The Relations Among Physical Indicators, Cognitive Status, Community Participation, and Depression of the Frail Male Elderly in Taiwan

This study explored the basic attributes, physiological indices, cognitive states, and community participation of older male outpatients with frailty for predicting depression. Questionnaires were collected using purposive sampling from a medical clinic in a teaching hospital in northern Taiwan. One hundred and ninety frail men enrolled as participants. The results revealed that older male adults with frailty, the age, residence, income, self-reported health status, alcohol consumption, total instrumental activities of daily living (IADL) scores in physiological indices, IADL grouping, cognitive state score, each Mini-Mental State Examination category, and involvement and dedication scores exhibited statistical differences from depression scores. Depression determinants, such as an excellent and normal self-reported health status and IADL total score, could predict the depression status of male older adults with frailty. Nursing personnel should assess the self-reported health status and self-care ability of male older adults with frailty early to prevent or delay geriatric depression.

Sarcopenia in female patients with Alzheimer's disease are more likely to have lower levels of haemoglobin and 25-hydroxyvitamin D

AIM

Few studies have investigated sarcopenia in patients with cognitive impairment. However, identifying the characteristics and factors associated with sarcopenia in these patients may help to decrease the risk of falls, prevent disabilities, and maintain an independent life, all of which can affect the quality of life of both patient and caregiver. Therefore, the aim of this study was to investigate associated factors of sarcopenia in patients with mild to moderate Alzheimer's disease.

METHODS

This cross-sectional study enrolled 125 outpatients aged 65 to 89 years (mean age 79.5 ± 7.9 years) from January 2018 to December 2018. In addition to demographic characteristics, cognitive status, depressive mood, activities of daily living, body mass index (BMI), handgrip strength, gait speed, muscle mass, and serum levels of 25-hydroxyvitamin D (Vit D), haemoglobin (Hb), albumin and creatinine were assessed. Sarcopenia was defined based on the presence of low muscle mass and either low muscle strength or low physical performance.

RESULTS

Overall, 29.6% of the patients had sarcopenia. The patients with sarcopenia were mostly male, significantly older, and had a lower BMI and lower levels of Vit D. The female patients with sarcopenia were more likely to have lower levels of Hb. Multiple logistic regression showed that sarcopenia was associated with BMI in both genders. The level of Vit D was associated with sarcopenia in the female patients, whereas age was associated with sarcopenia in the male patients.

CONCLUSIONS

A low BMI may be a dementia-related risk factor for sarcopenia. The female patients with sarcopenia were more likely to have lower levels of Hb and Vit D. There may be different risk profiles for sarcopenia in men and women with Alzheimer's disease. Further studies are needed to devise different nutritional support for muscle weakness in patients with cognitive decline by gender.

BMI, functional and cognitive status in a cohort of nonagenarians: results from the Mugello study

Aim

Our aim was to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians.

Findings

By grouping the participants according to BMI categories, overweight and obese participants showed lower functional capability, higher risk of falling but better Mini-Mental State Examination (MMSE) performance than participants with normal weight or underweight.

Message

This cross-sectional survey supports the hypothesis that adiposity could affect the cognitive state of people reaching the old age.

Purpose

The study of the relationship between body weight and health in old age has attracted increasing interest. The aim of the present study is to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians.

Methods

We analyzed 475 participants (348 women, 127 men; median age 92 years) from the Mugello study. Participants were evaluated through laboratory, instrumental examinations and questionnaires.

Results

By grouping the participants according to BMI categories, a better perception of health and nutritional status and a lower prevalence of sarcopenia (p < 0.05) were observed in participants with overweight and obesity compared to participants with normal weight or underweight. Concerning functional and cognitive measures, overweight and obese participants showed significantly worse performance on short physical performance battery and timed up and go tests and better performance on the mini-mental state examination (MMSE). As regards the other tests performed, no statistically significant differences were observed. In a multivariate logistic regression analysis adjusted for possible confounding factors, participants with BMI ≥ 30 kg/m² showed lower probability to achieve poor performance on the MMSE (OR 0.42; 95% CI 0.19–0.94; p = 0.035).

Conclusion

Our results support the hypothesis that in nonagenarians, a higher BMI is associated with better cognitive ability. Further studies are needed to explore the mechanisms underlying this association.

Osteoporosis and cognitive impairment interwoven warning signs: community-based study on older adults-Bushehr Elderly Health (BEH) Program

Cognitive impairment and osteoporosis are frequently seen to coincide in clinical practice. Osteoporosis was higher in elderly populations with cognitive impairment, especially in postmenopausal women. Thus, prophylaxis for osteoporosis, falls, and fractures should be considered as part of the treatment of patients with cognitive impairment.

INTRODUCTION

Cognitive impairment and osteoporosis are two important health concerns among older adults that their possible relationship, concurrent occurrence, and linking mechanism have recently been highlighted. The purpose of this study was to assess the sex-independent association of these two conditions.

MATERIALS AND METHODS

From among 2331 individuals aged ≥ 60 years selected in Bushehr Elderly Health (BEH) Program, Iran; data of 1508 participants were analyzed. Cognitive status was assessed using Category Fluency Test and Mini-cog assessment instrument. Association between osteopenia-osteoporosis and cognitive impairment were assessed using uni- and multivariable logistic regression models.

RESULTS

Osteoporosis was diagnosed in 598 (39.6%) of the participants (58.3% female and 21.9% male, P < 0.001). From among them, 677 (44.9%) had evidence of cognitive impairment (64.5% female and 31.0% male, P < 0.001). Multivariate logistic regressions showed spinal and total hip osteoporosis was associated with 1.83 (CI 95% 1.13-2.96) and 2.24-fold (CI 95% 1.28-3.89) increase in the risk of cognitive impairment among female subjects, respectively. Ordinal logistic regression, on the other hand, revealed cognitive impairment to be associated with 1.42-fold (CI 95% 1.04-1.92) increase in the risk of spinal osteopenia-osteoporosis, 1.5-fold increase in total hip osteoporosis (CI 95% 1.09-2.05), and 1.48-fold increase in general osteoporosis (CI 95% 1.06-2.0).

CONCLUSION

Different degrees of bone loss and cognitive impairment may be a risk factor for each other among women but not in men. It is suggested that the screening, adopting preventive measures for the other condition and regular follow-ups, if needed, could be of utmost importance.

Targeting Multiple Mitochondrial Processes by a Metabolic Modulator Prevents Sarcopenia and Cognitive Decline in SAMP8 Mice

The age-dependent declines of skeletal muscle and cognitive functions often coexist in elderly subjects. The underlying pathophysiological mechanisms share common features of mitochondrial dysfunction, which plays a central role in the development of overt sarcopenia and/or dementia. Dietary supplementation with formulations of essential and branched-chain amino acids (EAA-BCAA) is a promising preventive strategy because it can preserve mitochondrial biogenesis and function. The senescence-accelerated mouse prone 8 (SAMP8) is considered an accurate model of age-related muscular and cognitive alterations. Hence, we aimed to investigate the progression of mitochondrial dysfunctions during muscular and cognitive aging of SAMP8 mice and to study the effects of a novel EAA-BCAA-based metabolic modulator on these changes. We evaluated body condition, motor endurance, and working memory of SAMP8 mice at 5, 9, 12, and 15 months of age. Parallel changes in protein levels of mitochondrial respiratory chain subunits, regulators of mitochondrial biogenesis and dynamics, and the antioxidant response, as well as respiratory complex activities, were measured in the quadriceps femoris and the hippocampus. The same variables were assessed in 12-month-old SAMP8 mice that had received dietary supplementation with the novel EAA-BCAA formulation, containing tricarboxylic acid cycle intermediates and co-factors (PD-0E7, 1.5 mg/kg/body weight/day in drinking water) for 3 months. Contrary to untreated mice, which had a significant molecular and phenotypic impairment, PD-0E7-treated mice showed preserved healthy body condition, muscle weight to body weight ratio, motor endurance, and working memory at 12 months of age. The PD-0E7 mixture increased the protein levels and the enzymatic activities of mitochondrial complex I, II, and IV and the expression of proliferator-activated receptor γ coactivator-1α, optic atrophy protein 1, and nuclear factor, erythroid 2 like 2 in muscles and hippocampi. The mitochondrial amyloid-β-degrading pitrilysin metallopeptidase 1 was upregulated, while amyloid precursor protein was reduced in the hippocampi of PD-0E7 treated mice. In conclusion, we show that a dietary supplement tailored to boost mitochondrial respiration preserves skeletal muscle and hippocampal mitochondrial quality control and health. When administered at the early onset of age-related physical and cognitive decline, this novel metabolic inducer counteracts the deleterious effects of precocious aging in both domains.

