How Age at Diagnosis Affects Multiple Sclerosis Symptoms and Progression
Updated on August 11, 2026
ON THIS PAGE
ON THIS PAGE
Most people with multiple sclerosis (MS) are diagnosed between age 20 and 50, though it can occur in children as well as in older adults, according to the National Multiple Sclerosis Society (NMSS).
About 85 percent of people diagnosed with MS are initially diagnosed with the relapsing form of the condition, usually referred to as relapsing-remitting MS, which is characterized by periods of active symptoms — relapses, sometimes called flares or exacerbations — alternating with periods of less-severe symptoms, or remissions.
By age 75, many of these people reach a stage known as secondary-progressive MS (SPMS), in which symptoms gradually worsen and a person experiences increasing levels of disability. That might include more difficulty walking, bowel and bladder problems, and cognitive problems. Some people with SPMS continue to experience relapses, but others don’t. And earlier diagnosis and high-efficacy disease-modifying therapies (DMTs) have decreased the percentage of cases that become SPMS.
MS is complex, and a number of factors are likely at play in the progression of the disease. But the transition from relapsing-remitting MS to secondary-progressive MS appears to be age-dependent, with the forties being the most common period to experience it, according to a review of research.
Next up video playing in 10 seconds
Why Do People With MS Need to Be Careful About Getting a Flu Shot?
People with multiple sclerosis have good reason to get the flu shot every year, because the disease and certain MS treatments can leave them vulnerable to complications, says Purvi S. Parikh, MD, of NYU Langone Health.
Age at Diagnosis and MS Progression
The thinking used to be that MS progressed more quickly in people diagnosed at an older age. Indeed, a study of 12,482 people with MS found that pediatric-onset cases had a slower disability progression than the adult-onset cases from disease onset. Researchers estimate a median of 31 years from MS onset to relatively severe disability. However, people with pediatric-onset MS reached disability milestones at a significantly younger age.
Research has looked into the ways that aging itself affects multiple sclerosis: immune system changes, the reduction of sex hormones, the decline of compensation strategies, and simply more time to accumulate injury and disability all affect disease progression.
Late-onset MS is diagnosed in people 50 and over. Research has shown that with late-onset MS, there’s a greater burden of progressive disease and of conversions from relapsing-remitting MS to secondary progressive MS.
Childhood-Onset MS
Up to 5 percent of MS is diagnosed in children and teens. Although MS in children is generally understood to be the same disease as MS in adults, there are some key differences.
“Children experience similar MS symptoms to adults, including motor symptoms [affecting movement and coordination] and weakness, but children tend to have more relapses than adults,” says Tanuja Chitnis, MD, a professor of neurology at Harvard Medical School and director of the Mass General Brigham Pediatric MS Center in Boston.
Research has found that children are more likely to be diagnosed with relapsing forms of the disease and often experience longer diagnostic delays than adults.
Dr. Chitnis adds, “There is a slower course of progression, and kids have less disability early on in their disease course.”
Still, she says, it’s important to note that a 30-year-old with pediatric-onset MS will have more disability than a 30-year-old with adult-onset MS. “Better treatment strategies are required in kids,” she says.
Clinical trials have led to approval by the U.S. Food and Drug Administration (FDA) of the medication ocrelizumab (Ocrevus) for the treatment of RRMS in patients age 10 and older who weigh 55 pounds or more. Fingolimod (Gilenya) was previously the only FDA-approved therapy for pediatric MS.
Adult-Onset MS
Symptoms and progression in adult-onset MS appear to vary by age. Research has found that motor symptoms were more common as the first manifestation of MS as age increases, affecting 19.3 percent in people under 30, 37 percent in people 30 to 39, 44.4 percent in those 40 to 49, and 61.5 percent in those 50 and over. Visual and sensory symptoms were responsible for nearly half of first manifestations in patients under 50, but they affected a significantly lower proportion of those over 50.
The Expanded Disability Status Scale (EDSS) is a metric for measuring disability levels, from 0 to 10, and research has shown that median EDSS score at diagnosis was higher with advancing age. There’s also a higher proportion of older patients with progressive forms of the disease, especially primary-progressive MS, which is characterized by symptoms at onset that don’t relapse or remit but worsen over time. One study found that progressive forms of MS affected 3.7 percent in those between age 30 and 39, 14.8 percent between 40 and 49, and 51.3 percent in those 50 and older.
Disease-modifying therapies have significantly improved the natural history of the disease, modifying its prognosis; and a lower age at the start of treatment has been linked to enhanced effects on annualized relapse rate and disability progression. Delayed DMT initiation has been associated with a higher risk of progression and relapse-related worsening events in people with either adult-onset or pediatric-onset MS.
Smoking, along with older age, greater disability, motor and brain stem dysfunction, and spinal lesions at the time of diagnosis, have also been identified as risk factors for transitioning from relapsing-remitting MS to secondary-progressive MS.
Late-Onset MS
There’s evidence that the age of onset of MS has shifted forward over the past five decades. Researchers say that a rise in the incidence of late-onset MS might be due to more awareness and improvement of diagnostic tools. Still, the time needed to diagnosis late-onset MS is almost double that of adult early-onset MS.
