Sarcopenia and the Common Mental Disorders: a Potential Regulatory Role of Skeletal Muscle on Brain Function?

Associations of muscle mass and strength with depression among US adults: A cross-sectional NHANES study

OBJECTIVES

The aim of our study was to assess the association between muscle mass and strength and depression through a cross-sectional study of the National Health and Nutrition Examination Survey from 2011 to 2014.

METHODS

Muscle mass was calculated by summing the lean body mass of the limbs and muscle strength was assessed by grip strength. Depression was determined by The 9-item Patient Health Questionnaire. We used weighted multivariate logistic regression models to explore the relationship between muscle mass and strength and depression. Generalized additive models were used to test for the presence of nonlinear associations. We then constructed a two-piece-wise linear regression model and performed a recursive algorithm to calculate inflection points. In addition, subgroup analyses and interaction tests were performed.

RESULTS

The study recruited 4871 adults from the United States. In regression models adjusted for all confounding variables, the OR (95 % CI) for the association between grip strength and appendicular lean mass (ALM) and depression were 0.943 (0.903, 0.985), 0.945 (0.908, 0.983), respectively. There was a non-linear association between grip strength and depression with a turning point of 46.3. The OR (95 % CI) before the turning point was 0.920 (0.872, 0.972). The interaction was statistically significant only in the age analysis. There was also a nonlinear association between ALM and depression, but no significant turning point was found. The interaction was statistically significant in the gender and BMI analyses.

CONCLUSION

Grip strength and ALM are negatively associated with an increased likelihood of depression in US adults. Exercises for muscle mass and strength may help prevent depression.

Association of handgrip strength asymmetry and weakness with depression among middle-aged and older population in China: A cohort study

BACKGROUND

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population.

METHODS

8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015-2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms.

RESULTS

The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19-2.02; 20 % rule: OR 1.71, 95 % CI 1.16-2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38-1.54; 20 % rule: β 0.94, 95 % CI 0.08-1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance.

LIMITATIONS

Depressive assessment was based on self-reported screening instrument.

CONCLUSIONS

The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions.

Bidirectional Association between Sarcopenia and Depressive Symptoms among Chinese Middle- and Older-Aged Adults: Longitudinal Observational Study

BACKGROUND

The study aimed to examine the bidirectional relationship between sarcopenia and depressive symptoms in a national, community-based cohort study, despite the unclear temporal sequence demonstrated previously.

METHODS

Data were derived from four waves (2011 baseline and 2013, 2015, and 2018 follow-ups) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 17,708 participants aged 45 years or older who had baseline data on both sarcopenia status and depressive symptoms in 2011 were included in the study. For the two cohort analyses, a total of 8092 adults without depressive symptoms and 11,292 participants without sarcopenia in 2011 were included. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Depressive symptoms were defined as a score of 20 or higher on the 10-item Center for Epidemiologic Studies Depressive Scale (CES-D-10). Cox proportional hazard regression models were conducted to examine the risk of depressive symptoms and sarcopenia risk, while cross-lagged panel models were used to examine the temporal sequence between depressive symptoms and sarcopenia over time.

RESULTS

During a total of 48,305.1 person-years follow-up, 1262 cases of incident depressive symptoms were identified. Sarcopenia exhibited a dose-response relationship with a higher risk of depressive symptoms (HR = 1.7, 95%CI: 1.2-2.3 for sarcopenia, and HR = 1.5, 95%CI: 1.2-1.8 for possible sarcopenia, p trend < 0.001). In the second cohort analysis, 240 incident sarcopenia cases were identified over 39,621.1 person-years. Depressive symptoms (HR = 1.5, 95%CI: 1.2-2.0) are significantly associated with a higher risk of developing sarcopenia after multivariable adjustment (p < 0.001, Cross-lagged panel analyses demonstrated that depressive symptoms were associated with subsequent sarcopenia (β = 0.003, p < 0.001). Simultaneously, baseline sarcopenia was also associated with subsequent depressive symptoms (β = 0.428, p < 0.001).

CONCLUSION

This study identified a bidirectional relationship between depressive symptoms and sarcopenia. It seems more probable that baseline sarcopenia is associated with subsequent depressive symptoms in a stronger pattern than the reverse pathway. The interlinkage indicated that maintaining normal muscle mass and strength may serve as a crucial intervention strategy for alleviating mood disorders.

Exploring the Association between Elevated Anxiety Symptoms and Low Skeletal Muscle Mass among Asymptomatic Adults: A Population-Based Study in Republic of Korea

Individuals with mental health problems are at higher risk of musculoskeletal diseases. However, the association between low muscle mass (LMM) and anxiety symptoms remains uninvestigated. This cross-sectional study enrolled 174,262 adults (73,833 women, 100,429 men), aged 18 to 89, who completed the anxiety scale and body composition analyses. Using bio-electrical impedance analysis, skeletal muscle mass index (SMI) was calculated based on appendicular skeletal muscle mass (ASM) (kg)/height (m2). LMM was defined as SMI < 7.0 kg/m2 in men and <5.4 kg/m2 in women. Anxiety symptoms were screened using the Clinical Useful Anxiety Outcome Scale (CUXOS) with cut-off scores of 20, 30, and 40. Multivariable logistic regression analyses were performed. LMM prevalence was 20.17% in women, 3.86% in men (p < 0.001). The prevalence of anxiety symptoms in LMM group decreased from mild (CUXOS > 20: women, 32.74%, men, 21.17%) to moderate (CUXOS > 30: 13.34%, 7.32%), to severe anxiety symptoms (CUXOS > 40: 4.00%, 1.73%). In multivariable-adjusted models, LMM was associated with mild (aOR (95% confidence interval)), women, 1.13 (1.08-1.17); men, 1.17 (1.08-1.27)), moderate (1.17 (1.11-1.24); 1.35 (1.19-1.53) and severe anxiety symptoms (1.18 (1.07-1.3), 1.36 (1.06-1.74)), demonstrating an increased risk of ORs with escalating anxiety severity. LMM was independently associated with a higher prevalence of anxiety symptoms.