Barthel Index, but not Lawton and Brody instrumental activities of daily living scale associated with Sarcopenia among older men in a veterans' home in southern Taiwan

BACKGROUND

Older adults are more likely to experience the disorder of skeletal muscles.

OBJECTIVE

This study aimed to examine the prevalence of sarcopenia using the diagnostic procedures of sarcopenia recommended by the Asian Working Group for Sarcopenia in 2019. The association of sarcopenia with physical activity and other factors was also explored.

METHODS

A cross-sectional study was designed. The sample came from a veterans' home in southern Taiwan during the months of July-September 2018. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) criteria in 2019. Skeletal muscle mass and grip strength were determined using bioelectrical impedance analysis and a digital dynamometer, respectively. The walking speed for a 6-m distance was also measured. Furthermore, the Barthel Index (BI), Lawton and Brody Instrumental Activities of Daily Living scales (IADL), mini-mental state examination (MMSE), and body mass index (BMI) were also collected.

RESULTS

Overall, 139 men with a mean age of 84.3 years (± 10.3 years) were analyzed. According to the recommendation of the AWGS in 2019, the prevalence of sarcopenia was 66.9% (n = 93), whereas 55.4% (n = 77) of men were determined to have severe sarcopenia. After adjusting for age, BMI (OR 0.63, 95% CI 0.53-0.75, p < 0.001] and BI scale score [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99, p = 0.011) were significantly associated with sarcopenia, but the mini-mental state examination and Lawton and Brody IADL scales scores not.

CONCLUSION

A high prevalence of sarcopenia was evident in this study sample. The impaired score of the BMI and BI were risk factors of sarcopenia. Health providers should pay more attention to residents who have these risk factors, so possible stratagem or intervention can be figured out to improve their health status.

Sarcopenia is Independently Associated with an Increased Risk of Peptic Ulcer Disease: A Nationwide Population-Based Study

Background and objective: Although obesity is associated with an increased risk of peptic ulcer disease (PUD), no study has evaluated the association of PUD with sarcopenia. The aim of this study was to evaluate the association of sarcopenia and obesity with PUD. Material and Methods: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV and V for 2007–2012 were used. PUD history, dietary, alcohol consumption, smoking, physical activity patterns, and other socioeconomic factors were analyzed. Sarcopenia index (appendicular skeletal muscle mass (kg) ÷ body mass index (kg/m2)) and body fat mass were determined by dual-energy X-ray absorptiometry. Univariate and multivariate analyses were performed to evaluate the association of sarcopenia with the prevalence of PUD. Results: The 7092 patients were divided into the sarcopenic obesity (SO, n = 870), sarcopenic non-obesity (n = 2676), non-sarcopenic obesity (NSO, n = 2698), and non-sarcopenic non-obesity (NSNO, n = 848) groups. The prevalence of PUD in these groups was 70 (7.9%), 170 (7.4%), 169 (6.3%), and 47 (3.8%), respectively (p < 0.001). A crude analysis revealed that the prevalence of PUD was 2.2-fold higher in the SO group than in the NSNO group (odds ratio (OR), 2.2; 95% confidence interval (CI), 1.5–3.2), the significance of which remained after adjustment for age, sex, body mass index, and HOMA-IR (homeostatic model assessment insulin resistance) score (OR, 1.9; 95% CI, 1.3–2.7). Conclusion: In conclusion, in this nationally representative cohort, the combination of muscle and fat mass, as well as obesity, was associated with an increased risk of PUD.

Corticospinal Control of Human Locomotion as a New Determinant of Age-Related Sarcopenia: An Exploratory Study

Sarcopenia is a muscle disease listed within the ICD-10 classification. Several operational definitions have been created for sarcopenia screening; however, an international consensus is lacking. The Centers for Disease Control and Prevention have recently recognized that sarcopenia detection requires improved diagnosis and screening measures. Mounting evidence hints towards changes in the corticospinal communication system where corticomuscular coherence (CMC) reflects an effective mechanism of corticospinal interaction. CMC can be assessed during locomotion by means of simultaneously measuring Electroencephalography (EEG) and Electromyography (EMG). The aim of this study was to perform sarcopenia screening in community-dwelling older adults and explore the possibility of using CMC assessed during gait to discriminate between sarcopenic and non-sarcopenic older adults. Receiver Operating Characteristic (ROC) curves showed high sensitivity, precision and accuracy of CMC assessed from EEG Cz sensor and EMG sensors located over Musculus Vastus Medialis [Cz-VM; AUC (95.0%CI): 0.98 (0.92-1.04), sensitivity: 1.00, 1-specificity: 0.89, p < 0.001] and with Musculus Biceps Femoris [Cz-BF; AUC (95.0%CI): 0.86 (0.68-1.03), sensitivity: 1.00, 1-specificity: 0.70, p < 0.001]. These muscles showed significant differences with large magnitude of effect between sarcopenic and non-sarcopenic older adults [Hedge's g (95.0%CI): 2.2 (1.3-3.1), p = 0.005 and Hedge's g (95.0%CI): 1.5 (0.7-2.2), p = 0.010; respectively]. The novelty of this exploratory investigation is the hint toward a novel possible determinant of age-related sarcopenia, derived from corticospinal control of locomotion and shown by the observed large differences in CMC when sarcopenic and non-sarcopenic older adults are compared. This, in turn, might represent in future a potential treatment target to counteract sarcopenia as well as a parameter to monitor the progression of the disease and/or the potential recovery following other treatment interventions.

Associations between low muscle mass, blood-borne nutritional status and mental health in older patients

Background

Although low muscle mass is an important predictor of increased physical morbidity in older patients, information on its impact on mental health and well-being is lacking. The first aim of this report is to look for associations if any between low muscle mass and mental health of older people in clinical practice. The second aim is to study underlying mechanisms including nutritional status.

Methods

In this prospective longitudinal study we randomly selected and studied 432 hospitalized older patients’ baseline demographic data, clinical characteristics and nutritional status on admission, at 6 weeks and at 6 months. Low muscle mass was diagnosed using anthropometric measures based on the European Working Group criteria. Mental health outcome measures including cognitive state, depression symptoms and quality of life were also measured.

Results

Out of 432 patients assessed 44 (10%) were diagnosed with low muscle mass. Patients diagnosed with low muscle mass at admission and over a 6-month follow up period had significantly poor cognitive function, quality of life and increased depression symptoms compared with those with normal muscle mass. After adjustment for poor prognostic indicators, age, disability, severity of acute illness and low muscle mass were associated with poor cognitive function and quality of life and higher depression symptoms in older patients over a 6 months period (p < 0.05). Although patients with low muscle mass had lower micronutrient concentrations compared to those patients with normal muscle mass, only serum albumin showed significant correlations with quality of life at admission and depression symptoms at 6 weeks.

Conclusion

Low muscle mass is associated with poor blood-borne poor nutritional status and mental health in hospitalized older patients, however, this is partly explained by underlying co morbidity.

Combined effect of poor appetite and low masticatory function on sarcopenia in community-dwelling Japanese adults aged ≥ 75 years: A 3-year cohort study

OBJECTIVE

This study aimed to investigate the longitudinal association of the combination of poor appetite (PA) and low masticatory function (LMF) with sarcopenia in community-dwelling older adults.

