Therapeutic interventions and lifestyle modifications in the aging population with multiple sclerosis

Advances in disease-modifying therapies, diagnostics, and comorbidity management have increased life expectancy in people with multiple sclerosis (MS), creating a growing cohort of older adults living with MS. In later life, MS typically features fewer relapses and more progressive disability, as age-related neurodegeneration, immunosenescence, polypharmacy, and accumulated disability interact with MS-specific inflammatory and neurodegenerative mechanisms. These processes, together with common comorbidities such as cardiovascular disease, diabetes, osteoporosis, and arthritis, complicate symptom interpretation and make it difficult to distinguish MS progression from normal aging. Older adults frequently experience mobility limitations, cognitive decline, fatigue, mood disturbances, and urological problems, which impair quality of life and independence. Disease-modifying therapies may become less effective and carry higher risks after 55 to 60 years of age, necessitating careful reassessment of treatment goals. Optimal care for this population relies on multidisciplinary management and targeted lifestyle modifications, including tailored physical activity, nutrition, sleep, and social engagement strategies.This Research Topic aims to improve therapeutic decision making and functional outcomes in older adults with multiple sclerosis (MS), including those diagnosed later in life and those who have discontinued disease-modifying therapies (DMTs). It focuses on how aging processes, immunosenescence, comorbidities, frailty, and polypharmacy intersect with MS pathophysiology to shape treatment efficacy, safety, and trajectories of disability and cognition. A key goal is to generate age-inclusive evidence on the use, de-escalation, or discontinuation of DMTs after age 55 – 60, supported by biomarkers and advanced imaging that help distinguish inflammatory activity from neurodegeneration. The Topic invites studies on pharmacological, rehabilitative, psychosocial, and lifestyle-based strategies, including exercise, nutrition, sleep, mental health care, and digital monitoring of mobility and cognition. By integrating geriatric assessment, equity and access considerations, and shared decision making, this collection seeks to support personalized, safer long-term care so that extended life expectancy, now approaching 75 years, is accompanied by a lower disability burden.This Research Topic focuses on improving care for the growing population of older adults with multiple sclerosis (MS), including those diagnosed later in life and individuals over 60 who discontinue disease-modifying therapies (DMTs). We welcome age-inclusive work that clarifies how aging, comorbidities, and immunosenescence affect MS biology, treatment decisions, and long-term function.• Article types: original research, systematic or scoping reviews, meta-analyses, brief reports, case series, qualitative studies, and perspective pieces• Pharmacological strategies: use, de-escalation, switching, or discontinuation of DMTs in older adults• Aging and complexity: impact of multimorbidity, frailty, polypharmacy, and targeted management of comorbidities and immunosenescence• Rehabilitation and function: rehabilitation programs, assistive technologies, physical activity, obesity prevention, and metabolic health• Lifestyle and risk factors: smoking cessation, maintenance of serum vitamin D3 levels around 40 – 50 ng/ml, sleep, diet, and broader lifestyle interventions• Outcomes and systems: cognitive and emotional health, caregiver-focused research, digital monitoring, and health system or equity-oriented studies.Please note that Dr Kazuo Fujihara has acted as either Speaker, Chair or Advisor for the following: Biogen, Chugai/Roche, Novartis, Tanabe, Zenyaku, UCB Japan, Alexion and Cosmic Corporation. Topic editors: Dimitrios N. Kanakis, Antonia Kaltsatou, ANASTASIOS OROLOGAS, KAZUO FUJIHARA Source: https://www.frontiersin.org/research-topics/77579/therapeutic-interventions-and-lifestyle-modifications-in-the-aging-population-with-multiple-sclerosis