Understanding the brain age gap (BAG) in patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) may provide insight regarding disease progression and prognosis, according to a study recently published in the Journal of Neurology, Neurosurgery & Psychiatry.

“BAG was a predictive biomarker of Expanded Disability Status Scale worsening in NMOSD and relapsing-remitting MS,” the authors wrote.

This cohort study included 199 patients previously diagnosed with NMOSD, 200 with a diagnosis of relapsing-remitting MS, and 269 healthy individuals. The researchers retrieved the data from 6 different centers in China in a retrospective manner to analyze the brain age gap assessed through magnetic resonance imaging (MRI) in all participants. 

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Deep learning technology confirmed the existence of an important brain age gap between patients with NMOSD and MS compared with healthy individuals. The MS group showcased the highest difference, with a mean of 13.0 years. Patients with NMOSD had a considerably lower gap, at 5.4 years on average.

The rather big differing brain age gap between the entities could be explained by the varying pattern of atrophy seen with each disorder.

“NMOSD exhibits more atrophy in the spinal cord but less atrophy in the brain, which can partially explain the lower BAG in NMOSD given the strong association between BAG and brain atrophy,” the authors noted.

Importantly, a higher score on the disability assessment conducted at baseline and greater brain volume loss are associated with increased brain age gaps, regardless of the specific etiopathology. On the other hand, the longer duration of the disease is specifically correlated with a higher gap only in patients with MS. 

Perhaps one of the most interesting findings is that the brain age gap seems to accurately predict disease progression and symptom worsening, as evidenced by the Expanded Disability Status Scale in both entities. These results suggest a potential use of the brain age gap as a prognostic tool that could aid in selecting more personalized management strategies for patients with NMOSD and MS.


Wei R, Xu X, Duan Y, et al. Brain age gap in neuromyelitis optica spectrum disorders and multiple sclerosis. J Neurol Neurosurg Psychiatry. Published online October 10, 2022. doi:10.1136/jnnp-2022-329680