One study comparing late-onset MS in pediatric- and adult-onset MS found that late onset affected a higher proportion of males and was associated with the longest diagnostic delay, highest comorbidity rates, and a greater level of disability. The median EDSS score was highest in the late-onset group.
People with late-onset MS frequently have primary-progressive MS, and if they have RRMS, they face an earlier conversion to secondary-progressive MS compared with those diagnosed at a younger age. Onset at age 50 tripled the risk of developing SPMS versus onset at age 20.
For equivalent disease duration, late onset has been associated with a higher EDSS score: one study found that once EDSS 4 is reached – significant disability but you can walk without aid or rest for 500 meters – age at disease onset was the only predictor of progression of irreversible disability. In a study of over 81,000 people with MS, those with late-onset and very late-onset MS exhibited a more progressive form of disease at onset and higher disability milestones than people with adult-onset MS.
Research has shown that a diagnosis of MS after age 50 is significantly associated with a higher risk of reaching an irreversible EDSS 6 – requiring a walking aid to walk about 100 meters with or without resting – in a shorter time than patients with a younger age at onset.
Mental and physical changes associated with aging can be similar to, or overlap with, symptoms of MS. Such symptoms may include muscle weakness, balance problems, fatigue, visual changes, cognitive impairment (such as problems thinking and remembering), and sleep disturbances.
The combination of aging and MS-related symptoms can exacerbate any of the health problems a person has. For instance, people with mobility problems due to MS may have difficulty traveling to and from healthcare appointments, so they may forgo these trips and miss needed care — for both their MS and other medical conditions.
Effect of MS on Life Expectancy
Ultimately, MS is a chronic illness, not a terminal one. While it can slightly shorten life expectancy, Chitnis says that the reduction is unsubstantial: “I have seen many MS patients who live to be 70 or 80 years old.”
Over the years, the life expectancy of people living with MS has progressively increased, according to studies. Researchers say that with reduced diagnostic delay, availability of more potent DMTs, more aggressive treatment approaches, and better care of comorbidities, the survival rate could approach that of the general population.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Who Gets Multiple Sclerosis? National Multiple Sclerosis Society.
- Types of MS. National Multiple Sclerosis Society.
- Ziemssen T et al. Secondary Progressive Multiple Sclerosis: A Review of Clinical Characteristics, Definition, Prognostic Tools, and Disease-Modifying Therapies. Neurology Neuroimmunology and Neuroinflammation. November 22, 2022.
- Secondary Progressive Multiple Sclerosis (SPMS). National Multiple Sclerosis Society.
- Meca-Lallana V et al. Deciphering Multiple Sclerosis Progression. Frontiers in Neurology. April 6, 2021.
- McKay KA et al. Long-term Disability Progression of Pediatric-Onset Multiple Sclerosis. Neurology. June 11, 2019.
- New Research Explores Aging with MS. National Multiple Sclerosis Foundation. December 10, 2024.
- Guerra T et al. Refining Prognostic Factors in Adult-Onset Multiple Sclerosis: A Narrative Review of Current Insights. International Journal of Molecular Sciences. August 11, 2025.
- Mouresan EF et al. Clinical Characteristics and Long-Term Outcomes of Late-Onset Multiple Sclerosis. Neurology. February 23, 2024.
- Pediatric Multiple Sclerosis. Ann & Robert H. Lurie Children’s Hospital of Chicago.
- FDA Approves Ocrevus for Relapsing-Remitting Multiple Sclerosis in Pediatric Patients 10 Years of Age and Older. Genentech. May 8, 2026.
- Małecka I et al. Clinical and Laboratory Parameters by Age for Patients Diagnosed with Multiple Sclerosis Between 2000 and 2015. Polish Journal of Neurology and Neurosurgery. 2021.
- Primary Progressive Multiple Sclerosis (PPMS). National Multiple Sclerosis Society.
- Expanded Disability Status Scale. MSTrust.
- Barzegar M et al. Progression to Secondary Progressive Multiple Sclerosis and its Early Risk Factors: A Population-based Study (2171). Neurology. April 14, 2020.
- Fernández Ó et al. Managing Multiple Sclerosis in Individuals Aged 55 and Above: A Comprehensive Review. Frontiers in Immunology. April 5, 2024.
- Oleksy PT et al. From Youth to Late Age: A Comparative Analysis of Clinical and Demographic Profiles in Multiple Sclerosis by Age at Onset. Advances in Psychiatry and Neurology. December 2025.
- Trust MS. Expanded Disability Status Scale (EDSS) | MS Trust.
- Souissi A et al. Effect of Late-Onset on Multiple Sclerosis Phenotype and Outcome: Evidence from a Multi-National Registry. Journal of Neurology. February 4, 2026.
- Kuutti K et al. Mortality and Causes of Death for People with Multiple Sclerosis: A Finnish Nationwide Register Study. Journal of Neurology. May 2, 2025.
Meet Our Experts
Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM
Medical Reviewer
Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM, is a neurologist who has specialized in the care of persons with multiple sclerosis since 1982. She has been faculty in the departme...
Connie Brichford
Author
Connie is Boston-based freelance writer who focuses on science and current events. Her interests include child development, science literacy for children and adults and the interse...