METHODS

In total, 173 community-dwelling Japanese adults aged ≥ 75 years participated in the 3-year cohort study. Appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) and masticatory function assessment using spectrophotometric measurement of differences in gum colour before and after masticating colour-changeable chewing gum (ΔE*ab) were performed at baseline. SNAQ score of ≤ 14 was defined as PA. The lowest tertile of ΔE*ab was defined as LMF. Follow-up examinations were administered annually over a 3-year period to determine sarcopenia incidence, which was defined by the criteria proposed by the Asian Working Group for Sarcopenia. Adjusted hazard ratios (HRs) of sarcopenia incidence according to the presence of PA and LMF were calculated using Cox proportional hazards regression models.

RESULTS

At baseline, 81 participants (46.8%) had neither PA nor LMF, 34 (19.7%) had PA alone, 35 (20.2%) had LMF alone, and 23 (13.3%) had both PA and LMF. On follow-up, 31 participants (17.9%) developed sarcopenia. After adjusting for covariates, the adjusted HR for sarcopenia in participants with both PA and LMF was 4.4 (95% confidence interval = 1.6-12.2) compared with those without PA or LMF. PA or LMF alone was not significantly associated with sarcopenia development.

CONCLUSIONS

Coexisting PA and LMF increase the risk of sarcopenia development among community-dwelling Japanese adults aged ≥ 75 years.

Association between Lower Extremity Skeletal Muscle Mass and Impaired Cognitive Function in Type 2 Diabetes

Lower extremity skeletal muscle mass (LESM) in Type 2 Diabetes (T2D) has been linked to adverse clinical events, but it is not known whether it is associated with cognitive difficulties. We conducted a cross-sectional study on 1,235 people (mean age 61.4 ± 8.0 years) with T2D under primary and secondary care in Singapore. Bioelectrical impedance analyses (BIA) measures of upper extremity skeletal muscle mass (UESM), LESM and appendicular skeletal muscle index (SMI) were related to the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measures of cognition, in multiple linear regression. In multivariable models, tertile 1 LESM (b = −2.62 (−3.92 to −1.32)) and tertile 2 LESM (b = −1.73 (−2.73 to −0.73)), referenced to tertile 3) were significantly associated with decreased RBANS total score. Significant associations of LESM with cognitive domain performances were observed for tertile 1 (b = −3.75 (−5.98 to −1.52)) and tertile 2 (b = −1.98 (−3.69 to −0.27)) with immediate memory, and for tertile 1 (b = −3.05 (−4.86 to −1.24)) and tertile 2 (b = −1.87 (−3.25 to −0.48)) with delayed memory, and for tertile 1 (b = −2.99 (−5.30 to −0.68)) with visuospatial/constructional ability. Tertile 1 SMI (b = −1.94 (−3.79 to −0.08) and tertile 2 SMI (b = −1.75 (−3.14 to −0.37)) were also associated with delayed memory. There were no associations between UESM with cognitive performance. Lower LESM may be a useful marker of possible co-occuring cognitive dysfunction.

Prevalence of sarcopenia in multi ethnics adults and the association with cognitive impairment: findings from West-China health and aging trend study

Background

Sarcopenia is a condition that is characterized by loss of muscle mass, muscle strength and muscle functional impairment with ageing. It is associated with poor health outcomes, premature death and a significant burden on the global health economy. The prevalence of sarcopenia in China is unknown since most of the studies are lack of uniform standard. The study was undertaken to study the prevalence of sarcopenia and the association with cognitive impairment among multi-ethnic adults aged 50 years old or older in western China.

Methods

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants and 4500 participants were eligible for the analysis. We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). We assessed the participants’ cognitive functions using the 10-item Short Portable Mental Status Questionnaire (SPMSQ). Relationships between sarcopenia and cognitive impairment were analyzed using univariate and multivariate analyses.

Results

Of 4500 participants (mean age 62.4 ± 8.3 years), 869 (19.31%) adults were sarcopenia. 446 (9.9%) participants were identified as having mild cognitive impairment, 144 (3.2%) adults were identified as having moderate/severe cognitive impairment. After adjusting for age, gender, ethnics and other potential cofounders, cognitive impairment was found to be independently associated with sarcopenia with a dosage effect (mild cognitive impairment: odds ratio [OR]: 1.41, 95% CI 1.10–1.82; moderate/severe cognitive impairment: OR: 3.05, 95% CI 2.08–4.49). After gender stratification, the association between mild cognitive impairment with sarcopenia in male is not significant, while is still significant in female. While the association between moderate/severe cognitive impairment is independently associated with sarcopenia in both male and female.

Conclusions

The prevalence rates of sarcopenia, mild cognitive impairment, moderate/severe cognitive impairment among the communities aged 50 or older in western China were 19.31, 9.9 and 3.2%, respectively. Cognitive impairment was significantly associated with sarcopenia with a dosage effect, especially in female.

Nutritional intervention and functional exercises improve depression, loneliness and quality of life in elderly women with sarcopenia: a randomized clinical trial

Abstract Introduction: Loneliness interferes with the eating habits and functionality of the elderly, compromising their quality of life. Objective: This study aimed to evaluate the effects of eating and performing functional group-based exercises on depressive symptoms, loneliness and quality of life in patients with sarcopenia treated at a public health service. Method: This is a randomized clinical trial with a convenience sample of elderly women with sarcopenia according to the European Work Group of Sarcopenia on Older People (EWGSOP), divided into three groups of 20 subjects each: a control group (CG), functional exercise group (FEG), monitored using the Home-based Older People’s Exercise (HOPE) program, and functional exercise and nutritional intervention group (NIG), which in addition to HOPE, received pre-training fruit juice (fast-absorbing carbohydrates) and post-training banana smoothie reinforced with peanut (leucine). These groups met twice a week for 12 weeks, the control group (CG) received health guidance at weekly meetings for 12 weeks. The results of the interventions were analyzed using the geriatric depression scale and UCLA loneliness scale, and quality of life using the EQ-5D. Results: Significant post-intervention differences were observed in the NIG group in depressive (p=0.008) and loneliness symptoms (0.04) and quality of life (0.009), demonstrating the effects of group exercise and eating as a social activity. Conclusion: Nutritional intervention and functional group-based exercises were effective at minimizing depressive symptoms, social isolation, and improving the quality of life of elderly women with sarcopenia.

Sarcopenia and cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Sarcopenia and cognitive impairment are two of the most prevalent causes of disability in the aging population. Despite the vast amount of research that has been done to quantify the association between these two conditions, extensive systematic reviews and meta-analyses remain limited.

METHODS

We performed a systematic review using the PubMed, EMBASE, Scopus, and Google Scholar databases. Sarcopenia was defined as the loss of skeletal muscle mass and muscle function, as measured by muscle strength or performance. Cognitive impairment was diagnosed by validated cognitive or neuropsychological tests.

RESULTS

We identified 303 potentially relevant articles in the initial search. Observational studies quantifying a relationship between sarcopenia and cognitive impairment were selected. Information was extracted from 15 studies, and random-effects models were used for the meta-analysis. The pooled odds ratios for cognitive impairment for patients with sarcopenia compared with patients without sarcopenia were 2.85 (95% confidence interval: 2.19-3.72) in the unadjusted analysis and 2.25 (95% confidence interval: 1.70-2.97) in the adjusted meta-analysis. These results remained constant in subgroup analyses by study population, study region, the definition of sarcopenia, and cognitive impairment. Although half of the studies (8 out of 15) were of fair quality, we conducted a sensitivity analysis to exclude studies with fair quality and obtained similar results.

CONCLUSIONS

Sarcopenia is associated with an increased risk of cognitive impairment independent of study population, the definition of sarcopenia, and cognitive impairment. This suggests the importance of the early recognition of sarcopenia for the prevention of cognitive impairment in clinical practice.

Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study

Background

Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.

Methods

ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas.

Results

The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.

Conclusions

The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.

Sarcopenic obesity predicts nonremission of late-life depression

BACKGROUND/OBJECTIVES

Aging-related physiological changes like metabolic dysregulation and physical frailty are associated with depression and worsen its prognosis. Since central obesity is a key component of the metabolic syndrome and sarcopenia of physical frailty, we examined the association of sarcopenic obesity with depression cross-sectional and over time.

