The interaction between ageing and multiple sclerosis is complex and carries significant implications for patient care. Managing multiple sclerosis effectively requires an understanding of how ageing and multiple sclerosis impact brain structure and function. Ageing inherently induces brain changes, including reduced plasticity, diminished grey matter volume, and ischaemic lesion accumulation. When combined with multiple sclerosis pathology, these age-related alterations may worsen clinical disability. Ageing may also influence the response of multiple sclerosis patients to therapies and/or their side effects, highlighting the importance of adjusted treatment considerations. MRI is highly sensitive to age- and multiple sclerosis-related processes. Accordingly, MRI can provide insights into the relationship between ageing and multiple sclerosis, enabling a better understanding of their pathophysiological interplay and informing treatment selection. This review summarizes current knowledge on the immunopathological and MRI aspects of ageing in the CNS in the context of multiple sclerosis. Starting from immunosenescence, ageing-related pathological mechanisms and specific features like enlarged Virchow-Robin spaces, this review then explores clinical aspects, including late-onset multiple sclerosis, the influence of age on diagnostic criteria, and comorbidity effects on imaging features. The role of MRI in understanding neurodegeneration, iron dynamics and myelin changes influenced by ageing and how MRI can contribute to defining treatment effects in ageing multiple sclerosis patients, are also discussed.

中文翻译：

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多发性硬化症中中枢神经系统的衰老：影像学角度


老龄化和多发性硬化症之间的相互作用很复杂，对患者护理具有重大影响。有效管理多发性硬化症需要了解衰老和多发性硬化症如何影响大脑结构和功能。衰老本身会引起大脑变化，包括可塑性降低、灰质体积减少和缺血性病变积累。当与多发性硬化病理相结合时，这些与年龄相关的改变可能会加重临床残疾。衰老也可能影响多发性硬化症患者对治疗和/或其副作用的反应，这凸显了调整治疗考虑的重要性。MRI 对年龄和多发性硬化相关过程高度敏感。因此，MRI 可以深入了解衰老与多发性硬化症之间的关系，从而更好地了解它们的病理生理相互作用并为治疗选择提供信息。本综述总结了多发性硬化症背景下 CNS 衰老的免疫病理学和 MRI 方面的当前知识。本文从免疫衰老、衰老相关病理机制和 Virchow-Robin 间隙扩大等特定特征开始，探讨了临床方面，包括迟发性多发性硬化症、年龄对诊断标准的影响以及合并症对影像学特征的影响。还讨论了 MRI 在理解受衰老影响的神经退行性变、铁动力学和髓鞘变化方面的作用，以及 MRI 如何有助于确定老年多发性硬化症患者的治疗效果。