Spinal cord atrophy in multiple sclerosis exceeds normal aging
In 1,295 patients, normalized upper cervical cord area dropped below healthy control levels starting at age 30, diverging most in the fifth and sixth decades.
Neurology
In a cross-sectional study of 1,295 patients with multiple sclerosis and 480 healthy controls aged 18 to 70 years, researchers modeled lifespan trajectories of mean upper cervical cord area. The team analyzed 3.0T brain MRI scans to normalize cord size for head volume and generate age-adjusted Z-scores.
In healthy controls, upper cord area rose until the late 30s and declined after age 50. In patients with multiple sclerosis, cord Z-scores dropped below zero starting at age 30. The disease-specific loss was steepest up to the late 40s, showing the greatest reduction relative to controls in the fifth and sixth decades before attenuating as normal aging effects increased. These trajectories did not differ between sexes, and greater cord atrophy correlated with higher disability.
Why it matters
Separating normal tissue senescence from disease-specific neurodegeneration helps clarify how chronic pathology interacts with baseline biological aging in the central nervous system.
Caveats
The findings come from a cross-sectional dataset rather than longitudinal tracking of individuals over time, and data collection was limited to three medical sites in Italy.
The paper
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Paolo Preziosa, Alessandro Meani, Silvia Tommasin, Claudia Piervincenzi, Antonio Gallo, Alessandro D'Ambrosio, Massimo Filippi,IRCCS Ospedale San Raffaele · Vita-Salute San Raffaele University
Neurology · 30 Sep 2026