MULTIPLE SCLEROSIS IN OLDER ADULTS: EPIDEMIOLOGY, PATHOPHYSIOLOGY, CLINICAL FEATURES, AND TREATMENT CONSIDERATIONS

Although multiple sclerosis predominantly affects young adults, recent advances in diagnostic methods and therapeutic strategies have led to an increasing recognition of the disease in older adults. Aging induces distinct pathophysiological, clinical, and radiological changes in patients with multiple sclerosis, and management in this population requires a tailored approach due to comorbidities and age-related differences in treatment response. This narrative review synthesizes evidence published between 2000 and 2025 on the epidemiology, age-related pathophysiological mechanisms, clinical course, and therapeutic considerations of multiple sclerosis in older adults, based on findings retrieved from PubMed, Scopus, and Web of Science, to support age-adapted clinical decision-making. The reviewed literature indicates a growing prevalence of multiple sclerosis in older adults across diverse geographic regions. With advancing age, disability accumulation and disease progression independent of relapse activity become more prominent than inflammatory relapse-related activity, and age-associated impairment of remyelination is thought to contribute significantly to this process. The limited number of clinical studies specifically focusing on this population highlights an important unmet need in the field. Increasing research efforts in older adults with multiple sclerosis may enhance clinicians’ understanding and improve the effectiveness of treatment strategies.