Multiple sclerosis (MS) is a chronic disease of the central nervous system that occurs when the immune system attacks the myelin sheath surrounding nerve fibres.
Symptoms vary from person to person but generally include difficulty with coordination and motor control, muscle weakness, speech issues, fatigue and cognitive symptoms of varying severity. The cause of MS is often autoimmune, but can also be environmental, genetic or brought on by infectious agents such as viruses. MS generally occurs in younger people between the ages of 20 and 40. But a study by Cicero and colleagues published in November 2024 in Nature Scientific Reports suggests a new trend of increasing incidence of late-onset multiple sclerosis (LOMS).
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Cicero and colleagues studied the annual incidence of LOMS in the province of Catania, Italy. LOMS is defined as onset after the age of 50. A total of 183 newly diagnosed LOMS patients were identified using electronic medical records from 2005 to 2020. The study found that the incidence of LOMS was higher in women than men (3.26 per 100,000 person-years versus 2.40 per 100,000 person-years) – a pattern that is consistent with the sex distribution in MS overall (3.50 versus 8.70 cases per 100,000 population in men and women, respectively, according to GlobalData’s 2024 estimates). Over the study period, the incidence of LOMS increased notably, from 2.54 cases per 100,000 person-years in 2005 to 2010, to 3.32 cases per 100,000 person-years in 2016 to 2020.
According to GlobalData epidemiologists, incident cases of MS in Italy are forecast to decrease slightly, from approximately 3,880 in 2024 to 3,800 in 2028. This decrease is due to changes in the underlying population of Italy, with only a very small decrease in the incidence rate of MS. Across the 16 major markets (16MM: Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, Russia, South Africa, South Korea, Spain, the UK and the US), the incidence of MS is holding steady, though overall incident cases are increasing due to population growth.
This shift to older incident cases of MS in Italy may suggest broader changes in the epidemiology of MS. There is some speculation by Cicero and colleagues that it may be due in part to revised diagnosis criteria from MS published in 2017, which improved the diagnosis of MS in men who would have otherwise been diagnosed incorrectly with a different disease. The study emphasises, however, that there is strong evidence that an ageing population is at least somewhat causative. MS has long been a disease of young adults, and with an increase in the incidence of LOMS, there are concerns about the correct and timely diagnosis of LOMS. There must be a renewed focus on older patients with symptoms that match MS, especially those with motor dysfunctions, sensory disturbances and cognitive impairment, which occur more frequently and severely in LOMS, to guarantee that LOMS is not misdiagnosed.
As demographics in countries around the world shift towards increased older populations, diseases such as MS, which were previously rare in older populations, may become more common, and monitoring the changing epidemiology will be key.
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