Multiple sclerosis (MS) is a disease that affects the myelin sheath that surrounds nerves in the human body.
As the myelin sheath is progressively damaged and destroyed by MS, nerve function is compromised, eventually leading to debilitating conditions such as irreversible muscle weakness and paralysis. MS is thought to be an autoimmune disorder, meaning that the body’s own immune system attacks the myelin, but researchers still have significant work to do to fully understand the causes of this disease.
MS has a reputation for being a disease of youth; MS typically initially presents in men and women between the ages of 20 and 40 and was thought to take a significant toll on life expectancy. Improvements in multiple sclerosis care as well as a greater understanding that life expectancy reductions are due to complications from MS rather than the MS itself are raising important questions about aging with MS.
Types of Multiple Sclerosis
Patients’ experiences with MS are varied; the progression of the disease is as unique as the patient. That said, four general disease courses, also called types or phenotypes, have been identified to classify patients with MS.
CIS (Clinically Isolated Syndrome)
Patients carry a diagnosis of CIS when they have experienced one isolated episode of neurologic symptoms that has lasted a minimum of 24 hours. The neurologic episode in patients with CIS is caused by inflammation or demyelination of the nerve sheath and isn’t associated with any other disease or infection. As the name suggests, CIS is often an isolated incident that does not lead to MS. However, CIS has a high chance of progressing to MS when the neurologic symptoms are accompanied by the presence of active brain lesions or by evidence of past brain lesions, visible via MRI. If MS is determined to be a high risk, patients with CIS may begin a treatment regimen designed to delay or prevent the onset of MS.
RRMS (Relapsing-Remitting Multiple Sclerosis)
RRMS is the most common course for MS patients; approximately 85% of MS patients are initially diagnosed with RRMS. RRMS patients experience clearly defined attacks of neurologic symptoms, called relapses, when myelin layers are attacked and damaged by inflammatory cells. These relapses are followed by periods of partial or full recovery, called remissions. During a remission, the disease doesn’t progress; symptoms may continue or disappear, but the disease itself doesn’t worsen or get better.
RRMS patients can also be classified as active, not active, or worsening, depending upon relapses, new MRI activity, or an increase in disability over time. These characterizations are important because they assist caregivers in evaluating and designing treatment programs.
SPMS (Secondary Progressive MS)
SPMS is generally considered to be a second phase of MS; it follows an initial diagnosis of RRMS. Patients progress from RRMS to SPMS as their disease moves from the inflammation seen in RRMS to more significant nerve damage or loss. Patients with SPMS experience a progressive worsening of neurologic function. SPMS patients can further be classified as active, not active, progressing, or not progressing.
PPMS (Primary Progressive MS)
PPMS stands alone and outside of the CIS, RRMS, SPMS progression seen in the majority of MS patients. PPMS patients, about 15% of all MS patients, experience degenerating neurologic function without any early relapses or remissions. Patients with PPMS have fewer brain lesions than patients with RRMS, but they have more lesions in the spinal cord. PPMS lesions contain fewer inflammatory cells than RRMS lesions, making the condition more difficult to diagnose and treat. PPMS patients experience far more mobility problems than other MS patients. PPMS patients can also be classified as active, not active, progressing, or not progressing.
Multiple Sclerosis Treatment
MS treatment begins early in the disease and lasts a lifetime. Patients and health care providers work closely together to manage the disease and maintain quality of life. Treatments for all types of MS include a patient-specific combination of medications prescribed for three general purposes:
- Disease modification. A number of therapies exist that help reduce relapses, delay the onset and progression of disability, and inhibit new disease activity.
- Relapse management. During a relapse, inflammation in the central nervous system causes damage to the myelin sheath around nerve fibers, which, in turn, disrupts the transmission of nerve impulses. During severe relapses that interfere with the patient’s overall ability to function, high doses of corticosteroids can be prescribed. These medications don’t alter the course of the disease, but they can make severe relapses more manageable.
- Symptom management. MS patients experience a wide range of symptoms caused by disruptions to the central nervous system, including poor bladder function, impaired vision, dizziness, bowel disruption, itchiness, tremors, and emotional changes. MS patients have access to several medications that help manage these symptoms.
Multiple Sclerosis and Aging
MS is a degenerative, incurable disease; by the time the patient reaches their senior years, it’s likely that irreversible muscle weakness, paralysis, and other debilitating conditions are present. Aging MS patients and their caregivers must consider comorbidities, cognitive changes, emotional changes, self-care, and end-of-life planning. Many of the symptoms experienced by MS patients are also experienced by normally aging individuals. For example, it’s normal to suffer fatigue, loss of muscle strength, changes in optical acuity, and cognitive changes with age; MS exacerbates these issues and makes life more challenging. It can also be difficult to distinguish between symptoms of age, symptoms of MS, or symptoms that arise as a side effect of medications. In addition, older MS patients report significant limitations in most areas of self-care, including bathing, toileting, and getting around the house. Transportation, nutrition, exercise, and maintaining good mental health are also exceptionally difficult.
All this means that senior MS patients require specialized care. These older adults are likely struggling with multiple chronic conditions associated with aging and MS. Medication management is a significant issue; coordinating multiple medications at different times throughout the day is a critical task. In addition, self-care assistance, attention to mental health, help with physical therapy, and palliative care should also be part of a long-term care program for aging MS patients. The caregivers at 24 Hour Home Care have specialized training in MS care for seniors; our caregivers understand the complexity of aging with MS and are prepared to offer expert assistance. With our help, seniors living with MS can live in their own home and maintain their quality of life for as long as possible. Call 800-522-1516 today to learn more about our in-home MS care services.