- Typically, people are diagnosed with multiple sclerosis (MS) between the ages of 20 and 40, but late-onset MS (LOMS) affects people 50 and older.
- LOMS usually progresses faster than MS diagnosed at a younger age.
- There are several steps doctors take before making a diagnosis and determine the best treatment.
- Treatments, including rehabilitation and medication, can help manage the symptoms of MS.
Typically, people are diagnosed with multiple sclerosis (MS) between the ages of 20 and 40, but late-onset MS (LOMS) begins to affect people 50 and older. The progression of the disease is usually faster in LOMS.
If you have MS, you are one of the most 2.3 million people around the world who share this diagnosis. Although there is no cure for the disease, treatments are available that slow the progression of MS and help reduce symptoms.
MS is a disease of the central nervous system (CNS). With MS, the brain, optic nerves, or spinal cord, which are all part of the CNS, become inflamed. When this happens, the protective lining of the nerves, known as myelin, is damaged.
This damage manifests itself in MS symptoms ranging from difficulty concentrating to muscle spasms. There are a number of other symptoms, some more common than others.
There are four pathological changes, or stages, in the development of MS:
- Clinically isolated syndrome (CIS). This happens when symptoms first appear and last for at least 24 hours. Symptoms result from myelin damage in the CNS, but not all people with CIS develop MS.
- Relapsing-remitting MS (RRMS). This stage is characterized by attacks, also called relapses, of new or increasing neurological symptoms. Relapses are followed by partial or complete remissions, or recovery.
- Secondary progressive MS (SPMS). It starts with RRMS but gradually gets worse over time. Not all cases of RRMS will progress to SPMS.
- Primary progressive MS (PPMS). This stage is defined by the worsening of neurological functions as soon as the first symptoms appear. LOMS often begins at this most serious stage.
Adult MS (AOMS) is usually diagnosed in adults between the ages of 20 and 40, but MS can also develop in the elderly, adolescents and, in rare cases, children.
Children with pediatric MS usually have CIS or RRMS. Children with MS tend to recover faster than adults diagnosed with MS because complete remission or recovery is common in the RRMS stage.
Pediatric MS is difficult to diagnose because it is similar to acute demyelinating encephalomyelitis (ADEM). However, it can lead to serious disability from an early age.
LOMS, that is, when symptoms first appear in adults over 50 years of age, represents 10 percent of all MS diagnoses.
Late diagnosis sometimes occurs when people do not see a doctor for mild sensory symptoms.
There are a number of symptoms associated with MS. Symptoms are unpredictable and can change over time. Also, not all people diagnosed with MS will experience the same symptoms.
Some common symptoms include:
- vision changes
- loss of equilibrium
- bladder dysfunction
- difficulty understanding or remembering new information
Other symptoms include:
- pain or itching
- sexual problems
- emotional changes
Typical symptoms of LOMS are related to motor dysfunction and visual problems.
There isn’t a single test used to diagnose MS. Instead, doctors will perform many tests and exams to rule out other medical conditions first.
Here are the typical strategies used by healthcare professionals:
- Neurological examination. This exam assesses things like mental state, reflexes, coordination, and sensory function.
- Detailed clinical history. This process identifies previous symptoms, other diagnoses, and any information relevant to your health.
- Blood tests. These tests can help rule out other medical conditions that may share symptoms similar to those of MS.
- Magnetic resonance imaging (MRI). This test can detect MS lesions in the brain and spinal cord.
- Screening of oligoclonal bands. This screening checks the cerebrospinal fluid (CSF) for oligoclonal bands (OCBs) – proteins that can indicate the presence of CNS inflammation.
- Evoked potential test. This test measures how quickly the brain responds to visual, sound and tactile stimulation.
To assess the progression of MS, doctors sometimes use the Extended Disability Status Scale (EDSS). This scale goes from 0 (normal neurological examination without disability in any functional system) to 10 (death from MS). A 2016 study in
This study looked at people over 40 in its analysis of people with LOMS.
People who are diagnosed with MS in adulthood are the most likely to be diagnosed with RRMS. This is the most common course of the disease with about 85 percent of people with MS determined to have this type.
There are treatments to help you manage the symptoms of MS.
Rehabilitation can help improve your energy, memory, and mobility. The types of rehabilitation your doctor may recommend include:
- physical rehabilitation to improve balance, strength and range of motion
- cognitive rehabilitation to help with communication, organization and attention
- vocational rehabilitation for self-management and personal care, including household chores and hobbies
Medicines called disease-modifying therapies (DMT) can also be used to treat MS. DMTs work to reduce the number of relapses and slow the progression of the disease.
Daily symptoms, such as fatigue or bladder and bowel problems, are usually managed with other types of medication, not DMTs. A healthy lifestyle can also treat MS symptoms and improve overall quality of life.
Your doctor will make a treatment plan based on how your MS is progressing and your age at onset.
MS is most often diagnosed between the ages of 20 and 40, but LOMS is usually diagnosed after the age of 50. The disease progression may be faster in LOMS because it is often diagnosed as PPMS, the most severe stage of the disease.
Your doctor’s goal is to make an accurate diagnosis after tests including a neurological exam, clinical history, MRI, screening for OCBs, and testing for evoked potential. After the diagnosis, you and your doctor can decide on a treatment plan that’s right for you.