METHODS

Cohort study of depressed patients and a nondepressed comparison group.

SETTING

Primary and secondary mental health care.

PARTICIPANTS

Three hundred seventy-eight older (≥60 y) depressed patients of which 285 were followed up at 2 years and 132 nondepressed persons participating in the Netherlands Study of Depression in Older (NESDO) persons.

MEASUREMENTS

Sarcopenic obesity was based on predefined cutoffs for both maximum handgrip strength (assessed with a dynamometer) and waist circumference (dichotomous) as well as the product term of handgrip strength by waist circumference (dimensional). Depressive disorder according to DSM-IV-TR criteria was assessed with fully structured psychiatric interview at baseline and 2-year follow-up.

RESULTS

Sarcopenic obesity was more prevalent among depressed patients compared with nondepressed participants (18.9% versus 10.7%, P = 0.030). Neither the dichotomous nor dimensional operationalization of sarcopenic obesity was associated with baseline depressive disorder when adjusted for covariates. Nonetheless, among depressed patients, logistic regression showed that the interaction of handgrip strength by waist circumference was associated with remitted depression at 2-year follow-up (P = 0.044). Only among patients with a low handgrip strength, a higher waist circumference predicted nonremission.

CONCLUSION

Among depressed patients, sarcopenic obesity predicts nonremission of depression. Therefore, combined exercise and nutritional interventions might be effective for depressed patients with sarcopenic obesity.

Role of gait speed and grip strength in predicting 10-year cognitive decline among community-dwelling older people

BACKGROUND

The gait speed and handgrip strength represented the core determinants of physical frailty and sarcopenia, which were reported to be associated with cognitive impairment and decline. Different physical measures might differentially affect cognitive changes, such as higher-level cognitive change and global cognitive decline. This study examined the differential associations of gait speed and handgrip strength with 10-year cognitive changes among community-dwelling older people.

METHODS

Participants aged 60 years and over living in the community were invited for study. Gait speed and handgrip strength were classified into 5 groups based on quintiles at baseline. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and Digit Symbol Substitution Test (DSST) every 2 years from baseline for a period of 10 years. Linear mixed effects models were used to determine the role of gait speed and handgrip strength in the prediction of 10-year cognitive changes by adjusting covariates, including age, gender, education, depressive symptoms, marital status, smoking status, instrumental activities of daily life (IADL), Charlson Comorbidity Index (CCI), and body mass index (BMI) at baseline.

RESULTS

A total of 1096 participants were enrolled in the study. The mean age was 69.4 ± 5.8 years and 50.9% were male. The slowest gait speed group showed a significantly greater decline in the DSST scores over 10 years than the highest group (estimate = 0.28 and P = 0.003), but not in the MMSE scores (estimate = 0.05 and P = 0.078). The lowest handgrip strength group showed a significantly greater decline in the MMSE scores than the highest group (estimate = 0.06 and P = 0.039) and in the DSST scores than the highest two quintiles (estimate = 0.20 and P = 0.033 for the fourth quintile; estimate = 0.20 and P = 0.040 for the highest quintile) over 10-year follow-up.

CONCLUSIONS

A slow gait speed could predict 10-year cognitive decline using DSST, and a low handgrip strength could predict 10-year cognitive decline using MMSE in addition to DSST. Thus both physical measures are lined to cognitive decline but there may be different mechanisms between brain and physical functions.

The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men

Background

Preserved functions of daily life and cognition are cornerstones of independent aging, which is crucial for maintaining a high quality of life. The aim of this study was to examine the impact of sarcopenia, and its underlying components, on independent ageing in a cohort study of very old men.

Methods

The presence of sarcopenia and independent ageing at a mean age of 87 was investigated in 287 men from the Uppsala Longitudinal Study of Adult Men. Five years later 127 men were re-evaluated for independent ageing. Sarcopenia was defined by two different definitions from the European Working Group on Sarcopenia in Older People. In the first definition sarcopenia was defined as skeletal muscle index < 7.26 kg/m² and either gait speed ≤0.8 m/s or hand grip strength < 30 kg. In the later up-dated definition, HGS < 27 kg and/or chair stand test > 15 s defines probable sarcopenia, which is confirmed by SMI < 7.0 kg/m². Independent ageing was defined as a Mini-Mental State Examination score of ≥25 points, absence of diagnosed dementia, community-dwelling, independency in personal care and ability to walk outdoors alone.

Results

Sarcopenia at baseline was observed in 21% (60/287) and 20% (58/287), respectively, due to definition. The prevalence of independent ageing was 83% (239/288) at baseline and 69% (87/127) five years later. None of the sarcopenia diagnoses were associated with independent ageing. In contrast, gait speed was both in cross-sectional (odds ratio (OR) per one standard deviation increase 2.15, 95% confidence interval (CI) 1.47–3.15), and in longitudinal multivariate analyses (OR 1.84, 95% CI 1.19–2.82). In the cross-sectional analysis also higher hand grip strength was associated with independent ageing (OR 1.58, 95% CI 1.12–2.22), while a slower chair stand test was inversely associated (OR 0.61, 95% CI 0.43–0.86). Muscle mass; i.e. skeletal muscle index, was not associated with independent ageing.

Conclusions

For very old men, especially a higher gait speed, but also a higher hand grip strength and a faster chair stand test, were associated with independent ageing, while skeletal muscle index alone, and the composite sarcopenia phenotype measured with two different definitions, were not.

Association of Sarcopenia With Performance on Multiple Cognitive Domains: Results From the ELSA-Brasil Study

Background

Sarcopenia and cognitive impairment share pathophysiological paths and risk factors. Our aim was to investigate the association of sarcopenia and its defining components with cognitive performance in middle-aged and older adults.

Methods

This cross-sectional analysis included 5,038 participants from the ELSA-Brasil Study, aged ≥ 55 years. Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health. Cognition was evaluated using delayed word recall test, semantic verbal fluency test, and trail making test version B. Possible confounders included sociodemographic characteristics, lifestyle, and clinical comorbidities.

Results

The frequencies of sarcopenia, low muscle mass, and low muscle strength were 1.8%, 23.3%, and 4.4%, respectively. After adjustment for possible confounders, poorer performance on the verbal fluency test was associated with sarcopenia (β = −0.20, 95% confidence interval [CI] = −0.38; −0.01, p = .03) and low muscle mass (β = −0.08, 95% CI = −0.14; −0.01, p = .02). Low muscle strength was associated with poorer performance in the delayed word recall test (β = −0.14, 95% CI = −0.27; −0.02, p = .02), verbal fluency test (β = −0.14, 95% CI = −0.26; −0.02, p = .03), and trail making test (β = −0.15, 95% CI = −0.27; −0.03, p = .01).

Conclusions

Sarcopenia was associated with poorer performance on the verbal fluency test, and low muscle strength was associated with poorer performance in all cognitive tests in middle-aged and older adults.

Sarcopenia Is Associated with Cognitive Impairment Mainly Due to Slow Gait Speed: Results from the Korean Frailty and Aging Cohort Study (KFACS)

Sarcopenia and cognitive impairment may share common risk factors and pathophysiological pathways. We examined the association between impairments in specific cognitive domains and sarcopenia (and its defining components) in community-dwelling older adults. We analyzed 1887 patients who underwent cognitive function tests and dual-energy X-ray absorptiometry from the baseline data of adults aged 70-84 years obtained from the Korean Frailty and Aging Cohort Study. Those with disability in activities of daily living, dementia, severe cognitive impairment, Parkinson's disease, musculoskeletal complaints, neurological disorders, or who were illiterate were excluded. Cognitive function was assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, the Frontal Assessment Battery. For sarcopenia, we used the diagnostic criteria of the Asian Working Group for Sarcopenia. The prevalence of sarcopenia was 9.6% for men and 7.6% for women. Sarcopenia (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.04-2.99) and slow gait speed (OR 2.58, 95% CI 1.34-4.99) were associated with cognitive impairment in men. Only slow gait speed (OR 1.88, 95% CI 1.05-3.36) was associated with cognitive impairment in women. Sarcopenia is associated with cognitive impairment mainly due to slow gait speed. Our results suggested that cognitive impairment domains, such as processing speed and executive function, are associated with sarcopenia-related slow gait speed.

