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Multiple Sclerosis in the Elderly: Considerations in the Geriatric Population for Diagnosis and Management

  • Neurology of Aging (KS Marder, Section Editor)
  • Published:
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Abstract

Multiple sclerosis is less commonly diagnosed among the elderly. Careful consideration of potential mimics is critical. History, physical exam, and magnetic resonance imaging are important, as are serum and often cerebrospinal fluid testing in diagnosing multiple sclerosis. In the elderly, multiple sclerosis is more often of the progressive subtype and may lead to greater disability. When disease-modifying therapy is offered to a newly or remotely diagnosed elderly patient, the physician must carefully consider the potential risks and benefits. There is limited data from clinical trials to predict the response to these treatments in the elderly. Symptomatic therapies for multiple sclerosis may modify gait impairment, mood disturbance, bladder and bowel dysfunction, neuropathic pain, and spasticity. Interventions include pharmacotherapies, physical and occupational therapies, and rehabilitative strategies to maximize function. In this review, existing data on the features unique to multiple sclerosis in the elderly population are discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000;343(13):938–52.

    Article  CAS  PubMed  Google Scholar 

  2. Frohman EM, Racke MK, Raine CS. Multiple sclerosis—the plaque and its pathogenesis. N Engl J Med. 2006;354(9):942–55.

    Article  CAS  PubMed  Google Scholar 

  3. Beecham AH, Patsopoulos NA, Xifara DK, Davis MF, Kemppinen A, Cotsapas C, et al. Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis. Nat Genet. 2013;45(11):1353–60. ImmunoChip genotyping array was used to analyze 14,498 MS subjects and 26,703 healthy controls, yielding 135 potentially associated regions. This was replicated with a prior GWAS data set. Forty-eight new susceptibility variants for MS were identified. The majority of the variants lie close to a gene for immune function.

    Article  CAS  PubMed  Google Scholar 

  4. Kurtzke JF, Heltberg A. Multiple sclerosis in the Faroe Islands: an epitome. J Clin Epidemiol. 2001;54(1):1–22.

    Article  CAS  PubMed  Google Scholar 

  5. Rose AS, Ellison GW, Myers LW, Tourtellotte WW. Criteria for the clinical diagnosis of multiple sclerosis. Neurology. 1976;26(6 pt 2):20–2.

    Article  CAS  PubMed  Google Scholar 

  6. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983;13(3):227–31.

    Article  CAS  PubMed  Google Scholar 

  7. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292–302.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Polliack ML, Barak Y, Achiron A. Late-onset multiple sclerosis. J Am Geriatr Soc. 2001;49(2):168–71.

    Article  CAS  PubMed  Google Scholar 

  9. Evans C, Beland SG, Kulaga S, Wolfson C, Kingwell E, Marriott J, et al. Incidence and prevalence of multiple sclerosis in the Americas: a systematic review. Neuroepidemiology. 2013;40(3):195–210.

    Article  PubMed  Google Scholar 

  10. Koch-Henriksen N, Sorensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol. 2010;9(5):520–32.

    Article  PubMed  Google Scholar 

  11. Martinelli V, Rodegher M, Moiola L, Comi G. Late onset multiple sclerosis: clinical characteristics, prognostic factors and differential diagnosis. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2004;25 Suppl 4:S350–5.

    Google Scholar 

  12. Fazekas F, Schmidt R, Kleinert R, Kapeller P, Roob G, Flooh E. The spectrum of age-associated brain abnormalities: their measurement and histopathological correlates. J Neural Transm Suppl. 1998;53:31–9.

    Article  CAS  PubMed  Google Scholar 

  13. Group TIBMSS. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993;43(4):655–61.

    Article  Google Scholar 

  14. Clanet M, Radue EW, Kappos L, Hartung HP, Hohlfeld R, Sandberg-Wollheim M, et al. A randomized, double-blind, dose-comparison study of weekly interferon beta-1a in relapsing MS. Neurology. 2002;59(10):1507–17.

    Article  CAS  PubMed  Google Scholar 

  15. Group PS. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet. 1998;352(9139):1498–504.

    Article  Google Scholar 

  16. Calabresi PA, Kieseier BC, Arnold DL, Balcer LJ, Boyko A, Pelletier J, et al. Pegylated interferon beta-1a for relapsing-remitting multiple sclerosis (ADVANCE): a randomised, phase 3, double-blind study. Lancet Neurol. 2014;13(7):657–65.

    Article  CAS  PubMed  Google Scholar 

  17. Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology. 1995;45(7):1268–76.

    Article  CAS  PubMed  Google Scholar 

  18. Millefiorini E, Gasperini C, Pozzilli C, D’Andrea F, Bastianello S, Trojano M, et al. Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome. J Neurol. 1997;244(3):153–9.

    Article  CAS  PubMed  Google Scholar 

  19. Polman CH, O’Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899–910.

    Article  CAS  PubMed  Google Scholar 

  20. Kappos L, Radue EW, O’Connor P, Polman C, Hohlfeld R, Calabresi P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362(5):387–401.

    Article  CAS  PubMed  Google Scholar 

  21. Confavreux C, O’Connor P, Comi G, Freedman MS, Miller AE, Olsson TP, et al. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247–56.

    Article  CAS  PubMed  Google Scholar 

  22. Gold R, Kappos L, Arnold DL, Bar-Or A, Giovannoni G, Selmaj K, et al. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med. 2012;367(12):1098–107.

    Article  CAS  PubMed  Google Scholar 

  23. Cohen JA, Coles AJ, Arnold DL, Confavreux C, Fox EJ, Hartung HP, et al. Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial. Lancet. 2012;380(9856):1819–28.

    Article  CAS  PubMed  Google Scholar 

  24. Beck RW, Cleary PA, Anderson MM, Keltner JL, Shults WT, Kaufman DI, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med. 1992;326(9):581–8.

    Article  CAS  PubMed  Google Scholar 

  25. Calabresi PA, Radue EW, Goodin D, Jeffery D, Rammohan KW, Reder AT, et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(6):545–56.

    Article  CAS  PubMed  Google Scholar 

  26. Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39(3):285–94.

    Article  CAS  PubMed  Google Scholar 

  27. Mikol DD, Barkhof F, Chang P, Coyle PK, Jeffery DR, Schwid SR, et al. Comparison of subcutaneous interferon beta-1a with glatiramer acetate in patients with relapsing multiple sclerosis (the REbif vs Glatiramer Acetate in Relapsing MS Disease [REGARD] study): a multicentre, randomised, parallel, open-label trial. Lancet Neurol. 2008;7(10):903–14.

    Article  CAS  PubMed  Google Scholar 

  28. O’Connor P, Filippi M, Arnason B, Comi G, Cook S, Goodin D, et al. 250 microg or 500 microg interferon beta-1b versus 20 mg glatiramer acetate in relapsing-remitting multiple sclerosis: a prospective, randomised, multicentre study. Lancet Neurol. 2009;8(10):889–97.

    Article  PubMed  Google Scholar 

  29. Ellis R, Brown S, Boggild M. Therapy-related acute leukaemia with mitoxantrone: four years on, what is the risk and can it be limited? Mult Scler. 2015;21(5):642-5.

  30. Rivera VM, Jeffery DR, Weinstock-Guttman B, Bock D, Dangond F. Results from the 5-year, phase IV RENEW (Registry to Evaluate Novantrone Effects in Worsening Multiple Sclerosis) study. BMC Neurol. 2013;13:80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Rudick RA, Stuart WH, Calabresi PA, Confavreux C, Galetta SL, Radue EW, et al. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):911–23.

    Article  CAS  PubMed  Google Scholar 

  32. Bloomgren G, Richman S, Hotermans C, Subramanyam M, Goelz S, Natarajan A, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366(20):1870–80. Analysis of data from AFFIRM, TYGRIS, STRATIFY-1, and Swedish registry of multiple sclerosis patients. This study identified natalizumab treatment over 24 months, JCV Ab positive status, and prior exposure to immunosuppression as the critical risk factors for development of PML. Age did not independently predict risk of PML.

    Article  CAS  PubMed  Google Scholar 

  33. O’Connor P, Wolinsky JS, Confavreux C, Comi G, Kappos L, Olsson TP, et al. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293–303.

    Article  PubMed  Google Scholar 

  34. Fox RJ, Miller DH, Phillips JT, Hutchinson M, Havrdova E, Kita M, et al. Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. N Engl J Med. 2012;367(12):1087–97.

    Article  CAS  PubMed  Google Scholar 

  35. Coles AJ, Twyman CL, Arnold DL, Cohen JA, Confavreux C, Fox EJ, et al. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial. Lancet. 2012;380(9856):1829–39.

    Article  CAS  PubMed  Google Scholar 

  36. Lulu S, Waubant E. Humoral-targeted immunotherapies in multiple sclerosis. Neurotherapeutics. 2013;10(1):34–43. This study describes rationale for B cell-directed therapies in multiple sclerosis, including chronically active B cell follicles in the meninges, oligoclonal band significance, and the data surrounding clinical trials with rituximab and ocrelizumab.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Hadjimichael O, Vollmer T, Oleen-Burkey M, North American Research Committee on Multiple S. Fatigue characteristics in multiple sclerosis: the North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes. 2008;6:100.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in multiple sclerosis. Arch Neurol. 1988;45(4):435–7.

    Article  CAS  PubMed  Google Scholar 

  39. Zifko UA. Management of fatigue in patients with multiple sclerosis. Drugs (New York, NY). 2004;64(12):1295-304.

  40. Murray TJ. Amantadine therapy for fatigue in multiple sclerosis. Can J Neurol Sci. 1985;12(3):251–4.

    CAS  PubMed  Google Scholar 

  41. A randomized controlled trial of amantadine in fatigue associated with multiple sclerosis. The Canadian MS Research Group. Can J Neurol Sci. 1987;14(3):273–8.

  42. Rosenberg GA, Appenzeller O. Amantadine, fatigue, and multiple sclerosis. Arch Neurol. 1988;45(10):1104–6.

    Article  CAS  PubMed  Google Scholar 

  43. Cohen R, Fisher M. Amantidine treatment of fatigue associated with multiple sclerosis. Arch Neurol. 1989;46:676–80.

    Article  CAS  PubMed  Google Scholar 

  44. Krupp L, Coyle P. Fatigue therapy in multiple sclerosis: results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. 1995

  45. Shaygannejad V, Janghorbani M, Ashtari F, Zakeri H. Comparison of the effect of aspirin and amantadine for the treatment of fatigue in multiple sclerosis: a randomized, blinded, crossover study. Neurol Res. 2012;34(9):854–8.

    Article  CAS  PubMed  Google Scholar 

  46. Zifko UA, Rupp M, Schwarz S, Zipko HT, Maida EM. Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study. J Neurol. 2002;249(8):983–7.

    Article  CAS  PubMed  Google Scholar 

  47. Rammohan K, Rosenberg J, Lynn D, Blumenfeld A, Pollak C, Nagaraja H. Efficacy and safety of modafinil (Provigil®) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. J Neurol Neurosurg Psychiatry. 2002;72:179–83.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Stankoff B, Waubant E, Confavreux C, Edan G, Debouverie M, Rumbach L, et al. Modafinil for fatigue in MS. A randomized placebo-controlled double-blind study. Neurology. 2005;64:1139–43.

    Article  CAS  PubMed  Google Scholar 

  49. Lange R, Volkmer M, Heesen C, Liepert J. Modafinil effects in multiple sclerosis patients with fatigue. J Neurol. 2009;256(4):645–50.

    Article  CAS  PubMed  Google Scholar 

  50. Shakespeare D, Boggild M, Young CA, Shakespeare D. Anti-spasticity agents for multiple sclerosis. 2003;(4):CD001332.

  51. Wagstaff AJ. Tizanidine. A review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs (New York, NY). 1997;53(3):435–52.

    CAS  Google Scholar 

  52. Groves L. Tizanidine treatment of spasticity: a meta-analysis of controlled, double-blind, comparative studies with baclofen and diazepam. Adv Ther. 1998;15(4):241–51.

    CAS  PubMed  Google Scholar 

  53. Nance PW, Sheremata WA, Lynch SG, Vollmer T, Hudson S, Francis GS, et al. Relationship of the antispasticity effect of tizanidine to plasma concentration in patients with multiple sclerosis. Arch Neurol. 1997;54(6):731–6.

    Article  CAS  PubMed  Google Scholar 

  54. Smith C. Tizanidine treatment of spasticity caused by multiple sclerosis: results of a double-blind, placebo-controlled trial. US Tizanidine Study Group. Neurology. 1994;44(11 suppl 9):S34–42. discussion S-3.

    CAS  PubMed  Google Scholar 

  55. Vakhapova V, Auriel E, Karni A. Nightly sublingual tizanidine HCl in multiple sclerosis: clinical efficacy and safety. Clin Neuropharmacol. 2010;33(3):151–4.

    Article  CAS  PubMed  Google Scholar 

  56. Beard S, Hunn A, Wight J. Treatment for spasticity and pain in multiple sclerosis: a systematic review. Health Technol Assess. 2003;7.

  57. Mueller ME, Gruenthal M, Olson WL, Olson WH. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil. 1997;78(5):521–4.

    Article  CAS  PubMed  Google Scholar 

  58. Cutter NC, Scott DD, Johnson JC, Whiteneck G. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2000;81(2):164–9.

    Article  CAS  PubMed  Google Scholar 

  59. Vender JR. Intrathecal baclofen therapy and multiple sclerosis: outcomes and patient satisfaction. Neurosurg Focus. 2006;21(2):e6.

    Article  PubMed  Google Scholar 

  60. Hyman N, Barnes M, Bhakta B, Cozens A, Bakheit M, Kreczy-Kleedorfer B, et al. Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry. 2000;68(6):707–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Giovannelli M, Borriello G, Castri P, Prosperini L, Pozzilli C. Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis. Clin Rehabil. 2007;21:331–7.

    Article  CAS  PubMed  Google Scholar 

  62. Goodman AD, Brown TR, Krupp LB, Schapiro RT, Schwid SR, Cohen R, et al. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet. 2009;373(9665):732–8.

    Article  CAS  PubMed  Google Scholar 

  63. Birnbaum G, Iverson J. Dalfampridine may activate latent trigeminal neuralgia in patients with multiple sclerosis. Neurology. 2014;83:1610–2. This case series demonstrated for the first time that dalfampridine can exacerbate trigeminal neuralgia in patients with MS.

    Article  CAS  PubMed  Google Scholar 

  64. Khan F, Turner-Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev. 2007;(2):CD006036.

  65. Patti F, Ciancio MR, Reggio E, Lopes R, Palermo F, Cacopardo M, et al. The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J Neurol. 2002;249(8):1027–33.

    Article  PubMed  Google Scholar 

  66. Mathiowetz V, Matuska K, Finlayson M, Luo P, Chen H. One-year follow-up to a randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Int J Rehabil Res. 2007;30:305–13.

    Article  PubMed  Google Scholar 

  67. Yu CH, Mathiowetz V. Systematic review of occupational therapy-related interventions for people with multiple sclerosis: part 1. Activity and participation. Am J Occup Ther Off Publ Am Occup Ther Assoc. 2014;68(1):27–32. This systematic review showed that both inpatient and outpatient occupational therapy strategies are effective for people living with MS.

    Article  Google Scholar 

  68. Nicholas RS, Friede T, Hollis S, Young CA. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev. 2009;(1):CD004193.

  69. Chapple C, Steers W, Norton P, Millard R, Kralidis G, Glavind K, et al. A pooled analysis of three phase III studies to investigate the efficacy, tolerability and safety of darifenacin, a muscarinic M3 selective receptor antagonist, in the treatment of overactive bladder. BJU Int. 2005;95(7):993–1001.

    Article  CAS  PubMed  Google Scholar 

  70. Cardozo L, Hessdorfer E, Milani R, Arano P, Dewilde L, Slack M, et al. Solifenacin in the treatment of urgency and other symptoms of overactive bladder: results from a randomized, double-blind, placebo-controlled, rising-dose trial. BJU Int. 2008;102(9):1120–7.

    Article  CAS  PubMed  Google Scholar 

  71. Ehren I, Volz D, Farrelly E, Berglund L, Brundin L, Hultling C, et al. Efficacy and impact of botulinum toxin A on quality of life in patients with neurogenic detrusor overactivity: a randomised, placebo-controlled, double-blind study. Scand J Urol Nephrol. 2007;41(4):335–40.

    Article  CAS  PubMed  Google Scholar 

  72. Sadovnick AD. Depression and multiple sclerosis. Neurology. 1996;46(3):628–32.

    Article  CAS  PubMed  Google Scholar 

  73. Schiffer RB, Wineman NM. Antidepressant pharmacotherapy of depression associated with multiple sclerosis. Am J Psychiatry. 1990;147(11):1493–7.

    Article  CAS  PubMed  Google Scholar 

  74. Scott TF. Measurement of treatment response to sertraline in depressed multiple sclerosis patients using the Carroll scale. Neurol Res (New York). 1995;17(6):421–2.

    CAS  Google Scholar 

  75. Shafey H. The effect of fluoxetine in depression associated with multiple sclerosis. Can J Psychiatr. 1992;37(2):147–8.

    CAS  Google Scholar 

  76. Mohr DC, Boudewyn AC, Goodkin DE, Bostrom A, Epstein L. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol. 2001;69(6):942–9.

    Article  CAS  PubMed  Google Scholar 

  77. Dahl OP, Stordal E, Lydersen S, Midgard R. Anxiety and depression in multiple sclerosis. A comparative population-based study in Nord-Trondelag County, Norway. Mult Scler. 2009;15(12):1495–501.

    Article  PubMed  Google Scholar 

  78. Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54(9):1116–21.

    Article  CAS  PubMed  Google Scholar 

  79. Panitch HS, Thisted RA, Smith RA, Wynn DR, Wymer JP, Achiron A, et al. Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59(5):780–7.

    Article  CAS  PubMed  Google Scholar 

  80. Potagas C, Giogkaraki E, Koutsis G, Mandellos D, Tsirempolou E, Sfagos C, et al. Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci. 2008;267(1–2):100–6.

    Article  PubMed  Google Scholar 

  81. Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008;7(12):1139–51.

    Article  PubMed  Google Scholar 

  82. Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev. 2006;(1):CD004431.

  83. Mattioli F, Stampatori C, Zanotti D, Parrinello G, Capra R. Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. J Neurol Sci. 2010;288(1–2):101–5.

    PubMed  Google Scholar 

  84. Krupp L. Donepezil improved memory in multiple sclerosis in a randomized clinical trial. Neurology. 2004;63(9):1579-85

  85. Morrow SA, Smerbeck A, Patrick K, Cookfair D, Weinstock-Guttman B, Benedict RH. Lisdexamfetamine dimesylate improves processing speed and memory in cognitively impaired MS patients: a phase II study. J Neurol. 2013;260(2):489–97

  86. Clifford DB, Trotter JL. Pain in multiple sclerosis. Arch Neurol. 1984;41(12):1270–2.

    Article  CAS  PubMed  Google Scholar 

  87. Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Arch Phys Med Rehabil. 2009;90(4):646–51.

    Article  PubMed Central  PubMed  Google Scholar 

  88. Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. 2009-08-12;11:21:36.

  89. Houtchens MK, Richert JR, Sami A, Rose JW. Open label gabapentin treatment for pain in multiple sclerosis. Mult Scler. 1997;3(4):250–3.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Claire Riley has received financial support through grants from Biogen Idec, and has also received compensation from Biogen Idec, Teva Neuroscience, Novartis, Genzyme/Sanofi, EMD Serono, Bayer, Questcor/Mallinckrodt, and Acorda (all listed) for service as a consultant.

Wendy Vargas has received financial support through grants from Teva Neuroscience and has also received compensation from Teva Neuroscience for service as a consultant.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, 710 West 168th Street, Suite 246, New York, NY, 10032, USA

    Claire S. Riley & Wendy Vargas

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Correspondence to Claire S. Riley.

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This article is part of the Topical Collection on Neurology of Aging

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Riley, C.S., Vargas, W. Multiple Sclerosis in the Elderly: Considerations in the Geriatric Population for Diagnosis and Management. Curr Geri Rep 4, 131–141 (2015). https://doi.org/10.1007/s13670-015-0128-7

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