Aging with multiple sclerosis: Clinical characterization of an elderly population, a cross-sectional study

Epidemiological studies suggest an upward trend regarding the mean age of the population of subjects with MS. Moreover, the incidence rate among people over the age of 50 is increasing ( Koch-Henriksen et al., 2018 Koch-Henriksen N. Thygesen L.C. Stenager E. Laursen B. Magyari M. Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology. 2018; 90: e1954-e1963 Crossref PubMed Scopus (102) Google Scholar ). The population of aged subjects affected with MS is characterized by heterogeneous disease characteristics with regards to the age of onset (onset at a young-adult age, late-onset, very-late-onset) ( Martinelli et al., 2004 Martinelli V. Rodegher M. Moiola L. Comi G. Late onset multiple sclerosis: clinical characteristics, prognostic factors and differential diagnosis. Neurol. Sci. 2004; 25 (official journal of the Italian Neurological Society and of the Italian Society of Clin. Neurophysiol.): S350-S355 Crossref PubMed Scopus (78) Google Scholar ), disease activity, and disability. The phenotype of MS in the elderly and its pathobiology are still poorly understood ( Vaughn et al., 2019 Vaughn C.B. Jakimovski D. Kavak K.S. Ramanathan M. Benedict R.H.B. Zivadinov R. Weinstock-Guttman B. Epidemiology and treatment of multiple sclerosis in elderly populations. Nat. Rev. Neurol. 2019; 15: 329-342 Crossref PubMed Scopus (142) Google Scholar ). Moreover, the safety and efficacy of almost all disease-modifying treatments (DMT) in this age group are unknown since the upper age limit of clinical trials is usually 50 years old. There are other interesting facets of the understudied topic of MS in the aged population. For example, the influence of aging on the course of the disease from a biological point of view (i.e., immunosenescence, failure of remyelination processes, and neurodegeneration) ( Sanai et al., 2016 Sanai S.A. Saini V. Benedict R.H. Zivadinov R. Teter B.E. Ramanathan M. Weinstock-Guttman B. Aging and multiple sclerosis. Mult. Scler. 2016; 22: 717-725 Crossref PubMed Scopus (57) Google Scholar ), comorbidities ( Laroni et al., 2017 Laroni A. Signori A. Maniscalco G.T. Lanzillo R. Russo C.V. Binello E. Lo Fermo S. Repice A. Annovazzi P. Bonavita S. Clerico M. Baroncini D. Prosperini L. La Gioia S. Rossi S. Cocco E. Frau J. Torri Clerici V. Signoriello E. Sartori A. Zarbo I.R. Rasia S. Cordioli C. Cerqua R. Di Sapio A. Lavorgna L. Pontecorvo S. Barrilà C. Saccà F. Frigeni B. Esposito S. Ippolito D. Gallo F. Sormani M.P. Assessing association of comorbidities with treatment choice and persistence in MS: a real-life multicenter study. Neurology. 2017; 89: 2222-2229 Crossref PubMed Scopus (41) Google Scholar ), concomitant treatments ( Thelen et al., 2021 Thelen J. Zvonarev V. Lam S. Burkhardt C. Lynch S. Bruce J. Polypharmacy in multiple sclerosis: current knowledge and future directions. Mo. Med. 2021; 118: 239-245 PubMed Google Scholar ), social and societal issues. The objective of this study is to characterize the clinical features of MS in a population aged 60 years and older, followed at one clinical center located in the Italian region with the highest mean age and aging index in Italy, Liguria.