Journal article 326 views 74 downloads
Comparing the Pathology, Clinical, and Demographic Characteristics of Younger and Older‐Onset Multiple Sclerosis
,
Benjamin Cooze,
Ildiko Farkas,
Yeung Yeung Leung,
Kelsey Allen,
MOLLY WINSLADE,
David R.J. Owen,
Roberta Magliozzi ,
Richard Reynolds,
James W. Neal,
Owen Pearson,
Richard Nicholas ,
Owen Pickrell ,
Owain Howell ,
(the UK MS Register Research Group)
Annals of Neurology, Volume: 95, Issue: 3, Pages: 471 - 486
Swansea University Authors:
Sarah Knowles, Rod Middleton , Benjamin Cooze, Kelsey Allen, MOLLY WINSLADE, Owen Pickrell , Owain Howell
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DOI (Published version): 10.1002/ana.26843
Abstract
Objective: Older people with multiple sclerosis have a less active radiological and clinical presentation, but many still attain significant levels of disability; but what drives worsening disability in this group?Methods: We used data from the UK MS Register to characterise demographics and clinica...
| Published in: | Annals of Neurology |
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| ISSN: | 0364-5134 1531-8249 |
| Published: |
Wiley
2024
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa65353 |
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| Abstract: |
Objective: Older people with multiple sclerosis have a less active radiological and clinical presentation, but many still attain significant levels of disability; but what drives worsening disability in this group?Methods: We used data from the UK MS Register to characterise demographics and clinical features of late-onset multiple sclerosis (LOMS; symptom onset at ≥50 years), compared to adult-onset MS (AOMS; onset 18-49 years). We performed a pathology study of a separate MS cohort with a later onset (n=18, mean age of onset 54 years) versus AOMS (n=23, age of onset 30 years).Results: In the Register cohort there were 1608 (9.4%) with LOMS. When compared with AOMS, there was a lower proportion of females, a higher proportion of primary progressive MS, a higher level of disability at diagnosis (median MS impact scale 36.7 v 28.3, p<0.001), and a higher proportion of gait-related initial symptoms. People with LOMS were less likely to receive a high efficacy disease modifying treatment and attained substantial disability sooner.Controlling for age of death and sex, neuron density in the thalamus and pons decreased with onset-age, whilst actively demyelinating lesions and compartmentalised inflammation was greatest in AOMS. Only neuron density, and not demyelination or the extent of compartmentalised inflammation, correlated with disability outcomes in older-onset MS.Interpretation: The more progressive nature of older-onset MS is associated with significant neurodegeneration but infrequent inflammatory demyelination. These findings have implications for the assessment and treatment of MS in older people. |
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| Keywords: |
Multiple Sclerosis, Disability |
| College: |
Swansea University Medical School |
| Funders: |
Multiple Sclerosis Society
HCRW BRAIN unit |
| Issue: |
3 |
| Start Page: |
471 |
| End Page: |
486 |