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MS research update - Do men and women experience ageing with MS differently? - 3 September 2017

Summary

Canadians aged 55 and older who had been living with MS for more than 20 years were asked to rate their health and complete questionnaires about themselves and their physical and mental health. 743 people responded, of whom 577 were women and 166 men.

Men and women had similar average age, years of education, years since MS diagnosis and level of disability. Despite being less likely to live alone and less likely to have additional health problems (such as arthritis), older men with MS had a lower perception of their health, coped less well with setbacks, had lower participation in household activities (such as housework and home/car maintenance), participated less in social activities outside of the home and had a poorer diet.

The researchers suggest that men cope less well as they grow older with MS because the loss of work, which brings daily routines and contact with other people, is more disruptive for men. Interventions to support healthy ageing with MS will need to take account of gender differences in coping with MS. In both men and women, the factor most closely linked to poor health perception was depression, emphasising the importance of treating this symptom, which could achieve the additional benefit of triggering other improvements in lifestyle such as greater motivation to follow a healthy diet, taking regular exercise and taking part in social activities.


Background

Because MS is generally diagnosed between the ages of 20 to 40, it tends to be thought of as a condition affecting young and middle aged adults. Yet a significant number of all people living with MS are 65 or older.  This research investigated gender differences in how older men and women experience ageing with MS.

How this study was carried out

Canadian researchers sent out surveys to people older than 55 who have been living with MS for more than 20 years. 743 people responded, of whom 577 were women and 166 were men. Participants were asked to rate their health on a visual analogue scale - a 10 cm line labelled with worst health at one end and best health at the other. They also completed questionnaires to capture data about other factors that might influence how they coped with living with MS.

What was found

Men and women had similar average age, years of education, years since MS diagnosis and level of disability. However, older men adapted less well to ageing with MS than older women; despite having similar degree of disability, being less likely to live alone and less likely to have additional health problems (such as arthritis), older men with MS had a lower perception of their health, coped less well with setbacks, had lower participation in household activities (such as housework and home/car maintenance) and out-of-home activities (such as social events), and had a poorer diet.

Older women reported higher levels of anxiety (feelings of unease, worry or fear) whereas older men reported higher levels of depression. Both men and women with higher levels of depression also had a lower perception of their health.

What does it mean?

The results indicate that men cope less well with ageing with MS - the researchers suggest that this may be due to the differences in the traditional roles of men and women. Although women were just as likely as men to retire early due to MS, older women continued to participate in household work and social opportunities more often than older men; these activities help to reduce the impact of depression on perceived health and quality of life. Any interventions developed to support people ageing with MS will need to take account of these gender differences.

Depression was the strongest predictor of poor health perception in both groups, emphasising the importance of treating this symptom, which could achieve the additional benefit of triggering other improvements in lifestyle such as greater motivation to follow a healthy diet, take regular exercise and take part in social activities.

The researchers recognized a number of shortcomings of the study. In common with most survey-based studies, people who have spent longer in formal education and have a more positive outlook may have been more likely to participate. With an average age of 65 years, the study sample may better represent the "young old"; further research is needed to explore health ageing in older groups of people with MS, such as those in their 80s.

Ploughman M, et al
Women's and men's differing experiences of health, lifestyle and aging with multiple sclerosis
International Journal of MS Care 2017; 19(4): 165-171
Abstract
Read the full text of this paper

More about ageing well with MS

Until recently, little attention has been paid to the issues or challenges of ageing with MS, and very few resources or services specifically designed for older adults with MS are readily available. However, there is a growing recognition that more attention should be paid to support people growing older with MS. This research was part of a larger Canadian study looking at healthy ageing for people with MS; an earlier report which investigated factors that people considered important to help them age well with MS was covered in a previous Research Update Ageing well with MS - what's the secret?.

Making decisions and preparing for the future is an important element of self-management. Although MS is unpredictable and it's difficult to know how it will affect you in later life, you can begin to develop self-management skills which will help you to anticipate problems and find ways to resolve them. The MS Trust booklet, MS and me: a self-management guide to living with MS  looks at setting goals, problem solving and healthy living.

