Disability, not age, drives cognitive impairment in MS adults: Study
Still, older adults experience more and worse problems than younger patients
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- A new study found that older MS patients experience more cognitive impairment than their younger counterparts.
- Key among the findings, however, was that disability level, not age, is the main predictor of cognitive impairment in MS.
- The researchers say that age-sensitive assessments and tailored interventions are needed for older people with MS.
Older adults with multiple sclerosis (MS) show a higher prevalence and severity of cognitive impairment — particularly affecting information processing speed and memory — than younger patients, a new study reports.
However, age was not directly associated with cognitive impairment, the results showed. Instead, greater disability emerged as the main predictor of such problems in older MS patients.
The researchers noted that having higher education or occupational attainment acted as a protective factor for older people with the neurodegenerative disease.
“Taken together, these findings indicate that the cognitive differences observed between age groups … may largely reflect the cumulative impact of disease-related factors rather than ageing itself. This reinforces the interpretation that lifelong disease burden, rather than chronological age, is the primary driver of cognitive decline in older [people with] MS,” the researchers wrote.
According to the team, these findings “underscore the need for age-sensitive neuropsychological assessments and tailored intervention strategies to preserve cognition in late adulthood.”
The study, “Neurocognitive Outcomes in Older Adults with Multiple Sclerosis: Evidence from a Cross-Sectional Cohort,” was published in the journal Multiple Sclerosis and Related Disorders.
MS is a chronic autoimmune disease of the brain and spinal cord marked by diverse motor, sensory, and cognitive symptoms. Although MS is mostly diagnosed in young adults, improved treatments have extended life expectancy, creating new challenges for older MS patients.
Looking at MS patients older and younger than 50
Cognitive impairment is a common and disabling feature of MS, affecting processing speed, memory, and executive function — the skills used to manage everyday tasks, such as making plans and solving problems. Although cognitive problems can occur at any age, it’s thought to become more frequent and more severe in older individuals with MS.
Despite its significance, cognitive impairment in older people with MS is understudied, according to the researchers. Most investigations focus on younger individuals or overlook the additional impact of ageing. This gap is particularly relevant in Latin America, where assessments of cognitive functioning in older MS populations are lacking, the team noted.
“Understanding how ageing and MS interact to shape cognitive outcomes can provide critical insights for the development of age-specific therapeutic strategies,” the researchers wrote.
To learn more, a team of scientists in Argentina explored the prevalence and profile of cognitive impairment in older MS patients. The team compared this with the symptoms’ impact on younger patients, and identified clinical factors that predicted cognitive impairment.
Of the 339 people with MS evaluated, 256 were adults aged 50 or younger, while 83 were older adults, ranging in age from 51 to 77. Progressive forms of MS were more common in older patients, who also had greater disability levels than the younger MS patients, the data showed.
The participants underwent a battery of cognitive assessments, and data showed that significantly more older MS patients than younger ones were cognitively impaired (59% vs. 42.6%).
In comparison, population studies based in Argentina reported that cognitive impairment affected about 25% individuals at least 60 years of age, “highlighting the disproportionately high cognitive burden associated with MS in later adulthood compared with non-neurological aging populations,” the team wrote.
Among older MS patients, the most impaired cognitive function was information-processing speed, followed by deficits in verbal, working, and visual memory.
When the team compared performance on cognitive tests, older MS patients generally scored worse than younger patients after adjusting for age and years of education. Significant differences were noted in information-processing speed, verbal, working, and visual memory, as well as in semantic verbal fluency, tested by quickly naming items in a category.
More education appears to be protective against cognitive impairment
After searching for potential risk factors, age was not significantly linked to cognitive impairment after adjustments, the researchers noted. According to the team, the findings suggest “that the impairment observed in older people with MS is more closely related to disease progression than to ageing per se.”
Similarly, disease duration, depression, anxiety, and fatigue showed no significant relationships with cognitive challenges in individuals with MS, the data showed.
Instead, higher disability scores were associated with an increased risk of cognitive impairment, the researchers noted.
This finding was consistent with previously reported data showing that disease progression and lesion burden better explain cognitive deficits than age, according to the team.
[These findings suggest] that the impairment observed in older people with MS is more closely related to disease progression than to ageing per se.
Conversely, higher education appeared to confer a protective effect against cognitive problems in MS, supporting the so-called cognitive reserve hypothesis. This idea suggests that individuals with higher levels of education or occupational attainment, or who engage in cognitively stimulating activities, are better able to cope with age-related changes in the brain.
“This study provides solid empirical evidence on cognitive impairment in older people with multiple sclerosis,” the researchers concluded. “These results reinforce the need to implement age-sensitive diagnostic and therapeutic strategies that take into account individual trajectories and the clinical course of the disease.”