The causal effect of sarcopenia-associated traits on brain cortical structure: A Mendelian randomization study

BACKGROUND

Previous observational studies have reported sarcopenia can affect the structure and function of brain cortical structure. However, the causality inferred from those studies was subjected to residual confounding and reverse causation. Herein, we use a two-sample Mendelian randomization (MR) analysis to illustrate the causal effect of sarcopenia-associated traits on brain cortical structure.

METHODS

We selected appendicular lean mass (ALM), hand grip strength (left and right) (HGSL and HGSR), and usual walking pace (UWP) to symbolize sarcopenia. The definition of brain cortical structure is human brain cortical surface area (SA) and cortical thickness (TH) globally and in 34 functional regions measured by magnetic resonance imaging. Instrumental variables at the genome-wide significance level were obtained from publicly available datasets, and inverse variance weighted as the primary method was used for MR analysis.

RESULT

At the global level, we found ALM (β=2604.68, 95 % confidence interval (CI): 1886.17 to 3323.19, P = 1.20 × 10-12) and HGSR (β=4733.05, 95 % CI: 2245.08 to 7221.01, P = 1.93 × 10-4) were associated with increased SA. At the region level, the SA of 25 functional gyrus without global weighted was influenced by ALM. The HGSR significantly increased SA of medial orbitofrontal and precentral gyrus without global weighted and ALM was associated with decrease of TH of lateral occipital gyrus with global weighted. No pleiotropy was detected.

CONCLUSION

This was the first MR study investigated the causal effect of sarcopenia-associated traits on brain cortical structure. In our study, we revealed genetically predicted sarcopenia-associated traits including ALM and HGSR could affect brain cortical structure.

Physical activity, physical frailty and depressive symptoms among Chinese male and female older adults: do different indicators make a difference?

Objectives

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults.

Methods

A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire.

Results

11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms.

Conclusion

There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.

Depression and sarcopenia-related traits: A Mendelian randomization study

BACKGROUND

Observational studies have suggested that depression is associated with sarcopenia. However, the causal relationship between depression and sarcopenia remains unclear.

AIM

To investigate the causal relationship between depression and sarcopenia.

METHODS

We performed a Mendelian randomization (MR) analysis to identify the bidirectional relationship between depression and sarcopenia-related traits. Summary-level data and independent variants used as instrumental variables came from large genome-wide association studies of depression (414055 cases and 892299 controls), of appendicular lean mass (ALM, 450243 participants), and of hand grip strength (exposure: 360000 participants; outcome: 334925 participants).

RESULTS

We identified a negative association of depression with lower ALM [odds ratio (OR): 0.932, 95% confidence interval (95%CI): 0.889-0.979, P = 0.005]. In the reverse MR analysis, we also observed an inverse association of hand grip strength with depression (OR: 0.200, 95%CI: 0.108-0.370, P < 0.001). Similar results were obtained in sensitivity analyses.

CONCLUSION

Depression was causally related to decreased muscle mass, and declined muscle strength might lead to a higher risk of depression.

Causality between sarcopenia-related traits and major depressive disorder: A bi-directional, two-sample Mendelian randomized study

Observational studies have demonstrated an association between sarcopenia and depression. However, these studies may be influenced by confounding factors, and the causal relationship between sarcopenia and major depressive disorder (MDD) remains unclear. This study aimed to apply the Mendelian randomization (MR) method to address confounding factors and assess the causal effect of sarcopenia on MDD. A two-way, two-sample MR method was employed in this study. Instrumental variables of genome-wide significance level were obtained from the open large-scale genome-wide association study summary data. MR analysis was conducted using inverse variance weighted, MR-Egger, and weighted median methods. The reliability of the results was verified using the heterogeneity test, pleiotropy test, and leave-one-out method for sensitivity analysis. Grip strength (right-hand grip strength: odds ratio [OR] = 0.880, 95% confidence interval [CI] 0.786-0.987, P = .027; left-hand grip strength: OR = 0.814, 95% CI 0.725-0.913, P < .001) and usual walking pace (OR = 0.673, 95% CI 0.506-0.896, P = .007) exhibited a direct causal effect on MDD. MDD had a significant causal effect on appendicular lean mass (β = -0.065, 95% CI -0.110, -0.019, P = .005). There was a causal relationship between sarcopenia-related traits and MDD. Loss of muscle strength, rather than skeletal muscle mass, is correlated with an increased risk of MDD. Furthermore, individuals with MDD are more likely to experience loss of skeletal muscle mass.