It can be helpful to discuss issues relating to living with multiple sclerosis with other people with first-hand experience. There are a host of support groups, both online and face-to-face, where you can share your own experiences and benefit from those of others.

Adopting a healthy lifestyle will keep you as healthy as possible and put you in the best position to deal with the challenges that MS brings.

Research by topic areas...

Causes of MS

Cortese M, Yuan C, Chitnis T, et al.
No association between dietary sodium intake and the risk of multiple sclerosis.
Neurology. 2017 Aug 25. pii: 10.1212/WNL.0000000000004417. [Epub ahead of print]
abstract

Disease modifying drugs

Holmøy T, Torkildsen Ø, Myhr KM.
An update on cladribine for relapsing-remitting multiple sclerosis.
Expert Opin Pharmacother. 2017 Sep 11:1-9. [Epub ahead of print]
abstract

Proschmann U, Thomas K, Thiel S, et al.
Natalizumab during pregnancy and lactation.
Mult Scler. 2017 Aug 1:1352458517728813. [Epub ahead of print]
abstract

Kalincik T, Jokubaitis V, Spelman T, et al.
Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis.
Mult Scler. 2017 Aug 1:1352458517728812. [Epub ahead of print]
abstract

Papadopoulou A, Derfuss T, Sprenger T.
Daclizumab for the treatment of multiple sclerosis.
Neurodegener Dis Manag. 2017 Aug 29. [Epub ahead of print]
abstract

Calabrese M, Pitteri M, Farina G, et al.
Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events.
J Neurol Neurosurg Psychiatry. 2017 Aug 26. pii: jnnp-2017-316236. [Epub ahead of print]
abstract

Vollmer B, Nair KV, Sillau SH, et al.
Comparison of fingolimod and dimethyl fumarate in the treatment of multiple sclerosis: Two-year experience.
Mult Scler J Exp Transl Clin. 2017 Aug 17;3(3):2055217317725102.
abstract
Read the full text of this paper

Ceuninck van Capelle A, Meide HV, Vosman FJH, et al.
A qualitative study assessing patient perspectives in the process of decision-making on disease modifying therapies (DMT's) in multiple sclerosis (MS).
PLoS One. 2017 Aug 24;12(8):e0182806.
abstract
Read the full text of this paper

Mansfield C, Thomas N, Gebben D, et al.
Preferences for Multiple Sclerosis Treatments: Using a Discrete-Choice Experiment to Examine Differences Across Subgroups of US Patients.
Int J MS Care. 2017 Jul-Aug;19(4):172-183.
abstract
Read the full text of this paper

Coles AJ, Cohen JA, Fox EJ, et al.
Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings.
Neurology. 2017 Sep 12;89(11):1117-1126.
abstract
Read the full text of this paper

Wiendl H, Bourdette D, Ciccarelli O.
Can immune reprogramming with alemtuzumab induce permanent remission in multiple sclerosis?
Neurology. 2017 Sep 12;89(11):1098-1100.
abstract

Lattanzi S, Danni M, Taffi R, et al.
Persistence to oral disease-modifying therapies in multiple sclerosis patients.
J Neurol. 2017 Aug 22. [Epub ahead of print]
abstract
Read the full text of this paper

D'Amico E, Ziemssen T, Cottone S.
Induction therapy for the management of early relapsing forms of multiple sclerosis. A critical opinion.
Expert Opin Pharmacother. 2017 Aug 22:1-4. [Epub ahead of print]
abstract

Leurs CE, van Kempen ZL, Dekker I, et al.
Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients.
Mult Scler. 2017 Aug 1:1352458517726381. [Epub ahead of print]
abstract
Read the full text of this paper

Afolabi D, Albor C, Zalewski L, et al.
Positive impact of cladribine on quality of life in people with relapsing multiple sclerosis.
Mult Scler. 2017 Aug 1:1352458517726380. [Epub ahead of print]
abstract
Read the full text of this paper

Col NF, Solomon AJ, Springmann V, et al.
Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals.
Med Decis Making. 2017 Aug 1:272989X17724434. [Epub ahead of print]
abstract
Read the full text of this paper

