Why Older Male MS Patients Are More Prone to Depression

Older men with multiple sclerosis (MS) are more susceptible to difficulties surrounding aging than their female patient peers, according to a recent study.

Canadian researchers from Memorial University in St. John’s and McGill University in Montreal — led by Michelle Ploughman (pictured), BScPT, MSc, PhD, assistant professor of Medicine at Memorial University — sought to determine whether there are differences in perceived health between genders of MS patients.

The disparity of sex is particularly interesting for a neurological condition such as MS. The female-to-male ratio of young MS patients is about 3:1, Clyde Markowitz, MD, director of the MS Center at the University of Pennsylvania, told MD Magazine. But that ratio drops closers to even as disease progression and average patient age advances.

“As you make these diagnoses later, you see more primary progressive (PPMS) patients in their 40s and 50s being diagnosed with MS, and there’s almost a 1-to-1 match with male to female ratios,” Markowitz said.

Markowitz said there’s “something hormonal” about the diagnostic rates, but researchers aren’t certain what it may be. Several studies have shown that testosterone plays a role in MS prevention, Markowitz said, while estrogen may cause greater susceptibility and disease progression.

The researchers studied older MS patients on as level of a playing field as possible. They obtained data from 743 Canadians (577 women, 166 men) at least 55 years old, and having been diagnosed with MS for at least 20 years. The genders’ differences of health, lifestyle, mood and socioeconomic standing were examined with various forms of analysis, according to researchers.

End results showed there was no difference in disability between surveyed men and women groups. They were similarly limited difference in average age, years of education, and years since MS diagnosis. Despite nearly similar baselines for evaluation, men had a significantly lower perception of their health than women, on average.

This standard was measured with the 100mm visual analogue scale (VAS), in which men scored themselves about 50% lower on average than women on their state of health. This was noted in spite of the statistics that showed men also were less likely to live alone and had fewer musculoskeletal comorbid conditions from their MS, according to researchers.

Though the women group scored greater for anxiety rates on the Hospital Anxiety and Depression Scale (HADS), men scored greater rates for depression. Women also reported better adherence to healthy diets, while men reported as having more alcoholic drinks per week.

Researchers pointed to “depressive symptoms, physical activity, financial flexibility, and alcohol consumption” as unique predictors of perceived health in the older MS male patient population.

“We show, for the first time, evidence that despite similarities in age, years with MS, level of disability, and social support, older men exhibit poorer adaptation to aging with MS than older women,” researchers wrote.

Ploughman and her team advocated for older MS male patients to have both health and support needs better addressed moving forward, as both are crucial to prevent health deterioration in the latter stage of their disease. In general, MS patients are dealing with a worse mental state than the average person.

“Although the lifetime prevalence of depression is approximately 50% for people with MS, 3 times higher than that for the general population, depression is a health condition that is treatable,” researchers wrote.

The study, "Women's and Men's Differing Experiences of Health, Lifestyle, and Aging with Multiple Sclerosis," was published online at International Journal of MS Care.

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