title: Diagnosing multiple sclerosis at a later age: more than just progressive myelopathy.
abstract: BACKGROUND
  Multiple sclerosis (MS) is usually considered a 'young persons' disease', typically presenting between the ages of 20 and 40. In this study we review our experience with patients diagnosed at age 60 or over, with particular emphasis on patients who continue to have evidence of active inflammation despite a later onset.
  
  
  METHODS
  We reviewed all cases of MS diagnosed at or over age 60 in our center over a 5-year period. We identified 111 patients and recorded their clinical and imaging characteristics using prespecified variables. Analyses were performed to describe their interval to diagnosis, clinical syndromes, imaging and laboratory characteristics.
  
  
  RESULTS
  At the time of diagnosis, 8% of patients had a clinically isolated syndrome, 33% were in the relapsing-remitting stage, while 23% had a secondary progressive course, and 32% were primary progressive. Eighty-eight percent of patients had a brain MRI judged 'typical for MS', and 32% of all patients receiving gadolinium had enhanced lesions. Forty-six percent of patients with relapsing-remitting MS or clinically isolated syndrome exhibited gadolinium enhancement. Myelitis was the most common initial clinical syndrome, and progressive myelopathy was a common but not exclusive clinical syndrome at the time of diagnosis.
  
  
  CONCLUSIONS
  A relapsing pattern of MS is not uncommon, even in patients diagnosed over the age of 60. Active inflammation (clinical relapses and gadolinium enhancement) occurs in a significant number of patients with MS with later diagnosis. These observations have implications for evaluation and treatment of patients with MS presenting at an older age.
authors.affiliation: Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA. bermelr@ccf.org
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bermel
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Rae-Grant
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fox
mesh_terms: D017668:Age of Onset; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000503:physiopathology*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology