Executive functions: current concepts, clinical diagnosis, and future prospects

Currently, the number of middle-aged and elderly patients with multiple sclerosis (MS) is increasing. The incidence of late-onset multiple sclerosis (LOMS), defined as disease onset after the age of 50, is also growing. Given that MS has always been considered a disease of young adults, its course and transformation in the context of aging, as well as its associations with aging processes, necessitate investigation. Diagnostic and treatment approaches require re-evaluation to find the most effective and safe options for elderly patients with MS. This article analyzes available data on the course, diagnosis, and treatment of MS in patients aged over 50. It has been shown that MS activity decreases with age, which can possibly be attributed to age-related changes in the immune system. At the same time, there is an increase in comorbidities associated with age and MS, as well as with a transition of the disease from an inflammatory to a neurodegenerative phenotype. The efficacy of pharmacologic interventions tend to decrease, or they become unsafe due to the risk of serious side effects. However, there is a growing body of evidence worldwide on the safety and efficacy of long-term use of disease-modifying drugs in elderly patients with MS.