Association between muscular strength and depressive symptoms : A narrative review

There is increasing evidence for an association between low muscular strength and depressive symptoms. In this review the existing literature on the association between muscular strength and depression particularly in older people as reported in epidemiological studies is summarized. From the literature search, conducted in PubMed (January 1980-May 2018), 17 papers (8 cross-sectional and 9 longitudinal studies) were selected. All cross-sectional studies reported significantly lower odds of having depressive symptoms with increased levels of muscular strength and this association persisted even after adjusting for several confounders including the level of physical activity. The majority of the longitudinal studies also reported that low muscular strength was independently associated with a higher risk of developing depression but more studies are needed to confirm this evidence. Furthermore, future investigations are needed to explore the exact mechanisms of muscular strength in relation to depression. Low muscular strength is a modifiable factor for depression, which is of great public health interest.

Association between sarcopenia and depressive mood in urban-dwelling older adults: A cross-sectional study

AIM

The aim of the present study was to examine the relationship between depressive mood and diagnostic components of sarcopenia.

METHODS

The study used baseline data of participants in the Toyota Prevention Intervention for Cognitive Decline and Sarcopenia study. Participants in this cross-sectional study were 432 older adults (46.5% women, mean age 72.5 ± 4.7 years). We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia, and all participants were classified into a sarcopenia or healthy control group. The skeletal muscle mass was measured by bioelectrical impedance. Depressive mood was assessed using the Geriatric Depression Scale-15 (range 0-15).

RESULTS

Among the 432 participants, 9.5% were classified as having sarcopenia. The mean ± SD Geriatric Depression Scale-15 scores in the control and sarcopenia groups were significantly different at 3.9 ± 2.8 and 5.3 ± 3.3, respectively (P = 0.003). Furthermore, depressive mood was significantly more prevalent in the sarcopenia group (P = 0.011). Multiple linear regression analysis showed that the Geriatric Depression Scale score was associated with grip strength (β = -0.23, P = 0.004) and walking speed (β = -0.15, P = 0.006), but not skeletal muscle mass index (β = -0.16, P = 0.142), after controlling for demographic factors, chronic diseases, inflammatory markers and physical activity.

CONCLUSIONS

Sarcopenia was associated with depressive mood. In terms of the diagnostic components of sarcopenia, depressive mood was not associated with decreased muscle mass, but was associated with low muscle strength and low physical performance. Geriatr Gerontol Int 2019; 19: 508-512.

Prospective associations of low muscle mass and strength with health-related quality of life over 10-year in community-dwelling older adults

AIMS

This study aims to describe the associations of low muscle mass, handgrip (HGS) and lower-limb muscle strength (LMS) with health-related quality of life (HRQoL) over 10 years in community-dwelling older adults.

METHODS

Participants (N = 1002; 51% women; mean age 63 ± 7.4 years) were prospectively followed for 10 years. HRQoL was measured using the validated assessment of quality of life (AQoL) instrument. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry and normalized to body mass index (BMI). HGS and LMS were assessed using dynamometers. Low ALM/BMI (ALM/BMI_LOW), LMS (LMS_LOW) and HGS (HGS_LOW) at baseline were defined as the lowest 20% of the sex-specific distribution for each measure. Linear mixed effect regression models, adjusting for confounders, were used to estimate the association between ALM/BMI_LOW, LMS_LOW, and HGS_LOW at baseline and HRQoL over 10 years.

RESULTS

Participants with LMS_LOW (β = -0.061, 95% CI: -0.089, -0.033) and women (β = -0.089, 95% CI: -0.129, -0.049) but not men (β = -0.023, 95% CI: -0.064, 0.019) with HGS_LOW had clinically meaningful reductions in HRQoL over 10 years compared to those with normal strength. There was a weaker but statistically significant association between ALM/BMI_LOW and 10-year HRQoL (β = -0.038, 95% CI: -0.068, -0.008).

CONCLUSIONS

Lower-limb muscle strength and handgrip strength (in women only), which can be easily measured in clinical practice, appear more important than muscle mass for HRQoL.

Prevalence of sarcopenia in patients with geriatric depression diagnosis

AIM

In this study, the aim was to identify the prevalence of sarcopenia among patients with geriatric depression (GD) diagnosis and to collect data to illuminate precautions to reduce disease load.

METHOD

The study was completed with 116 patients (GD group) aged 65 years or older with possible or definite depression diagnosis according to the Geriatric Depression Scale (GDS) criteria and 301 volunteers aged from 18 to 39 years (control 1) and above 65 years (control 2). Our prospective and cross-sectional study applied the Hamilton Depression Rating Scale (HDRS) to control 1 group and the GDS and Mini Mental Test (MMSE) to control 2 and GD groups. All groups had skeletal muscle mass index (SMMI), muscle strength, and physical performance assessed with sarcopenia diagnosis according to the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria.

RESULTS

In our study, in parallel with the severity of disease in patients with GD diagnosis, the prevalence of sarcopenia (led by severe sarcopenia) was observed to be high compared to the control group. The prevalence of sarcopenia was 12.7%/24.2% among women and 13.8%/44.0% among men and 13.4%/32.8% in total in the control 2 and GD groups, respectively. There was a significant increase observed in the prevalence of sarcopenia, led by severe sarcopenia with a definite depression diagnosis.

CONCLUSION

For GD patients, diagnosis of sarcopenia in the early stages and precautions like improving muscle functions with protein support in diet and resistance exercises will make it possible to contribute to improving clinical results of the disease.

Sarcopenia and hospital-related outcomes in the old people: a systematic review and meta-analysis

AIM

This systematic review was conducted to explore the associations between sarcopenia, hospitalization and length of stay in the old people.

METHODS

Pubmed, Embase, Medline and Cochrane Central Register of Controlled Trails from January 2009 to October 2017 were searched in this review. We included prospective studies, which had the clear definition of sarcopenia and reported the hospitalization or length of stay as one of outcomes. Adjusted Odd ratios (aORs), hazard ratios (aHRs) or relative risks (aRRs) extracted from the studies were combined to synthesize pooled effect measures. Heterogeneity, and methodological quality were assessed using I² statistic and Newcastle-Ottawa scale, respectively.

RESULTS

Nine studies were included in this review. Of these, 8 studies with 4174 individuals reported results for hospitalization, 3 studies involving 6276 old people in the community reported results for length of stay. Sarcopenia was significantly associated with future hospitalization (RR 1.40, 95% CI 1.04-1.89, p = 0.029; data from 8 studies). A subgroup analysis showed the associations between sarcopenia and readmission in hospitalized old patients that were statistically significant (RR 1.75, 95% CI 1.01-3.03, p = 0.044; data from 8 studies). However, this association were not found in the community-dwelling older subjects (RR 1.08, 95% CI 0.74-1.57, p = 0.688; data from 8 studies), uncertain in nursing home residents. The association of sarcopenia and length of stay was not statistically significant (OR 1.21, 95% CI 0.90-1.63, p = 0.20; data from 8 studies) in community-dwelling residents.

CONCLUSIONS

This systematic review demonstrates that sarcopenia is a significant predictor of readmission in old inpatients, but not associated with hospitalization or length of stay in community-dwelling old adults.

Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study

OBJECTIVES

To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults.

DESIGN

Prospectively longitudinal cohort study.

SETTING AND PARTICIPANTS

The study recruited 354 men aged 65 years and older in the veteran's retirement community.

MEASURES

Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality.

RESULTS

According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006).

CONCLUSIONS

Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.

Sarcopenia and cardiovascular risk indices in patients with chronic kidney disease on conservative and replacement therapy

OBJECTIVE

Chronic kidney disease (CKD) is a condition with high cardiovascular mortality associated with emerging risk factors, including sarcopenia. Several mechanisms can affect muscle mass, such as vitamin D deficiency, low protein intake, physical inactivity, metabolic acidosis, and inflammation leading to a worsening of cardiovascular outcomes and cognitive function. We aimed to evaluate the prevalence of sarcopenia in CKD patients on conservative and replacement therapy and the associations between sarcopenia and markers of atherosclerosis, endothelial dysfunction, psychological and cognitive function.

