Age of multiple sclerosis symptom onset affects mental and physical health-related quality of life in opposite directions

BACKGROUND: Age of symptom onset may affect health-related quality of life (HrQoL) in multiple sclerosis (MS). OBJECTIVE: To evaluate if age of MS symptom onset affects HrQoL in adulthood. METHODS: Participants from the Canadian Prospective Cohort Study to Understand Progression in MS (CanProCo) were assessed annually (2019-2022) using the MS Quality of Life-54 (MSQoL-54), which measures physical and mental health, with higher scores indicating better HrQoL. The minimally important clinical differences for physical and mental health are 1.5 and 2.5, respectively. Linear mixed-effect regression was used to model the effect of age of MS symptom onset on MSQoL-54 while adjusting for sex and disease duration. RESULTS: 699 participants with a total of 1699 observations were included. The mean age of MS symptom onset was 33.2 years (SD=8.60, minimum 12, maximum 50); 16.9 % had symptom onset before age 25 years (n = 118), and 2.3 % had symptom onset before age 18 years (n = 16). Mixed-effect models demonstrated, at any given disease duration, physical health scores were 1.5 points worse for approximately every 5-year later age of onset (CI:2.38, -0.72, p = 0.001). Conversely, the mental health scores were 2.5 points better for approximately every 12 year later age of onset (C.I: 0.44, 4.49, p = 0.017). CONCLUSIONS: We observed that individuals with younger age of MS symptom onset, including those with pediatric onset MS, have higher physical HrQoL but lower mental HrQoL over time compared to those with older age of onset. Examining HrQoL across ages of MS onset provides insights into person-centered MS care.