As people age, they may find it more difficult than before to recall words quickly, walk long distances, maintain balance, or stay positive. Sometimes, these changes result from the natural aging process. However, for older people living with chronic conditions such as multiple sclerosis (MS), it’s natural to wonder just what’s causing new or worse cognitive, physical, or emotional changes.

Members of MyMSTeam sometimes discuss whether new symptoms may be related to MS or to aging. “I am newly diagnosed (at the old age of 53). I’m trying to understand what might just be ‘old age’ vs. MS,” wrote a MyMSTeam member.

The relationship between aging and MS is a relatively new field of study — for a heartening reason: Over the past two decades, life expectancy among people with MS has steadily increased with the development of effective new therapies. A large 2015 study published in Neurology found that half of people with MS lived to 75.9, whereas half of those without the condition lived to 83.4.

However, older people first diagnosed with MS typically have a progressive form, whereas younger people usually have relapsing-remitting MS. Disease-modifying therapies are less effective in older people with the progressive form, possibly because of immunosuppression (a weakened immune system) and an aging brain.

Scientists still have much to learn about how MS affects people as they age. Despite the knowledge gaps, they have insight into how MS affects older people. In this article, we’ll look at physical, cognitive, and emotional changes people naturally experience with age and those that develop in older people with MS. Notably, there’s a lot of overlap — and it’s often possible for other factors to play a role, including other conditions, medications, and lifestyle factors such as diet and exercise.

How Aging and MS Affect Physical Abilities

MS and aging can affect a person’s physical function in various, sometimes similar ways.

Aging and Physical Abilities

Following are some parts of the body that naturally change with age, which can affect physical abilities:

• Bones — Bone density reduces over time, which can increase the risk of fractures. Changes to the spine can affect the ability to swallow and also cause loss of height.
• Cardiovascular changes — With age, a person’s blood vessels and arteries may start to stiffen, which can strain the heart to pump blood throughout the body. This condition can lead to high blood pressure and other cardiovascular issues.
• Joints — Cartilage lining the joints can wear down and increase the risk of injury.
• Ligaments and tendons — These binders for joints, muscle, and bone can lose elasticity, leading to tighter, stiffer joints.
• Muscles — Loss of muscle strength, flexibility, and endurance can affect balance, coordination, and stability.
• Bladder and urinary tract — Weakened muscles of the bladder and pelvic wall can make it difficult to control or fully empty your bladder. Also, the bladder can become less elastic, increasing the need to urinate.
• Eyes and ears — As people age, they may have trouble focusing on close-up objects, as well as develop light sensitivity and cataracts (cloudy vision). They also sometimes start to have trouble hearing high-frequency sounds or making out conversation in a noisy room.

MS and Physical Abilities in Older People

MS can compound some of the effects of natural aging on a person’s physical abilities. In MS, the immune system attacks the central nervous system (CNS) — part of the nervous system including the brain and spinal cord. The resulting inflammation wears away at the myelin sheath (protective layer) around nerve fibers. This damage can disrupt messages between the brain and other parts of the body, leading to gross- and fine-motor dysfunction and other types of physical disability.

Each person’s experience is different regarding how much MS affects physical function. According to the National Multiple Sclerosis Society, common symptoms among older people with MS include:

• Trouble maintaining balance — MS can directly affect balance by disrupting how messages from your body are sent to your brain, as well as how the brain processes them and responds.
• Fatigue — Although researchers aren’t sure what specifically causes MS-related fatigue, a 2019 review in the Journal of Neurology, Neurosurgery & Psychiatry indicated that inflammation, other immune system processes, and lesions in the brain’s gray matter all likely play a role.
• Weakness — Demyelination affects the way the muscles work, causing weakness, stiffness, spasms, pain, and loss of coordination.
• Pain — MS itself can cause neuropathic (nerve-related) damage, resulting in painful sensations ranging from minor to intense.
• Bladder and bowel problems — MS lesions can disrupt CNS signals that control the bladder and urinary sphincters. People with the condition may experience constipation, diarrhea, and loss of bowel control.
• Vision problems — MS can damage the optic nerve so that it can’t send signals to the brain effectively. This can cause symptoms such as blurred vision and eye pain.

Members of MyMSTeam often talk about physical symptoms they experience later in life. “I’m fortunate as I was diagnosed with MS in ’89 and started disease-modifying drugs in ’92. So I’m one of those people that you wouldn’t think have MS, but I deal with symptoms such as fatigue and balance issues, and I’m always hot,” wrote one member.

Another shared their experiences with MS-related vision problems: “I’m over 60. I just found out that a recent flare caused optic nerve damage in my left eye. So now I know that I still need to continue my injections with Copaxone. Finding out that my eyes are affected, and it’s a new kind of damage, means that MS is still causing damage even though I’m a senior!”

A third member described how their mobility had progressively worsened. “I was diagnosed in 1986. ... The MS has slowly advanced, but it hadn’t bothered me too much until 1998, when I couldn’t make the bed for someone I worked for,” they wrote. “After that, I used a cane and started volunteering. In 2007, I started using a four-wheel walker, and in 2021, I started using a power wheelchair because I could not stand or move my legs.”

Learn strategies to enhance your mobility when living with MS.

How Aging and MS Affect Cognitive Abilities

Cognitive changes affect the way you think, reason, or remember. MS, aging, and other health conditions can contribute to a decline in brain function at varying degrees.

Aging and Cognitive Abilities

As people age, their brain and nervous system are affected. Areas of the brain start to shrink (called brain atrophy) by as much as 1 percent annually, although this doesn’t necessarily affect brain function. Around age 60, people start losing nerve cells, which can affect brain function. Their nerves may also send signals at a slower rate and need more time to repair themselves. According to Merck Manual, “Blood flow to the brain may decrease by an average of 20 percent.” This change can deprive the cells in the brain of important nutrients.