METHODS

We enrolled CKD patients (stage 3/5 KDIGO [Kidney Disease: Improving Global Outcomes]) and hemodialysis, peritoneal dialysis, and post-kidney transplant patients. Clinical, laboratory and instrumental assessments, including bioimpedance analysis, hand-grip strength, intima media thickness, flow-mediated dilation, and epicardial adipose tissue, were performed in addition to analysis of psychological and cognitive status by the Montreal Cognitive Assessment, Mini-Mental State Examination, and Geriatric Depression Scale.

RESULTS

A total of 77 patients (43 male) with a mean age of 69.6 ± 9.85 y were studied. According to validated criteria (using bioimpedance analysis and hand-grip strength), the prevalence of sarcopenia was 49.4%. Sarcopenic patients had higher values of intima media thickness (P = 0.032) and epicardial adipose tissue (P = 0.012) and lower flow-mediated dilation (P = 0.002), total cholesterol (P = 0.005), and high-density lipoprotein cholesterol (P = 0.008) with respect to non-sarcopenic patients. We found higher Geriatric Depression Scale scores (P = 0.04) in sarcopenic patients, whereas we did not find differences between the two groups in Mini-Mental State Examination and Montreal Cognitive Assessment score.

CONCLUSION

Sarcopenia is highly prevalent in CKD/end stage renal disease patients and is associated with changes in early systemic indices of atherosclerosis and endothelial dysfunction, known as markers of worse prognosis.

Low Muscle Mass and Depressed Mood in Korean Adolescents: a Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys

BACKGROUND

Muscle mass and muscle function are related to depressed mood in studies of adults. Like adults, Korean students are highly likely to suffer from decreased muscle mass due to social conditions. In this study, we evaluated the muscle mass status of Korean adolescents and assess the effect of muscle on depressive mood.

METHODS

A total of 1,233 adolescent boys and girls participants from the Korea National Health and Nutrition Examination Survey were enrolled in our study. Participants underwent dual-energy X-ray absorptiometry for assessment of appendicular muscle mass and completed questionnaires regarding depressed mood, stress, suicidal ideations, and attempts.

RESULTS

There was no difference in depressive mood according to muscle mass among boys (P = 0.634); girls with decreased muscle mass had a greater tendency for depressed mood compared to girls with optimal muscle mass (P = 0.023). After adjusting for age, waist circumference-to-height ratio, smoking status, alcohol consumption, frequency of physical activity, self-reported obesity, weight-loss efforts, and monthly household income, girls with low muscle mass (LMM) were 2.60 times more at risk of developing depression than girls with normal muscle mass (95% confidence interval [CI], 1.05-6.49; P = 0.040). This trend was similar for girls with LMM with obesity (95% CI, 1.00-11.97; P = 0.049).

CONCLUSION

Adolescent girls who have insufficient muscle mass are more likely to report depressed mood than girls who have ideal muscle mass. Interventions for maintaining proper muscle mass are required.

Depression is Associated With Sarcopenia Due to Low Muscle Strength: Results From the ELSA-Brasil Study

OBJECTIVES

To investigate the association of sarcopenia and its defining components with depression in Brazilian middle-aged and older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

This analysis included 5927 participants from the ELSA-Brasil Study second data collection, aged 55 years and older, with complete data for exposure, outcome, and covariates.

MEASURES

Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by hand-grip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health (FNIH) criteria. Depression was assessed using the Clinical Interview Scheduled Revised (CIS-R). Information on sociodemographic characteristics, lifestyle, and clinical comorbidities were also obtained.

RESULTS

The frequencies of sarcopenia, presarcopenia, low muscle mass, low muscle strength, and low muscle strength without loss of muscle mass was 1.9%, 18.8%, 20.7%, 4.8%, and 2.9%, respectively. After adjustment for sociodemographic characteristics, clinical conditions, and lifestyle factors, depression was associated with sarcopenia (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 1.11-4.48, P = .024) and low muscle strength (OR = 1.94, 95% CI = 1.20-3.15, P = .007), but it was not associated with presarcopenia, low muscle mass, and low muscle strength without loss of muscle mass.

CONCLUSIONS

Depression is associated with sarcopenia defined by the FNIH criteria mainly because of its association with weakness. Future studies are needed to clarify the temporal relationship between both conditions.

A Prospective Investigation of Dietary Intake and Functional Impairments Among the Elderly

Limited information is available in Asian populations regarding the association of dietary intake and patterns with age-related functional impairments. Using data from 2 population-based cohort studies in China, the Shanghai Women's Health Study (1996-2015) and Shanghai Men's Health Study (2002-2015), we prospectively examined adherence to dietary guidelines, including the Chinese Food Pagoda, the Dietary Approaches to Stop Hypertension, and the Alternative Healthy Eating Index, as well as consumption of specific foods, for their associations with impairment in function, both physical (walking, hearing/vision) and mental (memory, decision-making). Included in the analyses were 30,484 participants who had been followed for an average of 14.4 years and were between the ages of 70 and 86 years at the functional status assessment. Higher dietary-recommendation adherence scores were associated with a lower likelihood of developing functional impairments. The odds ratios ranged from 0.61 (95% confidence interval: 0.54, 0.70) to 0.83 (95% confidence interval: 0.72, 0.95) when extreme quintiles were compared. Higher fish, poultry, vegetable, and fruit intake, moderate red meat intake, and low rice consumption were associated with a reduced probability of having physical or mental impairments. Our findings highlight the importance of a high-quality diet in maintaining functional status among the aged population.

Ultrasound measurements of gastrocnemius muscle thickness in older people with sarcopenia

Background

Sarcopenia, defined as low muscle mass and low muscle strength and/or low physical performance, is affecting more and more people. The European Working Group on Sarcopenia in Older People has suggested the routine community screening. However, selecting the most suitable method to evaluate muscle mass to detect sarcopenia in community screening is a challenge. This study sought to analyze the correlation between ultrasound (US) measurements of the gastrocnemius muscle and low muscle mass, as defined by sarcopenia.

Methods

One hundred thirty-five elderly participants were enrolled. US measurements included muscle thickness (MT), fat thickness (FT), MT/body mass index (BMI), and MT/FT. The definition of low muscle mass was based on the proposal from the Asian Working Group for Sarcopenia, in which the cutoff values for low muscle mass were 7.0 kg/m² for men and 5.4 kg/m² for women using dual energy X-ray absorptiometry (DXA). The participants were divided into low and normal muscle mass groups. Participants with low muscle mass were divided into presarcopenia, sarcopenia, and severe sarcopenia groups.

Results

Those in the low muscle mass group were older and had lower weights and BMIs (P<0.05). In addition, MT and MT/BMI were lower in the low muscle mass group (P<0.05). Binary logistic regression analysis revealed that MT was the factor associated with low skeletal muscle mass (OR =0.001, P<0.001). ANOVA revealed that MT was not significantly different between subjects with presarcopenia, sarcopenia, and severe sarcopenia (F=1.69, P=0.192). Receiver operating characteristic curve analyses indicated that the cutoff value of the gastrocnemius MT for low muscle mass was 1.50 cm.

Conclusion

MT measured by US was identified as the factor associated with low skeletal muscle mass. Those with gastrocnemius MT less than 1.5 cm can be considered as low muscle mass.

Association between appendicular skeletal muscle mass and depressive symptoms: Review of the cardiovascular and metabolic diseases etiology research center cohort

BACKGROUND

The effects of skeletal muscle mass on depressive symptoms remain poorly understood, especially in the middle-aged population. We examined the relationship between skeletal muscle mass and depressive symptoms according to sex and menopausal status in the middle-aged Korean population.