Osherov M, Milo R.
Daclizumab for the treatment of adults with relapsing forms of multiple sclerosis.
Expert Rev Clin Pharmacol. 2017 Aug 22:1-11. [Epub ahead of print]
abstract

Lorscheider J, Jokubaitis VG, Spelman T, et al.
Anti-inflammatory disease-modifying treatment and short-term disability progression in SPMS.
Neurology. 2017 Sep 5;89(10):1050-1059.
abstract

Prosperini L, Scarpazza C, Imberti L, et al.
Age as a risk factor for early onset of natalizumab-related progressive multifocal leukoencephalopathy.
J Neurovirol. 2017 Aug 8. [Epub ahead of print]
abstract
Read the full text of this paper

Ragonese P, Aridon P, Vazzoler G, et al.
Association between multiple sclerosis, cancer risk, and immunosuppressant treatment: a cohort study.
BMC Neurol. 2017 Aug 8;17(1):155.
abstract
Read the full text of this paper

Brochet B, Deloire MS, Perez P, et al.
Double-Blind Controlled Randomized Trial of Cyclophosphamide versus Methylprednisolone in Secondary Progressive Multiple Sclerosis.
PLoS One. 2017 Jan 3;12(1):e0168834.
abstract
Read the full text of this paper

Willis MD, Robertson NP.
Alemtuzumab for Multiple Sclerosis.
Curr Neurol Neurosci Rep. 2016 Sep;16(9):84.
abstract
Read the full text of this paper

Drugs in development

Bell C, Anderson J, Ganguly T, et al.
Development of Glatopa® (Glatiramer Acetate): The First FDA-Approved Generic Disease-Modifying Therapy for Relapsing Forms of Multiple Sclerosis.
J Pharm Pract. 2017 Jan 1:897190017725984. [Epub ahead of print]
abstract

Chaudhry BZ, Cohen JA, Conway DS.
Sphingosine 1-Phosphate Receptor Modulators for the Treatment of Multiple Sclerosis.
Neurotherapeutics. 2017 Aug 15. [Epub ahead of print]
abstract
Read the full text of this paper

Epidemiology

Wallin MT, Culpepper WJ, Maloni H, et al.
The Gulf War era multiple sclerosis cohort: 3. Early clinical features.
Acta Neurol Scand. 2017 Aug 22. [Epub ahead of print]
abstract

Guillemin F, Baumann C, Epstein J, et al.
Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study.
Neuroepidemiology. 2017;48(3-4):179-187.
abstract

Other treatments

Street T.
Management of the symptoms of multiple sclerosis using functional electrical stimulation and exercise.
Neurodegener Dis Manag. 2017 Aug 30. [Epub ahead of print]
abstract

Paediatric MS

Cappa R, Theroux L, Brenton JN.
Pediatric Multiple Sclerosis: Genes, Environment, and a Comprehensive Therapeutic Approach.
Pediatr Neurol. 2017 Jul 13. pii: S0887-8994(17)30297-7. [Epub ahead of print]
abstract

Prognosis

Ploughman M, Collins K, Wallack EM, et al.
Women's and Men's Differing Experiences of Health, Lifestyle, and Aging with Multiple Sclerosis.
Int J MS Care. 2017 Jul-Aug;19(4):165-171.
abstract
Read the full text of this paper

Tiftikcioglu BI, Ilgezdi I, Zorlu Y, et al.
Long-term disability and progression in spinal onset multiple sclerosis.
Acta Neurol Belg. 2017 Aug 10. [Epub ahead of print]
abstract
Read the full text of this paper

Provision of care

Browne C, Kehoe M, Salmon N.
How Beliefs About Bladder Dysfunction Among Health-Care Professionals Influence Clinical Practice Development: Perspectives of Allied Health Professionals, Nurses, and Managers.
Int J MS Care. 2017 Jul-Aug;19(4):191-198.
abstract
Read the full text of this paper

Psychological aspects

Greenberg B, Fan Y, Carriere L, et al.
Depression and Age at First Neurology Appointment Associated with Receipt of Behavioral Medicine Services Within 1 Year in a Multiple Sclerosis Population.
Int J MS Care. 2017 Jul-Aug;19(4):199-207.
abstract
Read the full text of this paper

