Letter From the Guest Editors - Volume 27, Theme II

As the population with multiple sclerosis (MS) ages, clinicians are increasingly caring for older adults living with the disease. Age profoundly impacts MS disease course by reducing focal inflammatory activity associated with relapses and new T2 hyperintense lesions on MRI, while increasing the risk of developing progressive MS.¹ These changes affect the use of MS disease-modifying therapies (DMT), which are more effective in treating relapsing MS and notably less useful in slowing disability accumulation in progressive MS. Adverse reactions to DMTs are also more frequent in older adults with MS, which can lead to higher risks of infection and lymphopenia.²

Older adults with MS also face unique and overlapping symptoms of both aging and MS. Geriatric conditions such as frailty, multimorbidity, and polypharmacy are often present in older adults with MS and contribute to the clinical complexity of discerning age-related changes from MS progression.³ Additional barriers impede access to care caused by impaired mobility, financial constraints, and limited availability of multidisciplinary specialists. These common geriatric issues require increased awareness from neurologists and other health care professionals, who often lack formal geriatric training.

In this special issue of the International Journal of Multiple Sclerosis Care (IJMSC), we focus on care for older adults with MS and issues that commonly occur and significantly impact their quality of life. The core of the issue comprises 4 review papers containing discussion and recommendations based on a consensus conference organized by the Consortium of Multiple Sclerosis Centers (CMSC) that took place at the CMSC annual meeting in Nashville, Tennessee, from May 29 to June 1, 2024. These papers address:

1. The interaction between the aging process and MS disease course;
2. DMT use and discontinuation in older adults;
3. The effects of comorbidity and polypharmacy; and
4. The value of multidisciplinary care and challenges in access to care for this population.

In preparation for the consensus conference, we formed a panel of clinicians with expertise on aging and MS and conducted a needs assessment survey on aging and MS. From the responses, we developed the aforementioned focus areas and assembled multidisciplinary working groups to summarize each topic based on “what we know,” “what we don’t know,” and “best practices and future directions for research.” Each group’s findings were presented at the conference and discussed among the full panel. A summary of the meeting was first published on the CMSC website and has since been adapted for this IJMSC special issue on aging and MS. In addition, this special issue features original research on aging and MS, such as the study by Jakimovski et al, examining discrepancies between physical and psychosocial status in older adults with MS. We will continue to welcome additional papers related to aging and MS until the close of 2025.

As the general population ages, older adults are becoming the predominant demographic group in many parts of the world, and this trend is noted in the MS field as well. This special issue conveys advances made in the care of older adults with MS. However, it is also meant to be a call to action: While great strides have been made in understanding the mechanisms and effects of aging in the general population, there is still much that is unknown in aging research, especially about how aging affects individuals with MS. Health care providers should incorporate geriatric assessments into the care of people with MS, recognize the impact of aging on the course of MS, and understand the psychosocial impact of aging with MS, all while navigating the limited but growing information that guides our decision-making. While significant progress has been made in our understanding and treatment of MS in older adults, there is still much to learn from science about the experience of aging with MS.