METHODS

Herein, 1,151 men and 2,176 women aged 30-64 years completed questionnaires and underwent health examinations in the Cardiovascular and Metabolic Disease Etiology Research Center study. Appendicular skeletal muscle mass (ASM) was measured via bioelectrical impedance analysis and adjusted for height squared (ASM/Ht²). Both continuous values and tertile groups of ASM/Ht² were used for analysis. Depressive symptoms were assessed using the Beck Depressive Inventory-II (BDI), and the prevalence of depressive symptoms was determined as a BDI score ≥ 20.

RESULTS

Multiple logistic regression analysis using a fully adjusted model showed that depressive symptoms were more frequently observed among men in the lower ASM/Ht² tertile and middle ASM/Ht² tertile than among those in the higher ASM/Ht² tertile. Each 1-kg/m² decrease in ASM/Ht² was significantly associated with the presence of depressive symptoms in men. Such significant association was not observed among premenopausal and postmenopausal women.

LIMITATIONS

The cross-sectional nature of the study design, measurement of skeletal muscle mass and depressive symptoms only once, estimation of skeletal muscle mass using bioelectrical impedance analysis, assessing depressive symptoms by self-reported questionnaire, and potential unknown confounding variables constitute the limitations of our study.

CONCLUSIONS

The independent association between low skeletal muscle mass and depressive symptoms was observed in men but not in women.

Association between depressive symptoms and sarcopenia in older Chinese community-dwelling individuals

Purpose

The aim of this study was to assess the prevalence of sarcopenia and depressive symptoms and estimate the association between them in elderly Chinese community-dwelling individuals.

Patients and methods

A total of 948 elderly Chinese community-dwelling individuals were recruited through leaflets and posters from three communities in Chengdu, and 865 participants were analyzed in this cross-sectional study. Muscle mass was measured using the bioimpedance analysis, handgrip strength was measured with a handheld dynamometer, and physical performance was assessed via usual gait speed on a 6 m course. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). Depressive symptoms were assessed using the Chinese version of 15-item Geriatric Depression Scale (GDS-15) with a score of ≥5 indicative of the presence of depressive symptoms.

Results

A total of 865 participants were included in the analysis. The participants had a mean age of 68.68±6.46 years. Sixty-one (7.1%) participants and 71 (8.2%) participants were identified as having sarcopenia and depressive symptoms, respectively. After adjusting for age, sex, and other potential confounders, sarcopenia was found to be significantly associated with depressive symptoms (odds ratio [OR]: 2.23, 95% CI 1.06–4.92).

Conclusion

The prevalence rates of sarcopenia and depressive symptoms were 7.1 and 8.2%, respectively, in elderly Chinese community-dwelling individuals, and sarcopenia was significantly associated with depressive symptoms.

Sarcopenic obesity and cognitive performance

BACKGROUND

Sarcopenia and obesity both negatively impact health including cognitive function. Their coexistence, however, can pose an even higher threat likely surpassing their individual effects. We assessed the relationship of sarcopenic obesity with performance on global- and subdomain-specific tests of cognition.

PATIENTS AND METHODS

The study was a cross-sectional analysis of data from a series of community-based aging and memory studies. The sample consisted of a total of 353 participants with an average age of 69 years with a clinic visit and valid cognitive (eg, Montreal Cognitive Assessment, animal naming), functional (eg, grip strength, chair stands), and body composition (eg, muscle mass, body mass index, percent body fat) measurements.

RESULTS

Sarcopenic obesity was associated with the lowest performance on global cognition (Est.Definition1=-2.85±1.38, p=0.039), followed by sarcopenia (Est.Definition1=-1.88±0.79, p=0.017) and obesity (Est.Definition1=-1.10±0.81, p=0.175) adjusted for sociodemographic factors. The latter, however, did not differ significantly from the comparison group consisting of older adults with neither sarcopenia nor obesity. Subdomain-specific analyses revealed executive function (Est.Definition1=-1.22±0.46 for sarcopenic obesity; Est.Definition1=-0.76±0.26 for sarcopenia; Est.Definition1=-0.52±0.27 for obesity all at p<0.05) and orientation (Est.Definition1=0.59±0.26 for sarcopenic obesity; Est.Definition1=-0.36±0.15 for sarcopenia; Est.Definition1=-0.29±0.15 all but obesity significant at p<0.05) as the individual cognitive skills likely to be impacted. Potential age-specific and depression effects are discussed.

CONCLUSION

Sarcopenia alone and in combination with sarcopenic obesity can be used in clinical practice as indicators of probable cognitive impairment. At-risk older adults may benefit from programs addressing loss of cognitive function by maintaining/improving strength and preventing obesity.

Locomotive syndrome: clinical perspectives

The deterioration of locomotive components, which comprise bones, joints, and intervertebral discs, and muscles and nerves, can lead to symptoms such as pain, limitations in the range of joint mobility, malalignment, impaired balance, and difficulty walking. Locomotive syndrome (LoS) was proposed by the Japanese Orthopedic Association in 2007 as a concept for people who are at a high risk of developing a musculoskeletal ambulation disability attributed to locomotor organs. Although many international articles related to LoS have been published, an international consensus of this concept seems to be lacking. This review article on LoS introduces the concept, the related assessment methods, and the condition's prevalence based on the most up-to-date literature, and discusses discrimination from frailty and sarcopenia, relevance to musculoskeletal problems, management plan, and future directions. Familiarity with recent evidence would be useful for the health care providers in an aging society to educate individuals with LoS or pre-LoS and to maintain their well-being and prevent them from requiring long-term care.

Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations

The possible roles of selected B vitamins in the development and progression of sarcopenia are reviewed. Age-related declines in muscle mass and function are associated with huge and increasing costs to healthcare providers. Falls and loss of mobility and independence due to declining muscle mass/function are associated with poor clinical outcomes and their prevention and management are attractive research targets. Nutritional status appears a key modifiable and affordable intervention. There is emerging evidence of sarcopenia being the result not only of diminished anabolic activity but also of declining neurological integrity in older age, which is emerging as an important aspect of the development of age-related decline in muscle mass/function. In this connection, several B vitamins can be viewed as not only cofactors in muscle synthetic processes, but also as neurotrophic agents with involvements in both bioenergetic and trophic pathways. The B vitamins thus selected are examined with respect to their relevance to multiple aspects of neuromuscular function and evidence is considered that requirements, intakes or absorption may be altered in the elderly. In addition, the evidence base for recommended intakes (UK recommended daily allowance) is examined with particular reference to original datasets and their relevance to older individuals. It is possible that inconsistencies in the literature with respect to the nutritional management of sarcopenia may, in part at least, be the result of compromised micronutrient status in some study participants. It is suggested that in order, for example, for intervention with amino acids to be successful, underlying micronutrient deficiencies must first be addressed/eliminated.

Prevalence of sarcopenia and associated factors in hospitalised older patients: A cross-sectional study

OBJECTIVE

To estimate the prevalence and factors associated with sarcopenia in a sample of older inpatients.

METHODS

A cross-sectional study was conducted in three acute geriatric wards in 2012. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia.

RESULTS

We included 407 patients aged 81.0 ± 8.0 years. The prevalence of sarcopenia was 31% in the whole study population. Multiple logistic regression showed that being a female (odds ratio (OR) 4.75, 95% confidence interval (CI) 2.45-9.20), smoking (OR 2.94, 95% CI 1.26-6.69), cognitive impairment (OR 2.08, 95% CI 1.10-3.95), polypharmacy (OR 2.36, 95% CI 1.28-4.34) and body mass index (OR 0.75, 95% CI 0.68-0.83) were independently associated with sarcopenia.

CONCLUSION

Sarcopenia was highly prevalent in older inpatients. In addition to factors previously reported to be associated with sarcopenia, we found that polypharmacy was associated with sarcopenia. As the direction of causality remains uncertain, these relationships deserve further study.

Depression and Handgrip Strength Among U.S. Adults Aged 60 Years and Older from NHANES 2011-2014

OBJECTIVES

Sarcopenia is a gradual loss of muscle mass and strength that occurs with aging. This muscle deterioration is linked to increased morbidity, disability, and other adverse outcomes. Although reduced handgrip strength can be considered a marker of sarcopenia and other aging-related decline in the elderly, there is limited research on this physical health problem in at-risk groups with common biopsychosocial conditions such as depression. Our primary objective was to ascertain level of combined handgrip strength and its relationship with depression among adults aged 60 years and older.

