Late-onset multiple sclerosis (LOMS) is multiple sclerosis that first appears after age 50. LOMS has some surprising differences from adult-onset MS (AOMS), the more typical type that starts between ages 20 and 49.

If you were diagnosed with MS later in life, your disease may progress differently than it would if you were diagnosed earlier. In this article, we’ll cover what to expect from LOMS, including the symptoms, prognosis, and other details specific to MS that starts after 50.

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Prevalence of Late Onset MS

LOMS is less common than AOMS. It accounts for 0.6 percent to 12 percent of all MS cases. Though it’s defined as MS that starts after age 50, the average age of onset for LOMS is between 53.8 and 67 years.

Both LOMS and AOMS are more common in females than in males, according to the Journal of Clinical Neurology. However, males are slightly more likely to develop late-onset MS than adult-onset MS, according to Annals of Neurology.

Known Risk Factors for Late-Onset MS

Researchers have identified a few risk factors that may make a person more likely to develop MS later in life. Some risk factors are related to behaviors or habits, and others are environmental.

You may be at an increased risk of developing multiple sclerosis after age 50 due to:

• Smoking or exposure to secondhand smoke
• A history of substance abuse
• Intense physical exertion
• A past measles infection
• Significant psychological stress, such as grief, depression, or homelessness

Late-onset MS starts after age 50. The average age of onset is between 53.8 and 67 years.

These risk factors have been linked specifically to LOMS. LOMS also shares some risk factors with AOMS, including stress, exposure to Epstein-Barr virus (EBV), and a family history of multiple sclerosis.

Symptoms in Late-Onset MS

Research suggests that people with LOMS tend to have significantly fewer MS relapses (periods of new or worsening symptoms) than people with AOMS. They can still experience many of the same MS symptoms as people with AOMS, however.

While many symptoms between LOMS and AOMS overlap, some MS symptoms tend to be more commonly self-reported in people with AOMS. According to a survey, people with LOMS are more likely to report that their initial MS symptoms involved walking problems, such as balance difficulties, foot drop, or an unsteady gait.

Less Common Symptoms

Some MS symptoms are less common in people with LOMS than in those with AOMS. People with LOMS tend to have fewer visual symptoms, such as double vision or optic neuritis (inflammation of the optic nerve). These are often among the first signs of MS in people with AOMS.

Numbness is also less common in LOMS than in AOMS. In one survey, fewer than 60 percent of people with LOMS reported experiencing numbness, compared to over 70 percent of people with AOMS.

Cognitive Effects of Late-Onset MS

Some research suggests that people with LOMS are more likely to experience cognitive decline (decline in their thinking processes) than people with AOMS. This may be linked to a higher number of MS lesions in their brains and a more significant reduction in brain cells.

Late-onset MS tends to have a more progressive disease course, and may result in developing disability sooner. compared with more common adult-onset MS.

Other research has found no significant difference in cognitive function between groups with LOMS and groups with AOMS. Keep in mind that signs of cognitive decline may be linked to normal aging or other age-related conditions.

Prognosis of Late-Onset MS

Being diagnosed with MS after 50 can impact your MS progression and prognosis (outlook). Primary progressive MS tends to be more common in people with LOMS, affecting nearly 40 percent, compared to just 9 percent of people with AOMS.

In general, LOMS tends to follow a more progressive disease course. However, research is mixed about the difference between LOMS prognosis and AOMS prognosis. Some research suggests that a higher age at onset doesn’t necessarily mean your prognosis will be worse.

Other research points to a faster disability progression from LOMS than in AOMS. That said, your age at onset may matter less than your current age when it comes to the severity of disability from MS.

Why Prognosis Might Differ

Researchers have noticed that people with LOMS had lower disability scores in more recent studies than in older ones. This has led some to believe that older people may now be diagnosed with milder forms of MS, or that treatments for LOMS have simply improved over time.

More evidence is needed to understand why the prognosis tends to be worse in people with LOMS than AOMS. Some health experts believe it may be partly due to a lower adherence to treatment in older age or because certain medications are less effective in older people who take them.

Differences in Treatment for LOMS and AOMS

Treatment recommendations for LOMS may differ from those for AOMS. Your age at onset, current age, and other medical conditions can all affect how you respond to various MS treatments.

It’s important to consider that older adults tend to take more medications, which can complicate treatment recommendations because of potential drug interactions.

More research is needed to confirm which treatments are most effective for people with late-onset MS. Your neurologist can make personalized recommendations based on your individual situation.

Taking a higher number of medications can make it harder to track your doses and manage your prescriptions. Challenges related to the number of medications you take might affect your overall outlook with AOMS.

Most Common Symptomatic Treatments for LOMS

Symptomatic treatments for MS aim to improve specific symptoms, not the disease itself or its underlying cause. Your doctor or neurologist may prescribe medications, therapies, or rehabilitation services to target the symptoms that affect you most.

The most common symptomatic treatments for LOMS are generally the same as the most common symptomatic treatments for AOMS. Here’s what they are and how many people with LOMS use them:

• Dietary supplements — 53.7 percent of people with LOMS use them, compared to 59.8 percent of people with AOMS.
• Antidepressants — 34.1 percent of people with LOMS take them, compared to 50.8 percent of people with AOMS.
• Pain relievers — Around 32 percent of people with both LOMS and AOMS take some type of pain reliever to manage MS pain.

Disease-Modifying Therapies for LOMS

Disease-modifying therapies (DMTs) are a key treatment for many people with MS, but they may have some different outcomes for people who were diagnosed with MS at an older age.

Many people with LOMS take DMTs to reduce relapses and slow MS damage. However, it’s harder for experts to measure their effectiveness in this group because late-onset MS tends to have a faster disease progression.

DMTs may also be less safe for people with LOMS to take than for those with AOMS. As the immune system declines with age, older adults become more susceptible to infections and autoimmune disorders. These changes make serious side effects from DMTs, such as a higher risk for cancer and certain infections, more likely in people of older ages.

Talk to Your Doctor

Talk to your doctor about which treatments may be more suitable for someone with late-onset multiple sclerosis. Even though more research is needed to confirm which treatments are most effective for people with LOMS, your neurologist can make personalized recommendations based on your age, overall health, and family history of MS.

Be sure to tell your doctor if you think your MS symptoms are getting worse, or if you notice any concerning side effects from your treatments. Never stop taking DMTs without talking to your healthcare team first.

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