing speed were similar for both groups. Hence, cognitive decline is more likely attributed to normal aging rather than MS.
However, symptoms related to Alzheimer’s disease are less common in persons with MS. Rapid forgetting and memory retrieval defects, common symptoms in Alzheimer’s disease (AD), might lead a clinician to diagnose new-onset AD in an elderly MS patient if these symptoms appear.
The challenges of activities of daily living
Even some of the more basic tasks elderly people do regularly can be compromised by MS. In a study of 53 elderly persons with MS, 22.6 percent were unable to take their daily medication out of the container without assistance and nearly a third needed help to make a meal. Only 28 of the patients were able to go to the toilet without assistance and 20.8 percent reported being able to take a shower or a bath independently. Because of these difficulties, 86.8 percent required help from professional caregivers.
However, a separate study showed that although a higher percentage of older MS patients, compared to younger MS patients, needed help with the activities of daily living, there were no significant differences when it came to eating, managing finances, preparing meals, or doing housework.
Bowel and bladder dysfunction
Bowel and bladder problems are common issues for those who have MS, especially among older patients as a higher percentage have reported such problems compared to younger patients. However, what’s causing symptoms to worsen, whether it’s related to MS or aging, is difficult to establish and may require more specific evaluations by urologists and/or gastroenterologists to determine the appropriate therapy. And since bladder infections often lead to acute worsening of symptoms in MS patients, or pseudo-exacerbation, it’s important to diagnose the underlying cause first. Similarly, bowel problems also need to be investigated to improve the quality of life of people with MS.
Cardiovascular comorbidities are known to increase with age, but their impact may be greater for people with MS. Although conditions such as hypertension, diabetes, and hyperlipidemia among people with MS occur at a rate similar to the general population, they have been shown to significantly increase the risk of ambulatory disability as well as decrease the time from diagnosis to ambulatory disability by about 6 years when compared to patients who don’t have such a condition (Marrie et al, 2015). Cardiovascular risk factors are also associated with a decrease in gray matter and cortical brain volume, as well as an increase in the number of lesions seen on an MRI.
In another study, researchers found that worsening disability was associated with higher levels of “bad” low-density lipoprotein (LDL) cholesterol, total cholesterol and triglycerides. However, higher levels of “good” high-density lipoprotein (HDL) cholesterol, which can be boosted with exercise, were associated with lower levels of acute neuro-inflammatory activity. And while cardiovascular causes and cancer are known to be frequent causes of death associated with increased age, researchers using the NARCOMS database determined that people with MS had a lower mortality rate from cardiovascular disease and cancer compared to the American elderly population. The effect of disability on mortality was roughly equal to the effect of aging on mortality in people with MS.
Sanai et al. suggest that a multidisciplinary approach toward care of elderly persons with MS is required. This includes using a team of physical therapists, urologists, orthopedic, and geriatric specialists in addition to neurologists specializing in MS.
Furthermore, it’s important to understand how to distinguish the results of normal aging from worsening MS. In particular, experts need to be able to differentiate between neurological disorders that are common in aging but may mimic some of the symptoms of MS. Problems with mobility, prevention of falls, social support, and ADLs and their implications on overall quality of life should not be overlooked.
See more helpful articles:
Ferreira AR, Dias CC, Fernandes L. Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms. Front Aging Neurosci. 2016 Apr 21;8:72. doi: 10.3389/fnagi.2016.00072. eCollection 2016.
Marrie RA, Elliott L, Marriott J, et al. Effect of comorbidity on mortality in multiple sclerosis. Neurology. 2015 Jul 21;85(3):240-7. doi: 10.1212/WNL.0000000000001718. Epub 2015 May 27.
Sanai SA, Saini V, Benedict RH, et al. Aging and multiple sclerosis. Mult Scler. 2016 Feb 19. pii: 1352458516634871. [Epub ahead of print]