DESIGN

Unadjusted and adjusted linear regression models were conducted with a cross-sectional survey dataset.

SETTING

Secondary dataset from the 2011-2014 National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

Community-dwelling, non-institutionalized adults ≥60 years old (n=3,421).

MEASUREMENTS

The predictor variables included a positive screen for clinically relevant depression (referent=PHQ-9 score <10). The criterion variable of combined handgrip strength (kg) was determined using a dynamometer.

RESULTS

Mean age and BMI were 69.9 years (51.5% female) and 28.8 kg/m2, respectively. Mean combined handgrip strength in the overall cohort was 73.5 and 46.6 kg in males and females, respectively. Three hundred thirty-six (9.8%) reported symptoms of depression. In unadjusted and fully adjusted models, depression was significantly associated with reduced handgrip strength (B = -0.26±0.79 and B = -0.19±0.08, respectively; p<0.001).

CONCLUSION

Our findings demonstrate handgrip strength has a significant inverse association with depression. Future longitudinal studies should investigate the causal processes and potential moderators and mediators of the relationships between depression and reduced handgrip strength. This information may further encourage the use of depression and handgrip strength assessments and aid in the monitoring and implementation of health care services that address both physical and mental health limitations among older adult populations.

Mild cognitive impairment is associated with poor physical function but not bone structure or density in late adulthood: findings from the Hertfordshire cohort study

This study investigated the association between mild cognitive impairment (MCI) and physical function and bone health in older adults. MCI was associated with poor physical performance but not bone mineral density or bone microarchitecture.

PURPOSE

Cross-sectional study to investigate the association between mild cognitive impairment (MCI) and physical performance, and bone health, in a community-dwelling cohort of older adults.

METHODS

Cognitive function of 222 men and 221 women (mean age 75.5 and 75.8 years in men and women, respectively) was assessed by the Strawbridge questionnaire and Mini Mental State Exam (MMSE). Participants underwent dual-energy X-ray absorptiometry (DXA), peripheral-quantitative computed tomography (pQCT) and high-resolution peripheral-quantitative computed tomography (HR-pQCT) scans to assess their bone density, strength and microarchitecture. Their physical function was assessed and a physical performance (PP) score was recorded.

RESULTS

In the study, 11.8% of women and 8.1% of men were cognitively impaired on the MMSE (score < 24). On the Strawbridge questionnaire, 24% of women were deemed cognitively impaired compared to 22.3% of men. Cognitive impairment on the Strawbridge questionnaire was associated with poorer physical performance score in men but not in women in the unadjusted analysis. MMSE < 24 was strongly associated with the risk of low physical performance in men (OR 12.9, 95% CI 1.67, 99.8, p = 0.01). Higher MMSE score was associated with better physical performance in both sexes. Poorer cognitive function, whether assessed by the Strawbridge questionnaire, or by MMSE score, was not associated with bone density, shape or microarchitecture, in either sex.

CONCLUSION

MCI in older adults was associated with poor physical performance, but not bone density, shape or microarchitecture.

Body Mass and Physical Activity Uniquely Predict Change in Cognition for Aging Adults

BACKGROUND

Physical activity and body mass predict cognition in the elderly. However, mixed evidence suggests that obesity is associated with poorer cognition, while also protecting against cognitive decline in older age.

PURPOSE

We investigated whether body mass independently predicted cognition in older age and whether these associations changed over time.

METHODS

A latent curve structural equation modeling approach was used to analyze data from a sample of aging adults (N = 8442) split into two independent subsamples, collected over 6 years.

RESULTS

Lower baseline Body Mass Index (BMI) and higher physical activity independently predicted greater baseline cognition (p < 0.001). Decreases in BMI and physical activity independently predicted greater decline in the slope of cognition (p < 0.001).

CONCLUSIONS

Our results support the obesity paradox in cognitive aging, with lower baseline body mass predicting better cognition, but less decline over time protecting against cognitive decline. We discuss how weight loss in the elderly may serve as a useful indicator of co-occurring cognitive decline, and we discuss implications for health care professionals.

Relationships between cognitive function and body composition among community-dwelling older adults: a cross-sectional study

Background

Previous studies reported mixed results regarding the association between cognition and body weight in late life. We evaluated the relationships between cognitive function and body composition among community-dwelling older adults.

Methods

Three hundred twenty subjects (≥65 years, women 53%) with available data of cognitive function and body composition from 2010 Hallym Aging Study. Cognitive function was assessed using Korean Mini-Mental State Examination (K-MMSE). Dual-energy X-ray absorptiometry (DEXA) was used for measuring body composition including body fat and lean body mass. Anthropometric measurements and laboratory data were collected in clinical examination. Body composition variables were divided into sex-specific tertiles, and examined by multivariable logistic regression.

Results

Among female, the highest tertile group of fat mass and second tertile group of total lean body mass were associated with lower risk for cognitive impairment compared to the respective first tertile groups (odds ratios, 0.23 and 0.09, respectively; 95% confidence intervals, 0.04–0.88 and 0.01–0.44, respectively) after adjusting for confounding factors. In male, higher arm bone mineral content was associated with lower risk for cognitive impairment, but significance was lost after adjusting for adiponectin, age, and education.

Conclusions

Higher fat mass and lean body mass were associated with lower risk of cognitive impairment in older women. These observations suggest that body fat and lean mass later in life might be beneficial for cognition.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0651-9) contains supplementary material, which is available to authorized users.

Patterns of productive activity engagement as a longitudinal predictor of depressive symptoms among older adults in urban China

OBJECTIVES

Using two waves of panel data from the China Health and Retirement Longitudinal Study, this study prospectively assessed whether four distinct patterns of productive activity engagement would predict depressive symptoms among older adults in urban China two years later.

METHODS

A sample of urban residents aged 60 or above at Wave 1 and who were interviewed in both waves (N = 2398) was used. Latent class analysis (LCA) was conducted to identify distinct patterns of productive activity engagement that occurred within the Wave 1 data. Next, the generalized estimating equations were used to assess whether identified patterns predicted the levels of depressive symptoms measured at Wave 2.

RESULTS

Our use of LCA confirmed the existence of four distinct patterns of productive activity engagement among the study sample: Informal Helper/Carer, Working-Caring Engager, Civic Contributor, and Low/Spousal Carer. All of these three patterns exhibited significantly lower levels of depressive symptoms than that of Low/Spousal Carer two years later.

CONCLUSIONS

Our use of individual-based categorization of productive engagement better captured the reality of older adults performing various productive activities than summative scales of productive activities did and, therefore, provided a more valid clarification of differential well-being outcomes among older adults.

Memory Resilience to Alzheimer's Genetic Risk: Sex Effects in Predictor Profiles

Objectives

Apolipoprotein E (APOE) ɛ4 and Clusterin (CLU) C alleles are risk factors for Alzheimer's disease (AD) and episodic memory (EM) decline. Memory resilience occurs when genetically at-risk adults perform at high and sustained levels. We investigated whether (a) memory resilience to AD genetic risk is predicted by biological and other risk markers and (b) the prediction profiles vary by sex and AD risk variant.

Method

Using a longitudinal sample of nondemented adults (n = 642, aged 53-95) we focused on memory resilience (over 9 years) to 2 AD risk variants (APOE, CLU). Growth mixture models classified resilience. Random forest analysis, stratified by sex, tested the predictive importance of 22 nongenetic risk factors from 5 domains (n = 24-112).

Results

For both sexes, younger age, higher education, stronger grip, and everyday novel cognitive activity predicted memory resilience. For women, 9 factors from functional, health, mobility, and lifestyle domains were also predictive. For men, only fewer depressive symptoms was an additional important predictor. The prediction profiles were similar for APOE and CLU.

Discussion

Although several factors predicted resilience in both sexes, a greater number applied only to women. Sex-specific mechanisms and intervention targets are implied.