Overall, according to Mayo Clinic, changes to the brain that come with age “may have minor effects on your memory or thinking skills.”

MS and Cognitive Abilities in Older People

Compared with the natural aging process, MS has a more pronounced effect on cognitive function over time. Researchers believe that brain lesions, changes in white matter, and brain atrophy from MS contribute to cognitive impairment. According to the journal Neurological Sciences, 40 percent to 65 percent of people diagnosed with the condition will experience cognitive changes over time.

Types of cognitive changes include:

• Problems with memory or recall
• Difficulty concentrating or paying attention
• Trouble processing information
• Difficulty with problem-solving and complex tasks
• Struggles with verbal fluency (such as thinking of the right words)

Cognitive decline is even more prevalent in older people living with MS compared with their younger counterparts. According to one study, around 77 percent of people with MS over 55 may have two or more cognitive impairments, compared with around 43 percent of younger people with MS.

MyMSTeam members sometimes share their frustration with cognitive symptoms, including when friends and family members dismiss these symptoms as being part of the natural aging process. “What I don’t think people without MS fully understand is the changes in our brains are causing the memory loss. Friends and family tell me not to worry about it if I can’t remember things because ‘they forget stuff all the time,’” a member wrote. “How can we explain this is a different kind of memory loss? It is caused by the effects of MS damage to our brain and not due to ‘old age, being too busy,’ or any other reasons.”

Look for these six signs of cognitive impairment in MS.

How Aging and MS Affect Mental Health

Mental health refers to a person’s psychological, emotional, and social well-being — and good mental health is essential to the overall quality of life. While the aging process can naturally affect a person’s physical and cognitive well-being, it doesn’t directly affect mood. MS, health conditions, and medications, however, can — directly and indirectly — cause feelings such as depression.

Aging and Mental Health

The National Institute on Aging states, “Depression is a common problem among older adults, but clinical depression is not a normal part of aging.” Clinical depression refers to persistent feelings of sadness or disinterest that last for weeks or months.

Although the natural aging process itself doesn’t cause clinical depression or anxiety, older people may develop these conditions as they cope with difficulties such as losing loved ones, feeling alone or isolated, or living with serious health conditions.

MS and Mental Health in Older People

Depression occurs in about half of all people with MS, and it can affect or worsen their cognitive functioning. Researchers have also found that depression and anxiety are associated with an increased hazard of death in people with MS.

People with MS are more prone to depression for a couple of reasons. Among them, MS can affect the processing of neurotransmitters that influence mood, such as serotonin, norepinephrine, and dopamine.

Learn more about the link between MS and depression.

MS-related inflammation may also play a role in depression. A 2017 study from the National Multiple Sclerosis Society found higher levels of inflammatory disease activity in the brains of people with MS who were depressed. This inflammation could damage nerves that control behavior and mood.

Also, symptoms of MS — including the physical and cognitive symptoms mentioned above — can contribute depression and anxiety. These feelings can not only be difficult in and of themselves but also can make it hard to be active and socialize.

Other Reasons for New Symptoms

People living with MS are at a higher risk of developing specific comorbidities, many of which have symptoms that overlap with MS, the effects of aging, and one another. These overlapping symptoms can cause physical, cognitive, or emotional side effects. Additionally, medications for MS carry a risk of side effects.

Comorbidities

The list of potential comorbidities associated with MS is long and includes:

• Diabetes
• Ischemic heart disease (narrowed heart arteries)
• Chronic (ongoing) lung disease
• Degenerative brain disorders, such as Alzheimer’s disease
• Hypothyroidism — Underactive thyroid gland
• Metabolic conditions — Conditions such as high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels
• Stroke
• Immunosuppression

Older MyMSTeam members have described how having multiple conditions affects their lives. “I have three delightful comorbidities to deal with: type 2 diabetes, prostate hyperplasia (which could be cancer), and alcoholism — actually, I suppose it’s four if you count old age!” a member shared. “MS, though, is the most distressing as it takes away my favorite pursuits of kayaking and hiking, and one or all of them conspire to ensure that nothing works properly between navel and knees!”

Medication Side Effects

Depending on the medications you take, you may also develop physical, cognitive, and emotional side effects, including:

• Anxiety
• Depression
• Chest pain
• Fatigue
• Erratic heartbeat
• Increased risk of infection, including urinary tract and respiratory infections
• Gastrointestinal issues
• Dizziness
• Chills
• Fever
• Breathing difficulties

In rare cases, medications can lead to serious conditions such as cancer and suicidal thoughts.

When starting a new drug, make sure you understand the potential side effects, and report any new symptoms to your doctor as soon as possible.

Tell Your Doctor About New Symptoms

It’s essential for older people living with MS to pay attention to changes in their health and not assume that a new or worsening symptom is part of aging or that it’s related to MS. You can never be sure of the cause, so when you notice symptoms, make sure to tell your doctor.

“If I’m having new symptoms or worsening symptoms, I think I would like to know through an MRI if I have new lesions or older ones that are now active — or if it could be a stroke,” one MyMSTeam recommended to another. “I’ve had mini-strokes in the past that have rendered me completely helpless for over an hour or so.”

It’s also important to follow the treatment regimen that, ideally, you and your doctor developed together. This plan includes taking medications as prescribed — as well as adopting and maintaining healthy lifestyle choices, including eating a healthy diet and being physically active to the best of your ability. Taking care of your mind and body can help you stay healthier longer.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 196,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you a senior living with MS? How has MS affected you as you’ve gotten older? Share your experience in the comments below, or start a conversation by posting on your Activities page.