Age at MS onset linked to long-term physical, mental health: Study
Those diagnosed when younger do better physically, worse mentally
People who develop multiple sclerosis (MS) at a younger age tend to consistently have better physical health but worse mental health than those diagnosed later, a study found.
While physical health declined in the long term for all age groups, and mental health increased, the differences between groups were sustained over time, which the researchers said highlighted the need for age-tailored care.
More research is needed to determine what kind of mental health support may maximize quality of life in people with younger age of onset, and which specific aspects of physical health may be targeted to improve quality of life in those with older onset disease, they said.
The study, “Age of multiple sclerosis symptom onset affects mental and physical health-related quality of life in opposite directions,” was published in the journal Multiple Sclerosis and Related Disorders.
In MS, the immune system mistakenly attacks the protective covering of nerve cells in the brain and spinal cord, causing damage. This results in MS symptoms such as blurred vision, fatigue, and difficulty walking — all of which pose limitations in daily life and take a toll on mental health.
MS onset and disability
While MS usually begins in adulthood, it can develop before age 18, in which case it is called pediatric-onset MS (POMS). Some studies have suggested that people with pediatric-onset disease may develop physical disability when they are several years younger than those who develop the disease in adulthood, but evidence to date has been mixed. It’s also not clear how the age at MS onset affects mental health.
To find out, a team of researchers in Canada examined data from 699 patients who were followed over time as part of the Canadian Prospective Cohort Study to Understand Progression in Multiple Sclerosis (CanProCo), which is funded in part by Biogen Canada, Roche Canada, and the Brain Canada Foundation.
The researchers looked at how the age at which someone first experiences MS symptoms affects their health-related quality of life — both physically and mentally — as they live with the disease.
The majority of participants had relapsing-remitting MS (93%), and the rest had primary progressive MS. The average age at symptom onset was 33.2, with 16.9% having symptoms before age 25 and 2.3% having POMS. At the time of the analysis, they had been living with the disease for a mean of 4.8 years.
Results showed that patients who developed MS at a younger age tended to report better physical health than those with a later onset. Physical health was measured using the MS Quality of Life-54 (MSQoL-54), where higher scores mean better health. For every five-year increase in age of onset, scores decreased by 1.5 points, which is considered the minimal clinically important clinical difference.
Mental health-related quality of life, which was also measured using the MSQoL-54, showed the opposite pattern. Patients who developed MS at a younger age reported worse mental health than those who developed it when they were older, with scores increasing 2.5 points — the minimal clinically important clinical difference for this score — for every 12-year increase in age of onset.
Over time, physical health scores dropped and mental health scores rose in all patients. This challenges the common practice of dividing study patients into two groups — pediatric and adult onset — and suggests researchers might look more closely at how different ages within those groups may lead to different outcomes.
“Patterns in physical and mental health perceptions seen in pediatric onset MS are also seen in people with young adult-onset MS, challenging the role for studying age of onset dichotomously as done previously,” the researchers wrote.
The length of time someone has had MS, known as disease duration, did not fully explain the differences in physical and mental health between age groups. Instead, disability levels, measured by the Expanded Disability Status Scale, did account for 63.7% of the differences in physical health and 61.3% of the differences in mental health.
This suggests that other factors — possibly related to self-management abilities, disease-modifying therapy use, and social participation — may influence how people with MS experience their physical and mental health, the researchers said. These factors could potentially be changed or improved, offering a strategy to achieve better long-term outcomes.
“Future studies evaluating HrQoL [health-related quality of life] over longer periods will be important to provide evidence-based mental health support to maximize HrQoL for people with young onset MS,” the team wrote. “In contrast, ongoing studies evaluating specific aspects of physical health in older onset MS … will be important to maximize the longevity of physical functioning in people with MS.”
About the Author