Obesity and sarcopenic obesity characterized by low-grade inflammation are associated with increased risk for major depression in women

Background

We aimed to determine women's risk of major depressive disorder (MDD) in relation to obesity phenotypes characterized by levels of circulating high-sensitivity C-reactive protein (hsCRP).

Methods

This population-based retrospective cohort study comprised 808 women (ages 20-84 y) recruited 1994-1997 and followed for a median 16.1 y (IQR 11.9-16.8). At baseline, body fat and lean tissue mass were measured by whole body dual-energy x-ray absorptiometry (DXA). Obesity was identified as high fat mass index (>12.9 kg/m2), body fat percentage (≥35%) and body mass index (≥30 kg/m2); sarcopenic obesity referred to a high ratio fat mass/fat-free mass (≥0.80). Systemic inflammation was operationalized as serum hsCRP concentration in the upper tertile (>2.99 mg/L). Obesity phenotypes were: non-obese + lowCRP, non-obese + highCRP, obese + lowCRP, and obese + highCRP. During follow-up, the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) was used to identify lifetime history of MDD and age of onset. Poisson regression models were used to estimate the MDD rate for each obesity phenotype during follow-up. Demographic, health and lifestyle factors were tested as potential confounders.

Results

During 11,869 p-y of follow-up, 161 (19.9%) women experienced an MDD episode. For obesity phenotypes based on fat mass index, models adjusted for baseline age and prior MDD, and non-obese + lowCRP as reference, RR for non-obese + highCRP was 1.21 (95% CI 0.80, 1.82), obese + lowCRP 1.46 (0.86, 2.47) and obese + highCRP 1.56 (1.03, 2.37). Patterns were similar for obesity by body fat percentage, body mass index and sarcopenic obesity.

Conclusion

Consistently across different obesity definitions, this longitudinal study reports that women with both obesity and systemic inflammation are at increased risk of subsequent MDD. Future research should examine whether tackling this metabolically unhealthy obesity type - through, for example, lifestyle or medication approaches - can reduce depression risk.

Relationships Between Body Composition and Cognitive Impairment in Hospitalised Middle-Aged Type 2 Diabetic Patients

Objective

The aim of this study was to elucidate the relationship between specific body composition and the risk of Cognitive Impairment (CI) in middle-aged Type 2 Diabetes Mellitus (T2DM) patients.

Methods

This cross-sectional study included 504 hospitalized patients with T2DM from the Department of Endocrinology and Metabolism of the Tianjin Union Medical Center. Subjects were grouped by sex, and cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The relationship between body composition and cognitive ability was investigated with the use of linear regression analysis. The association between body composition and CI risk was determined by logistic regression analysis.

Results

The prevalence of CI was 39.3% in middle-aged T2DM patients. After adjusting for age, education, marriage status, carotid atherosclerosis, cerebrovascular disease and hemoglobin, multiple linear regression analysis showed that lean mass index (LMI), body mass index (BMI) and appendicular skeletal muscle index (SMI) were significant predictors for the MoCA scores in men (p < 0.05). In addition, BMI (OR 0.913, 95% CI 0.840-0.992) and LMI (OR 0.820, 95% CI 0.682-0.916) were independent protective factors for CI in males. After adjusted for age, education, marriage status, dietary control of diabetes and cerebrovascular disease, visceral obesity (VO, OR 1.950, 95% CI 1.033-3.684) and abdominal obesity (AO, OR 2.537, 95% CI 1.191-5.403) were risk factors for CI in female patients.

Conclusion

The results suggest that there may be different mechanisms underlying the relationship of body compositions and cognitive performance between middle-aged male and female patients with T2DM. In addition, our finding of potential determinants of cognitive impairment may facilitate the development of intervention programs for middle-aged type 2 diabetic patients. Nevertheless, more large prospective studies looking at cognition and changes in body composition over time are needed in the future to further support their association.

The correlation between skeletal muscle index and anxiety in patients with lung cancer on the first day of chemotherapy

Aim: To evaluate the relationship between anxiety and skeletal muscle index (SMI) levels in lung cancer patients on the first day of chemotherapy. Materials & methods: This cross-sectional study included 108 patients. We analyzed patient characteristics, SMI levels, pain status and predicted anxiety factors. Results: Anxiety was detected in 61% of patients. SMI levels were significantly lower in the high anxiety group than the low anxiety group (p < 0.001). A significant correlation was observed between anxiety and SMI levels (r = -0.292; p = 0.002). Anxiety levels were significantly correlated with trait anxiety (r = 0.618; p < 0.001) and visual analog scale-pain (r = 0.364; p < 0.001). SMI (odds ratio: 0.94), trait anxiety (odds ratio: 1.12) and visual analog scale pain (odds ratio: 1.28) were independent risk factors for anxiety after adjusting for sex, stage and Eastern Cooperative Oncology Group performance status. Conclusion: Our study highlighted that higher anxiety scores were significantly correlated with lower SMI levels. We found that SMI, pain and trait anxiety were independent risk factors for anxiety.

Sex differences in the association between sarcopenia and mild cognitive impairment in the older Korean population

BACKGROUND

A link between sarcopenia and cognitive function has been proposed and is supported by several investigations. Nevertheless, the sex-linked relationship between these two diseases has been scarcely investigated. This cross-sectional study investigated sex differences in the association between sarcopenia and mild cognitive impairment.

