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Thread: Age and disability accumulation in MS (PubMed abstract)

  1. #1
    Distinguished Community Member agate's Avatar
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    Default Age and disability accumulation in MS (PubMed abstract)

    From PubMed, September 16, 2011:
    Neurology, September 14, 2011:

    Age and disability accumulation in multiple sclerosis

    Scalfari A, Neuhaus A, Daumer M, Ebers GC, Muraro PA.

    From the Centre for Neuroscience (A.S., P.A.M.), Division of Experimental Medicine, Imperial College London, UK; Sylvia Lawry Centre (A.N., M.D.), Munich, Germany; and Department of Neurology (G.C.E.), University of Oxford, Oxford, UK.

    OBJECTIVES:

    We tested the hypothesis that age is a prognostic factor with respect to long-term accumulation of disability in multiple sclerosis (MS).

    METHODS:

    Kaplan-Meier analysis and binary logistic regression models determined the effect of age at disease onset, age at onset of progression, and current age on attainment of severe disability levels (Disability Status Scale [DSS] 6-8-10) from the London, Ontario, database (n = 1,023).

    RESULTS:

    Older age at relapsing-remitting (RR) phase onset was associated with higher risk of reaching advanced DSS scores. This was independent of disease duration and early relapse frequency but secondary to increased risk of conversion to secondary progressive (SP) MS.

    Onset at age 40 (odds ratio [OR] = 4.22) and at age 50 (OR = 6.04) doubled and tripled risks of developing SP, compared to age 20 (OR = 2.05). Younger age at conversion to SPMS was associated with shorter times to high DSS scores from disease onset. The progressive course, unaffected by age at RR onset, was only modestly affected by age at SP onset. Among primary progressive and RR/SP patients, median ages at attainment of DSS scores were strikingly similar: DSS = 6, 49 vs 48 years; DSS = 8, 58 vs 58 years; and DSS = 10, 78 years for both (p = NS for all comparisons).

    CONCLUSIONS:

    Development of SP is the dominant determinant of long-term prognosis, independent of disease duration and early relapse frequency. Age independently affects disability development primarily by changing probability and latency of SP onset, with little effect on the progressive course.

    PMID:21917763
    http://www.ncbi.nlm.nih.gov/pubmed/21917763
    Last edited by agate; 09-16-2011 at 08:32 PM. Reason: Trying to get rid of some of the italics
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member Jeanie Z's Avatar
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    :) I don't completely understand their figures. I am 70. I had my first MS symptoms when I was 18 in 1959. I remained RRMS until 1992 when I was 51 following surgery. From 1992 until 1998 I continued to have new symptoms every few months and to gradually lose strength in my left leg even though during this period I was on Betaseron 5 years and Avonex 2 years. My doctor let me try them listing me as RRMS instead of SPMS. Neither helped at all.

    In 1998 I went on LDN and I have not progressed any further or had any new symptoms since going on LDN. I wish I had found it sooner when I was still walking, etc. but I am happy to just not be getting worse. Fatigue is probably the worst symptom and that has never totally gone away. Although I do have some days when I am less tired. Jeanie :)

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    Distinguished Community Member agate's Avatar
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    I think they're saying that for the contingent of people they studied--looks like 1,023 people in London, Ontario--the older these people were when RRMS developed, the more likely they were to have an advanced disability score (DSS) eventually.

    Also, if they were 40 or 50 when RRMS came on, they had twice or three times the risk of developing SPMS compared to people who had RRMS onset at age 20.

    According to this study, the younger you are when your MS changes to SPMS, the less time it will take to reach a high level of disability.

    It's great that you're doing well on LDN!

    I had similar experiences with the DMDs--3 years on Avonex and nearly 3 years on Copaxone, and who can say if I'd have been worse without them? I can't say I got worse or better while on them. I guess it's hoped that we'll get on one of these drugs just in case it might help....
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member SalpalSally's Avatar
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    My story is similar to Jeanie's, including the age..

    I never did fit in a comfy nitch/notch. I'm different, as we all are.:o

    I'm wondering why they don't quit waisting their time and money on these kinds of studies. Sooooo many diseases....Sooooo little time!!!
    Love, Sally


    "The best way out is always through". Robert Frost







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    Distinguished Community Member agate's Avatar
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    Sally, my MS course may fit in with what the study found. I may have had my first RRMS episode at age 20, a few more unrecognized flareups between 20 and my mid-30s, then conversion to SPMS and diagnosis at age 38-40. I haven't progressed very fast toward a higher DSS score because I'm 71 now and am nowhere near 10. AND I hope not to be at 10 at 78 either.

    I agree that studies aren't always very informative. I posted this one mainly because it was saying something I hadn't seen before and because it came from a reliable source.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member SalpalSally's Avatar
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    I always thank you for yor posts, Agate. I appreciate them even though I may not agree with what the study says or covers. Don't stop!!! (((Hugs)))
    Love, Sally


    "The best way out is always through". Robert Frost







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    Thanks for posting this Agate. I always like to read these things even if I do not always understand them.

    For one thing, even if a person is not diagnosed until age 40 or 50 or older (for me 63), that does not mean they have not had RRMS for much longer. After my diagnosis we were able to go back on old Doctor records and determine that I had had MS for many years - at least in my 30s. That was as far back as we were able to go, but I would not be surprised if it wasn't further. No Doctor just ever spotted that as the reason I was coming to them. During that time, I was still working full time and doing everything I wanted to do. No one just ever put the little things that were MS together.

    I remember in my 20s having very bad fatigue. I was working full time, and my husband and I were living in another state. It was so bad that my parents had me come home on a week-end and their Doctor opened his office on Saturday morning to do a physical on me. They were so concerned. I looked perfectly healthy and blood work and everything was good, so it was determined that I was overworking, which I just continued to do.

    My point is how do any of us really know when we started having MS symptoms. Was that extreme tiredness in my 20s a result of MS or a high pressure job? We do know, from very definite data that it was there in my 30s. So if I were to take part in one of these studies would it throw the study off or how do they take things like this into account?

    Virginia
    Virginia

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    Distinguished Community Member agate's Avatar
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    Thanks for the appreciative comments, Sally and Virginia.

    Virginia, you raised an interesting question. The abstract of the study doesn't indicate how they determined the onset date. It's probably around the date of the diagnosis, except that the diagnosing doctor might very well have asked, "When did you first notice these symptoms?" and written down that date as the date of onset.

    Sally, you're right about how many studies there are. Every day I get abstracts for 5-20 new MS studies by e-mail. There hasn't been a let-up in this for years. The studies just keep on rolling along, and meanwhile here we are with our MS.

    "Rome wasn't built in a day." The researchers are probably making some progress even if it's at a snail's pace....
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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