Prognosis

Developing an accurate prognosis for an individual MS patient is notoriously difficult owing to the multitude of variables including: age of onset, clinical type of disease, nervous system pathways involved, attack frequency, patient ability to compensate and patient comorbidities. The majority of patients experience MS as an incrementally disabling disease that evolves over decades. Most can expect a nearly normal lifespan with a cause of death similar to the general population.

• Palmer A.J., van der Mei I., Taylor B.V., Clarke P.M., Simpson S. Jr., Ahmad H. (2019) Found that the life expectancy of 35-year-old Australian women with MS was about 7.5 years less than the general population. They also found a loss of 13.1 quality-adjusted life years associated with MS.
• Zurawski J.; Glanz B. Estimated the time between Expanded Disability Status Scale (EDSS) scores in a large a single center MS cohort (n=2054) across (31,394 clinical visits) to determine the impact of functional system scores on EDSS transitions.
  • Time between specific EDSS levels varies considerably depending on baseline EDSS.
  • Time spent between EDSS 4 to 6 is shorter than time between EDSS 0 to 3 or 6 to 8.
  • Time between EDSS scores is greatest for the intervals from 3.5 to 4 and 6 to 7.
  • EDSS functional system subscores help predict time spent at a given EDSS score.
  • EDSS functional system subscores predict risk of future EDSS disability accrual.

While some patients will maintain independance, those whose disability cannot be managed at home may need placement in an assisted living center or skilled nursing facility. The National Multiple Sclerosis Society states that "only about 5–10% of the MS population requires chronic nursing home care .
In general, MS nursing home residents are:

• Younger
• Are mentally alert
• more physically dependent
• Often have some form of cognitive impairment
• Have more symptoms of depression
• Resident for longer stays

The National Multiple Sclerosis Society suggests that "A neuropsychology consult can be invaluable in defining the cognitive issue(s) and working with staff and the resident to compensate for it. Impairment of judgment, planning and organizational function may have an impact on the safety of operating wheelchairs, especially power-operated wheelchairs or scooters. An occupational therapist should be consulted to address issues of safe driving for individuals with MS who are experiencing cognitive problems."

As patients with MS age, common age-associated changes may complicate the management of MS patients in facilities primarily designed for aging adults. Other chronic illnesses such as osteoporosis, stroke, and diabetes may compound the management of these patients. Shared apartments with attendant care, group residences, and adult day treatment centers are potential settings where independent living can be promoted and nursing home placement for persons with severe MS can be delayed.