METHODS

We included all 286 participants aged 60 years or older with MCI who visited the Department of Neurology at Veterans Health Service Medical Center in South Korea from January to December 2021. The diagnosis of MCI was confirmed by two neurologists based on the participants' neuropsychological test scores. Diagnosis of sarcopenia was based on the algorithm of Asian Working Group for Sarcopenia (AWGS) 2019 including bioelectrical impedance analysis and handgrip strength, and cognitive function was assessed using Seoul Neuropsychological Screening Battery Core (SNSB-C) test.

RESULTS

Among the 286 participants, 171 and 112 were men and women. After adjustment for potential covariates including APOE genotype, in women participants, there were significant associations between diagnosis of sarcopenia and MCI (OR = 4.72, 95%CI [1.39-15.97]), while there was no significant relationship in men participants. In eight subdomains of SNSB-C, we also found that women participants with sarcopenia demonstrated a significant memory decline (OR = 3.21, 95%CI [1.01-10.19]) as compared with the reference women group without sarcopenia after adjusting all covariates mentioned above. No significant association between any SNSB-C subdomain and MCI was demonstrated in men participants.

CONCLUSIONS

We demonstrated that there was a different relationship between sarcopenia and MCI by sex and that sarcopenia may affect the cognitive subdomain differently by sex. These results imply that, with regard to cognitive function, maintaining muscle function and muscle mass might be more crucial for women than for men.

Clinical-grade human umbilical cord-derived mesenchymal stem cells improved skeletal muscle dysfunction in age-associated sarcopenia mice

With the expansion of the aging population, age-associated sarcopenia (AAS) has become a severe clinical disease of the elderly and a key challenge for healthy aging. Regrettably, no approved therapies currently exist for treating AAS. In this study, clinical-grade human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) were administrated to two classic mouse models (SAMP8 mice and D-galactose-induced aging mice), and their effects on skeletal muscle mass and function were investigated by behavioral tests, immunostaining, and western blotting. Core data results showed that hUC-MSCs significantly restored skeletal muscle strength and performance in both mouse models via mechanisms including raising the expression of crucial extracellular matrix proteins, activating satellite cells, enhancing autophagy, and impeding cellular aging. For the first time, the study comprehensively evaluates and demonstrates the preclinical efficacy of clinical-grade hUC-MSCs for AAS in two mouse models, which not only provides a novel model for AAS, but also highlights a promising strategy to improve and treat AAS and other age-associated muscle diseases. This study comprehensively evaluates the preclinical efficacy of clinical-grade hUC-MSCs in treating age-associated sarcopenia (AAS), and demonstrates that hUC-MSCs restore skeletal muscle strength and performance in two AAS mouse models via raising the expression of extracellular matrix proteins, activating satellite cells, enhancing autophagy, and impeding cellular aging, which highlights a promising strategy for AAS and other age-associated muscle diseases.

Dose-response association of handgrip strength and risk of depression: a longitudinal study of 115 601 older adults from 24 countries

BACKGROUND

Prior research has solely focused on the association between handgrip strength and risk of depression in single countries or general populations, but more knowledge is required from wider-spread cohorts and target populations.

AIMS

This study aimed to investigate the association between handgrip strength and risk of depression using repeated measures in adults aged 50 years and over.

METHOD

Data on handgrip strength and risk of depression were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6 and 7, using a hand dynamometer (Smedley, S Dynamometer, TTM) and the EURO-D 12-item scale, respectively. Time-varying exposure and covariates were modelled using both Cox regression and restricted cubic splines.

RESULTS

A total of 115 601 participants (mean age 64.3 years (s.d. = 9.9), 54.3% women) were followed-up for a median of 7.3 years (interquartile range: 3.9-11.8) and 792 459 person-years. During this period, 30 208 (26.1%) participants experienced a risk of depression. When modelled as a continuous variable, we observed an inverse significant association for each kg increase of handgrip strength and depression up to 40 kg in men and up to 27 kg in women.

CONCLUSIONS

Being physically strong may serve as a preventive factor for depression in older adults, but this is limited up to a maximum specific threshold for men and women.

Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study

PURPOSE

This study aimed to identify the factors influencing quality of life (QoL) of low-income older adults (LOAs) with sarcopenia.

METHODS

A convenience sample of 125 older adults was recruited from Jeonbuk Province, South Korea. Data were collected using a self-report questionnaire that included nutritional status, the Depression Anxiety Stress Scale-21, and the World Health Organization Quality of Life Instrument-Older Adults Module. Additionally, grip strength and appendicular skeletal muscle mass, were evaluated, along with the short physical performance battery.

RESULTS

Sarcopenia and severe sarcopenia were observed in 43.2% and 56.8% of participants, respectively. Using multiple regression analysis, depression (β = -.40, p < .001), nutritional status (β = .24, p = .003), and anxiety (β = -.15, p = .042) were identified as factors affecting the QoL of the older adults in low-income groups with sarcopenia, the explanatory power of these variables was 44%.

CONCLUSION

The results of this study can be used to develop a nursing intervention program and establish policies to improve depression, anxiety, and nutritional status to enhance QoL of LOAs with sarcopenia.

