You may think of multiple sclerosis as something that affects young adults, and it’s true: MS typically strikes between ages 20 and 40, attacking the nerves, brain and spinal cord. But the vast majority of young MS patients eventually become older MS patients. That’s reflected in research, such as a 60-year Norwegian study that observed people with MS living into their 70s; it’s also seen in doctors’ offices. “About 90 percent of our 2,000 patients have MS, and a third of them are in the 60-or-older category,” says Dr. Derrick Robertson, a neurologist who directs the MS program at the University of South Florida in Tampa.
The main issues of living with MS in younger life — cognitive, physical and emotional problems — remain major challenges into older age.
Cognitive Problems
When you have MS, the body targets and damages myelin — the coating on nerves — as well as the nerve fibers. The damage causes a range of cognitive issues in up to 70 percent of MS patients, and these problems may occur early in life. “It could be processing and how quickly you can remember things or problems with memory, attention, concentration and word-finding,” says Dr. Larry Sherman, a professor of neuroscience at Oregon Health and Science University who is studying how to reverse myelin damage.
Sherman says the pattern of cognitive change in MS is usually limited to the areas where you have damage. “You may have problems in just one or two areas of cognitive function, such as memory or executive function,” Sherman says. “Things like long-term memory, conversational skills and reading comprehension tend to remain intact.”
What does cognition look like in an older person with MS? “If you already have a deficit as a young person, then the deficits associated with normal aging may be greater than those faced by someone without MS. You start off with a deficit, and then you get hit with deficits associated with normal aging — or worse, dementia — resulting from processes unrelated to MS. That is a greater challenge than most people have to face,” Sherman explains.
But he says it is unclear if people with MS have more aggressive age-related cognitive decline than people without MS.
[See: Easy Ways to Protect Your Aging Brain.]
Physical Problems
When MS damages the central nervous system, it snarls or blocks the signals sent along nerves to the muscles. That can lead to weakness and a lack of muscle coordination. Early on, those changes may show up as:
— Balance or gait problems
— Bowel problems
— Bladder problems
— Numbness and tingling
— Involuntary muscle spasms
— Weakness
— Tremors
Later in life, as more damage occurs, MS-related physical problems are often more severe. If the muscles are not getting enough use, they may atrophy (shrink). You may lose the ability to walk or you may have paralysis. You may have trouble controlling your bladder, moving your muscles to speak or swallow, or feeding and dressing yourself. “It can be very disabling later in life, especially when the upper extremities have poor coordination and weakness. That limits daily function,” Robertson says.
Loss of mobility, and being unable to get around at work or at home, becomes a loss of independence. Robertson warns that this can lead to social withdrawal or isolation. Studies have shown that isolation and physical decline are risk factors for depression later in life. In the case of an older person with MS, those risk factors only add to the common problem of MS-related mood disorders.
Emotional Problems
Doctors believe the emotional side of MS may be linked to damage in brain areas that regulate mood, such as the prefrontal cortex and the amygdala. As a result, anxiety and depression are common in MS, even early on in the disease process. “As many as 70 percent of patients may experience mood disorders,” Robertson notes.
How does having emotional challenges throughout life affect mood in older age? Robertson points to two outcomes:
— Depression and anxiety may be become worse later in life, especially if you lose the ability to walk or care for yourself.
— Depression and anxiety may become more manageable, after having coped with the conditions for decades.
“The ability to cope later in life seems to be better. I’m of the opinion that it’s because it’s a gradual decline over the years. People learn that with the right treatment, you can find a new normal,” Robertson explains.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
Tips to Cope
Coping with MS in older age depends on the level of a person’s disability. Getting through each day may require the use of assistive walking devices or assistance with dressing, bathing and feeding. Coping will also require the same strategies that help MS patients of all ages.
Physical therapy. A physical therapist will assess your balance, coordination and muscle strength, and design an exercise program to improve all three. “Physical therapy keeps older people mobile. It takes the strength you still have, makes muscles stronger and preserves function longer,” Robertson says.
Occupational therapy. An occupational therapist will assess and help you strengthen fine-motor movements. “It’s code for coordination. That may mean improving muscle memory so you can feed yourself or button a shirt,” Robertson explains.
Aerobic exercise. Getting 150 minutes per week of moderate-intensity aerobic activity (that gets your heart and lungs working) has many benefits:
— It helps strengthen muscles and improve endurance.
— It can help reduce symptoms of anxiety and depression.
— It may improve cognition. “There’s a lot of data to suggest that strenuous exercise improves or increases neurogenesis (the creation of new brain cells), and has an effect on thinking skills,” Sherman says.
Robertson says the best type of aerobic activity for people with MS is pool therapy. “Getting overheated during exercise slows down nerve conduction when you have MS, which makes symptoms worse. Pool therapy keeps your body temperature down, and you can do 30 minutes of aerobic exercise without getting overheated,” Robertson says. “When you’re not overheated, exercise helps the nerves talk to each other.”
[See: The 10 Most Underrated Exercises, According to Top Trainers.]
Memory exercises. Sherman urges both younger and older people with MS to work out their brains as well as their bodies. “Try memory exercises, such as repeat-and-verify techniques: Repeat what you hear and verify it’s correct. That improves attention,” Sherman suggests.
Avoid isolation. Robertson recommends reaching out to family, friends and MS support groups, as well as volunteering, so you have meaning and purpose in your life. “Find the niche where you can do things. Ask what you’re passionate about and what you can do to keep your dignity in this phase of life,” he suggests.
A Final Word
People with MS are also susceptible to other common conditions associated with older age, such as heart disease, high blood pressure, high cholesterol and arthritis. So it’s especially important to exercise, eat a healthy diet and work with a good medical team. That team should include a primary care doctor and a neurologist who can supervise your prescription medications for MS and for any other conditions you may develop.
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Coping With MS as an Older Adult originally appeared on usnews.com