Mhizha-Murira JR, Drummond A, Klein OA, et al.
Reporting interventions in trials evaluating cognitive rehabilitation in people with multiple sclerosis: a systematic review.
Clin Rehabil. 2017 Aug 1:269215517722583. [Epub ahead of print]
abstract

Briones-Buixassa L, Milà R, Arrufat FX, et al.
A case-control study of psychosocial factors and their relationship to impairment and functionality in multiple sclerosis.
J Health Psychol. 2017 Feb 1:1359105317692142. [Epub ahead of print]
abstract

Rehabilitation

Kasser SL, Kosma M.
Social Cognitive Factors, Physical Activity, and Mobility Impairment in Adults with Multiple Sclerosis.
Behav Med. 2017 Sep 1:0. [Epub ahead of print]
abstract

Ciol MA, Matsuda PN, Khurana SR, et al.
Effect of Cognitive Demand on Functional Mobility in Ambulatory Individuals with Multiple Sclerosis.
Int J MS Care. 2017 Jul-Aug;19(4):217-224.
abstract
Read the full text of this paper

Sangelaji B, Smith CM, Paul L, et al.
The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis.
Clin Rehabil. 2016 Jun;30(6):559-76.
abstract

Relapses

Bergamaschi R, Cortese A, Pichiecchio A, et al.
Air pollution is associated to the multiple sclerosis inflammatory activity as measured by brain MRI.
Mult Scler. 2017 Aug 1:1352458517726866. [Epub ahead of print]
abstract

Stem cells

Atkins HL, Freedman MS.
Five Questions Answered: A Review of Autologous Hematopoietic Stem Cell Transplantation for the Treatment of Multiple Sclerosis.
Neurotherapeutics. 2017 Aug 18. [Epub ahead of print]
abstract
Read the full text of this paper

Symptoms and symptom management

Kim ES.
Fampridine Prolonged Release: A Review in Multiple Sclerosis Patients with Walking Disability.
Drugs. 2017 Sep 1. [Epub ahead of print]
abstract

Young J, Amatya B, Galea MP, et al.
Chronic pain in multiple sclerosis: A 10-year longitudinal study.
Scand J Pain. 2017 Jul;16:198-203.
abstract

Rossi S, Studer V, Motta C, et al.
Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis.
Neurology. 2017 Aug 25. pii: 10.1212/WNL.0000000000004411. [Epub ahead of print]
abstract

Zelaya JE, Murchison C, Cameron M.
Associations Between Bladder Dysfunction and Falls in People with Relapsing-Remitting Multiple Sclerosis.
Int J MS Care. 2017 Jul-Aug;19(4):184-190.
abstract
Read the full text of this paper

Costa SL, DeLuca J, Sandroff BM, et al.
Role of Demographic and Clinical Factors in Cognitive Functioning of Persons with Relapsing-Remitting and Progressive Multiple Sclerosis.
J Int Neuropsychol Soc. 2017 Aug 23:1-8. [Epub ahead of print]
abstract

Safarpour Y, Mousavi T, Jabbari B.
Botulinum Toxin Treatment in Multiple Sclerosis-a Review.
Curr Treat Options Neurol. 2017 Aug 17;19(10):33.
abstract
Read the full text of this paper

Francomano D, Ilacqua A, Cortese A, et al.
Effects of daily tadalafil on lower urinary tract symptoms in young men with multiple sclerosis and erectile dysfunction: a pilot study.
J Endocrinol Invest. 2017 Mar;40(3):275-279.
abstract
Read the full text of this paper

Vitamin D

Miclea A, Miclea M, Pistor M, et al.
Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity.
Brain Behav. 2017 Jul 11;7(8):e00761.
abstract
Read the full text of this paper

Fragoso YD, Adoni T, Alves-Leon SV, et al.
No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South.
Arq Neuropsiquiatr. 2017 Jan;75(1):3-8.
abstract
Read the full text of this paper

Work

Dorstyn DS, Roberts RM, Murphy G, et al.
Employment and multiple sclerosis: A meta-analytic review of psychological correlates.
J Health Psychol. 2017 Feb 1:1359105317691587. [Epub ahead of print]
abstract

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