Sex differences in the relationship of serum creatinine to cystatin C ratio and depressive symptoms among middle-aged and older adults in China

BACKGROUND

Sarcopenia is reported to be associated with depression. Recently, serum creatinine to cystatin C ratio (CCR) has been recommended as a promising biomarker for detecting sarcopenia. The purpose of this study was to explore the relationship between CCR and depressive symptoms among middle-aged and older adults using the baseline data of the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

This study included 7083 participants aged 45 and older. A score of 10-item Center for Epidemiological Studies Depression Scale (CESD-10) ≥ 12 was used as the cut-off of having depressive symptoms. CCR was calculated by serum creatinine (mg/dL)/cystatin C (mg/L). The t-test and Chi-squared test were applied to compare the differences between the depressive symptoms group and no depressive symptoms group in both sexes. Unadjusted and adjust logistic regression models were used to further investigate the relationship between CCR and depressive symptoms.

RESULTS

In the fully adjusted logistic regression models, higher CCR was significantly correlated with a lower incidence of depressive symptoms in males (OR = 0.486, P = 0.001, 95 % CI = 0.314-0.752), but not in females (OR = 0.775 P = 0.184, 95 % CI = 0.532-1.129).

LIMITATIONS

1. Self-reported method was used to define depressive symptoms by CESD-10; 2. History of chronic diseases were all self-reported; 3. Residual bias was still possible after controlling for many confounding factors.

CONCLUSIONS

Lower CCR was significantly correlated with increased depressive symptoms in males, but not in females. More studies are needed to further confirm this conclusion.

Musculoskeletal Deficits and Cognitive Impairment: Epidemiological Evidence and Biological Mechanisms

PURPOSE OF REVIEW

Cognitive impairment is associated with obesity, sarcopenia, and osteoporosis. However, no critical appraisal of the literature on the relationship between musculoskeletal deficits and cognitive impairment, focusing on the epidemiological evidence and biological mechanisms, has been published to date. Herein, we critically evaluate the literature published over the past 3 years, emphasizing interesting and important new findings, and provide an outline of future directions that will improve our understanding of the connections between the brain and the musculoskeletal system.

RECENT FINDINGS

Recent literature suggests that musculoskeletal deficits and cognitive impairment share pathophysiological pathways and risk factors. Cytokines and hormones affect both the brain and the musculoskeletal system; yet, lack of unified definitions and standards makes it difficult to compare studies. Interventions designed to improve musculoskeletal health are plausible means of preventing or slowing cognitive impairment. We highlight several musculoskeletal health interventions that show potential in this regard.

Diagnostic Values of Advanced Glycation End Products and Homocysteine in Patients with Alzheimer's Disease and Sarcopenia

This study is aimed at exploring the diagnostic value of advanced glycation end products (AGEs) and homocysteine (Hcy) in Alzheimer's disease (AD) complicated with sarcopenia (SP) and to analyze the risk factors related to AD complicated with SP. A total of 168 patients admitted to our hospital from November 2019 to December 2021 were enrolled. Patients were divided into the NC (no SP and AD) group with 29 cases, the AD group with 39 cases, the AD+SP group with 35 cases, and the SP group with 65 cases. The general information, Mini-Mental State Examination (MMSE) scores, and serum levels of AGEs and Hcy among the four groups were compared. Unordered logistic regression was used to analyze the influencing factors of SP patients complicated with dementia. The AGE level was higher in the AD or AD+SP group than the NC or SP group (P < 0.05). There was no significant difference between the SP group and the NC group or between the AD group and the AD+SP group (P > 0.05). The Hcy level was higher in the SP or AD group than the NC group (P < 0.05). There were no significant differences between the AD group and NC group or between the SP group and AD+SP group (P > 0.05). The ROC curve of serum AGEs and Hcy for the diagnosis of AD showed that the area under curve (AUC) was 0.887, P < 0.05 (95% CI: 0.821-0.954, sensitivity: 80.95%, specificity: 73.81%) and 0.7423, P < 0.05 (95% CI: 0.6382-0.8465, sensitivity: 60.42%, specificity: 57.59%), respectively. The ROC curve of serum AGEs and Hcy for the diagnosis of SP showed that the AUC was 0.5533, P > 0.05 (95% CI: 0.4294-0.6771) and 0.8744, P < 0.05 (95% CI: 0.8006-0.9483). Age (P < 0.001), depression (P = 0.001), malnutrition (P = 0.002), and BMI (P < 0.001) were independent influencing factors of SP complicated with AD in elderly inpatients. In conclusion, combined serum AGEs and Hcy had a good diagnostic value for AD combined with SP, which may be helpful for early detection of patient condition.

Chair stand test as a proxy for physical performance and muscle strength in sarcopenia diagnosis: the Korean frailty and aging cohort study

BACKGROUND

The 5-times chair stand test (5CST) is a proxy tool for measuring physical performance and muscle strength in diagnosing sarcopenia. The Asian Working Group for Sarcopenia 2019 guidelines recommends the 5CST for evaluating gait speed, whereas the European Working Group on Sarcopenia in Older People guidelines recommend the chair stand test as a proxy for muscle strength.

AIMS

This study sought to determine whether the chair stand test correlates with handgrip strength and gait speed, and investigate sex differences in these relationships.

METHODS

We used data collected from 1416 participants (678 men and 738 women) in the 2017 Korean Frailty and Aging Cohort Study (KFACS).

