The Effect of Aging in Multiple Sclerosis and the Model of Care: Ruth Ann Marrie, MD, PhD, FRCPC

WATCH TIME: 4 minutes

"As like other disease with neurodegenerative components, we think age does play a role in the expansion of MS. We know it influences things like the nervous system’s ability to repair, remyelinating, and so on. But we don’t fully understand what the interface is between aging and MS, nor how it may influence the balance or what the driving mechanisms are in individuals, how it influences clinical expression, or how it should influence what we do in terms of our clinical care."

Within the multiple sclerosis (MS) community, some have expressed that the clinical courses by which the disease is characterized by, should be dissolved, and that disease progression is not caused by a single uninform disease. Recently, a published paper from the International Advisory Committee on Clinical Trials in Multiple Sclerosis, further confirmed these thoughts, stating that patients with MS share quantitively similar pathology features independent of clinical course, and that progression is neither dichotomous nor genetically determined, ultimately implying the need for a new framework from which to view the disease.

Overall, the thought behind the paper was that disease evolution to progressive course reflects a partial shift from predominantly localized acute injury to widespread inflammation and neurodegeneration, coupled with the failure of compensatory mechanisms such as neuroplasticity and remyelination. The research also highlighted the effects of aging, which has been shown to be associated with faster accumulation of ambulatory disability and greater impairment.

Ruth Ann Marrie, MD, PhD, FRCPC, an author on the paper, feels we still don’t fully understand the effects of aging on MS, but there has been progress. Marrie, a professor of medicine at the University of Manitoba, detailed the knowns and unknowns surrounding aging in MS and how it might contribute to further disease progression. Additionally, she provided perspective on the long-term goals of the paper and how it might impact the field going forward.

REFERENCES
1. Kuhlmann T, Moccia M, Coetzee T, et al. Multiple sclerosis progression: time for a new mechanism-driven framework. Lancet Neurol. Published online November 18, 2022. doi:10.1016/S1474-4422(22)00289-7.