Comparative Analysis of Cognitive and Physical Characteristics in Late-Onset, Adult-Onset and Early-Onset Multiple Sclerosis Patients

Abstract

Background: Late-onset multiple sclerosis (LOMS or L; MS) and early-onset MS (EOMS or E) are less common, and their prognosis can be different. To characterize the demographic and clinical features, and clinical outcomes of LOMS and EOMS patients, comparing them to adult-onset MS (AOMS or A) patients. Methods: The study was conducted as a secondary analysis of a prospective study. The participants were divided into three groups according to age of MS onset: early onset (<18 years of age), adult-onset (20-40 years of age), and late-onset (>55 years of age). Demographic variables, oligoclonal bands, IgG index, and Expanded Disability Status Scale (EDSS) score in admission, first year, second year and current EDSS were evaluated. The Timed 25- Foot Walk Test (T25FW), Timed Up and Go (TUG), Multiple Sclerosis Walking Scale-12, Single Leg Standing Test, Activity-Specific Balance Confidence Scale, Nine-Hole Peg Test, Epworth Sleepiness Scale and Restless Legs Syndrome Severity Scale were performed. Appropriate statistical analysis was made. Results: A total of 658 pwMS was included in the study and divided into three groups: EOMS (n n = 117), AOMS (n n = 499), and LOMS (n n = 42). Statistically significant differences were determined between groups in terms of age [L (mean:59.86+5.45 +5.45 years-y-)> A (36.87+9.12 +9.12 y)> E (26.56 +8.85 y), p < 0.001], education level, current EDSS score (L L > E, p < 0.001), EDSS score in first admission, EDSS score in the first year, EDSS score in the second year (L L > A > E, p < 0.001), reached an EDSS score 6 (E E > L p = 0.001, E > A p = 0.015), disease duration (E E > A, E > L , mean E = 11.66+9.7 +9.7 y, A = 7.99+7.4 +7.4 y, L = 6.31+4.67 +4.67 y) time switching second-line treatment to the third line (E E > L p < 0.001, A > L p = 0.002, mean E = 171.73+83.29 +83.29 months-m-, A = 136.13+65.75 +65.75 m, L = 65.85 +45.96 m), number of relapses (A A > E > L , median E = 4.0, A = 3.0, L = 2.0), distribution of MS type and oligoclonal band types. Significant differences were found in T25FW and TUG. Post-hoc analysis showed that participants in the LOMS group have longer T25FW (mean L = 7.8 + 6.11, A = 6.25+5.09, +5.09, E = 5.72+3.13, +3.13, p = 0.011) and TUG (mean L = 11.01+5.53, +5.53, A = 9.57+8.04, +8.04, E = 8.38+5.51, +5.51, p = 0.007) times than the AOMS and EOMS groups. Conclusion: Our result revealed that individuals with LOMS face elevated disability levels and a heightened propensity to transition from first-line treatments to more advanced therapeutic interventions. LOMS have worse lower extremity functional status than AOMS and EOMS patient. Clinical evaluations and treatment choices require more attention in LOMS. However, according to the low number of LOMS in our cohort, these results were considered cautious, and more wide and multi-center studies must be designed.