RESULTS

The 5CST time had a higher correlation with gait speed (r =  - 0.470) than handgrip strength (r =  - 0.309). In addition, 5CST time predicted low gait speed (area under the curve [AUC] 0.727) better than low handgrip strength (AUC 0.641). The optimal cutoff values of the 5CST to estimate low gait speed were 10 s for men (sensitivity 62%, specificity 64%) and 11 s for women (sensitivity 68%, specificity 67%). The optimal cutoff values of the 5CST for low handgrip strength were the same as those for low gait speed (10 s for men and 11 s for women).

CONCLUSIONS

The 5-times chair stand test fits with gait speed and handgrip strength but seems to be a better proxy of gait speed than handgrip strength. The optimal cutoff values of the 5CST to estimate low gait speed and low handgrip strength were lower in men than women. Although none of the AWGS 2019 or EWGSOP guidelines present sex-specific cutoffs for the 5CST, it needs to be considered in the next guidelines.

Risk factors related to psychological distress among elderly patients with cardiovascular disease

AIM

Psychological distress is associated with poor prognosis in patients with cardiovascular disease (CVD). However, factors related to psychological distress in elderly patients with CVD is less understood. We aimed to investigate the rate of psychological distress in elderly patients with CVD in comparison with that of patients without CVD and to examine the clinical, socioeconomic, and lifestyle factors associated with this condition.

METHODS AND RESULTS

Data from a nationwide population-based study in Japan of patients aged ≥ 60 years were extracted, and 1:1 propensity score matching was conducted of patients with and without CVD. Psychological distress was assessed using the K6 scale, on which a score ≥ 6 was defined as psychological distress. Of the 24,388 matched patients, the rate of psychological distress was significantly higher among patients with CVD compared to those without CVD (29.8% vs. 20.5%, p < 0.0001). The multivariate analysis revealed that female sex, comorbidities except hypertension, current smoking, daily sleep duration of < 6  h versus ≥ 8  h, home renter versus owner, retired status, having a walking disability, and lower monthly household expenditure were independently associated with psychological distress. Walking disability was observed in greatest association with psychological distress (odds ratio 2.69, 95% confidence interval 2.46-2.93).

CONCLUSION

Elderly patients with CVD were more likely to have psychological distress compared to those without CVD. Multiple factors, including clinical, socioeconomic, and lifestyle variables, were associated with psychological distress. These analyses may help health care providers to identify high risk patients with psychological distress in a population of older adults with CVD.

Human umbilical cord-derived mesenchymal stromal cells ameliorate aging-associated skeletal muscle atrophy and dysfunction by modulating apoptosis and mitochondrial damage in SAMP10 mice

Background

Skeletal muscle mass and function losses in aging individuals are associated with quality of life deterioration and disability. Mesenchymal stromal cells exert immunomodulatory and anti-inflammatory effects and could yield beneficial effects in aging-related degenerative disease.

Methods and results

We investigated the efficacy of umbilical cord-derived mesenchymal stromal cells (UC-MSCs) on sarcopenia-related skeletal muscle atrophy and dysfunction in senescence-accelerated mouse prone 10 (SAMP10) mice. We randomly assigned 24-week-old male SAMP10 mice to a UC-MSC treatment group and control group. At 12 weeks post-injection, the UC-MSC treatment had ameliorated sarcopenia-related muscle changes in performance, morphological structures, and mitochondria biogenesis, and it enhanced the amounts of proteins or mRNAs for myosin heavy chain, phospho-AMP-activated protein kinase, phospho-mammalian target of rapamycin, phospho-extracellular signal-regulated kinase1/2, peroxisome proliferator-activated receptor-γ coactivator, GLUT-4, COX-IV, and hepatocyte growth factor in both gastrocnemius and soleus muscles, and it reduced the levels of proteins or mRNAs for cathepsin K, cleaved caspase-3/-8, tumor necrosis factor-α, monocyte chemoattractant protein-1, and gp91^phox mRNAs. The UC-MSC treatment retarded mitochondria damage, cell apoptosis, and macrophage infiltrations, and it enhanced desmin/laminin expression and proliferating and CD34⁺/Integrin α₇⁺ cells in both types of skeletal muscle of the SAMP10 mice. In vitro, we observed increased levels of HGF, PAX-7, and MoyD mRNAs at the 4th passage of UC-MSCs.

Conclusions

Our results suggest that UC-MSCs can improve sarcopenia-related skeletal muscle atrophy and dysfunction via anti-apoptosis, anti-inflammatory, and mitochondrial biogenesis mechanisms that might be mediated by an AMPK-PGC1-α axis, indicating that UC-MSCs may provide a promising treatment for sarcopenia/muscle diseases.

The acute effects of action observation on muscle strength/weakness and corticospinal excitability in older adults

Muscle weakness is a critical problem facing many older adults. Interventions targeting nervous system plasticity may show promise in enhancing strength. The purpose of this study was to examine the acute effects of action observation on muscular strength characteristics and corticospinal excitability in older adults. Isometric wrist flexion strength characteristics and corticospinal excitability of the first dorsal interosseous (FDI) were measured in 14 older adults (mean age = 73 years) in response to observation of (1) STRONG contractions of the hand/wrist, (2) WEAK contractions of the hand/wrist, and (3) a CONTROL condition. Results from repeated measures analyses of variance (ANOVAs) indicated that rate of torque development at 200 ms (RTD200) significantly decreased from PRE to POST observation for CONTROL and WEAK, but not STRONG. No other ANOVAs were significant. However, effect sizes indicated that maximal voluntary contraction (MVC) peak torque showed moderate declines following WEAK (d = − 0.571) and CONTROL (d = − 0.636), but not STRONG (d = 0.024). Similarly, rate of torque development at 30 (RTD30), 50 (RTD50), and 200 (RTD200) ms showed large declines from PRE to POST after WEAK and CONTROL, but small changes following STRONG. FDI motor-evoked potential (MEP) amplitude tended to increase over time, but these results were variable. There was a pronounced effect from PRE to 8MIN (d = 0.954) during all conditions. Action observation of strong contractions may exert a preservatory effect on muscular strength. More work is needed to determine whether this is modulated by increased corticospinal excitability. The study was prospectively registered (ClinicalTrials.gov Identifier: NCT03946709).

Association among calf circumference, physical performance, and depression in the elderly Chinese population: a cross-sectional study

BACKGROUND

Depression and sarcopenia are common diseases in the elderly population. However, the association between them is controversial. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database, a cross-sectional study was conducted to explore the relationship of calf circumference and physical performance with depression.

METHODS

From the 8th wave of CLHLS conducted in 2018, data on calf circumference, physical performance, depressive symptoms, and demographic, socioeconomic, and health-related characteristics were collected. Multiple logistic regression was conducted to explore the impact of calf circumference, physical performance and their combination on depressive symptoms.

RESULTS

We enrolled a total of 12,227 participants aged 83.4 ± 11.0 years, including 5689 (46.5%) men and 6538 (53.5%) women. Patients with depression were more likely to have low calf circumference (2274 [68.2%] vs. 5406 [60.8%], p<0.001) and poor physical performance (3[0, 6] vs. 1[0, 4], p<0.001). A significant multiplicative interaction was found between calf circumference and physical performance in their effect on depression. After adjusting for confounding factors, multiple logistic regression showed that a significant inverse correlation persisted between physical performance and depressive symptoms in normal (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.15-1.26, p<0.001) and low (OR = 1.14, 95% CI: 1.11-1.18, p<0.001) calf circumference group, while the association between calf circumference and depression disappeared. Participants with low calf circumference and poor physical performance were 2.21 times more likely to have depression than those with normal calf circumference and physical performance. All results were found to be robust in sensitivity analyses.

CONCLUSIONS

Physical performance was significantly associated with depression in the elderly Chinese population. Attention should be paid to assess depressive symptoms in patients with poor physical performance.

Relationships Between Depressive Symptoms, Dietary Inflammatory Potential, and Sarcopenia: Mediation Analyses

Background

Sarcopenia is a major public health problem. Depressive symptoms and dietary inflammatory potential play important roles in the development of sarcopenia. We aimed to disentangle the relationships between depressive symptoms, dietary inflammatory potential, and sarcopenia.

Methods

A total of 6,082 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Sarcopenia was defined according to the Foundation for the National Institutes for Health (FNIH) criteria. The Depressive symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Dietary Inflammatory Index (DII) was calculated based on 24-h dietary recall interview. Two sets of mediation models were constructed separately.

Results

Depressive symptoms and DII were associated with sarcopenia, with odds ratios [ORs] (95% CIs) 2.54 (1.27, 5.13) and 1.17 (1.00, 1.37), respectively. DII score mediated the association of depressive symptoms with low muscle mass, explaining a total of 10.53% of the association (indirect effect = 0.004). Depressive symptoms had a significant mediating effects on the association between DII with low muscle mass, explaining a total of 12.50% of the association (indirect effect = 0.001).

Conclusions

Our findings suggested that both depressive symptoms and dietary inflammatory potential had direct effects, and indirect effects on low muscle mass, handgrip strength, muscle mass, through each other. It provides important insights into integrated nutritional and psychological intervention strategies in preventing sarcopenia.

Brain CT can predict low lean mass in the elderly with cognitive impairment: a community-dwelling study

Background

The coexistence of sarcopenia and dementia in aging populations is not uncommon, and they may share common risk factors and pathophysiological pathways. This study aimed to evaluate the relationship between brain atrophy and low lean mass in the elderly with impaired cognitive function.

Methods

This cross-sectional study included 168 elderly patients who visited the multi-disciplinary dementia outpatient clinic at Kaohsiung Chang Gung Memorial Hospital for memory issues, between 2017 and 2019. The body composition was assessed by dual energy X-ray absorptiometry (DEXA) and CT based skeletal muscle index including L3 skeletal muscle index (L3SMI) and masseter muscle mass index (MSMI). The brain atrophy assessment was measured by CT based visual rating scale. Possible predictors of low lean mass in the elderly with cognitive impairement were identified by binary logistic regression. ROC curves were generated from binary logistic regression.

Results

Among the 81 participants, 43 (53%) remained at a normal appendicular skeletal muscle index (ASMI), whereas 38 (47%) showed low ASMI. Compared with the normal ASMI group, subjects with low ASMI exhibited significantly lower BMI, L3SMI, and MSMI (all p < 0.05), and showed significant brain atrophy as assessed by visual rating scale (p < 0.001). The accuracy of predictive models for low ASMI in the elderly with cognitive impairment were 0.875, (Area under curve (AUC) = 0.926, 95% confidence interval [CI] 0.844–0.972) in model 1 (combination of BMI, GCA and L3SMI) and 0.885, (Area under curve (AUC) = 0.931, [CI] 0.857–0.979) in model 2 (combination of BMI, GCA and MSMI).

Conclusions

Global cortical atrophy and body mass index combined with either L3 skeletal muscle index or masseter skeletal muscle index can predict low lean mass in the elderly with cognitive impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02626-8.

Mediating Effects of Malnutrition on the Relationship between Depressive Symptoms Clusters and Muscle Function Rather than Muscle Mass in Older Hemodialysis Patients

OBJECTIVES

The purpose of this study was to investigate the association and mediation pathways among muscle mass, muscle function (muscle strength and physical performance), and malnutrition with depressive symptoms clusters in the older hemodialysis patients.

DESIGN

A multi-center cross-sectional study.

SETTING AND PARTICIPANTS

A total of 499 patients aged ≥ 60 on hemodialysis from seven facilities in Shanghai of China from 2020 to 2021.

MEASUREMENTS

Muscle mass was assessed by skeletal muscle index(SMI). Muscle strength was measured by handgrip strength, and physical performance was measured via gait speed and Timed Up and Go Test (TUGT). Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Logistic regression and mediation analyses fully adjusted for all potential confounding factors.

RESULTS

Among 499 participants (312 men, mean age 69.2±6.6 years), 108 (21.6%) had depressive symptoms. The muscle strength, physical performance and malnutrition were associated with depressive symptoms. Furthermore, malnutrition significantly mediated the association of muscle function with total, cognitive-affective symptoms. The association of the muscle function with somatic symptoms were mediated by the nutritional status. The mediated proportions of malnutrition in the relationship between physical performance and depressive symptoms clusters were stronger in somatic symptoms than in cognitive-affective symptoms.

CONCLUSIONS

Our findings suggest that muscle function rather than muscle mass may contribute substantially to the development of depressive symptoms clusters in the hemodialysis via malnutrition. The malnutrition mediated stronger in the association of muscle function with somatic symptoms. These findings may help guide clinicians to better diagnose and manage depression in the context of concomitant muscle function and malnutrition.

Estimating Health-Related Quality of Life Based on Demographic Characteristics, Questionnaires, Gait Ability, and Physical Fitness in Korean Elderly Adults

The elderly population in South Korea accounted for 15.5% of the total population in 2019. Thus, it is important to study the various elements governing the process of healthy aging. Therefore, this study investigated multiple prediction models to determine the health-related quality of life (HRQoL) in elderly adults based on the demographics, questionnaires, gait ability, and physical fitness. We performed eight physical fitness tests on 775 participants wearing shoe-type inertial measurement units and completing walking tasks at slower, preferred, and faster speeds. The HRQoL for physical and mental components was evaluated using a 36-item, short-form health survey. The prediction models based on multiple linear regression with feature importance were analyzed considering the best physical and mental components. We used 11 variables and 5 variables to form the best subset of features underlying the physical and mental components, respectively. We laid particular emphasis on evaluating the functional endurance, muscle strength, stress level, and falling risk. Furthermore, stress, insomnia severity, number of diseases, lower body strength, and fear of falling were taken into consideration in addition to mental-health-related variables. Thus, the study findings provide reliable and objective results to improve the understanding of HRQoL in elderly adults.

Is sarcopenia associated with anxiety symptoms and disorders? A systematic review and meta-analysis protocol

INTRODUCTION

Sarcopenia is a skeletal muscle disorder characterised by a progressive decline in muscle mass and function (strength and performance). Sarcopenia is associated with numerous adverse health outcomes and has recently been linked to neurological and psychiatric disorders, including dementia and depression. Whether sarcopenia is related to other common psychiatric illnesses, such as anxiety, is unclear. We aim to systematically identify and review the extant literature regarding the association between sarcopenia and anxiety symptomatology and/or disorders (anxiety) in adults.

METHODS AND ANALYSIS

We will conduct a systematic search across four online databases (CINAHL, Embase, MEDLINE Complete and PsycINFO) from inception to September 2021. Two reviewers will independently confirm study selection and assess methodological quality of included studies. If possible, a meta-analysis will be performed to determine pooled OR for the relationship between sarcopenia and anxiety. If meta-analysis is not possible due to methodological heterogeneity a 'best evidence synthesis' will be performed.

ETHICS AND DISSEMINATION

This review will use published data only, thus, ethical approval will not be required. Findings will be published in a peer-reviewed journal and presented at conferences.

PROSPERO REGISTRATION NUMBER

CRD42020209420.

Effect of a 40-weeks multicomponent exercise program and branched chain amino acids supplementation on functional fitness and mental health in frail older persons

BACKGROUND

The ageing process implies several physiological and psychological changes that hence affect the general health, mood states, and quality of life of older persons. Exercise and adequate nutrition are renowned non-pharmacological strategies that significantly delay and alleviate the adverse consequences of the ageing process. This study aimed to evaluate the effects of branched-chain amino acid (BCAA) supplementation and a multicomponent exercise program (ME) on the physical frailty and mood states of older persons.

METHODS

35 participants (women and men; 83 ± 3 years old) from residential care homes were submitted to a 40-week exercise-washout-retraining intervention (16 weeks of the elastic band based exercise and/or supplementation, 8 weeks of washout, and 16 weeks of multicomponent exercise and/or resupplementing), with or without BCAA supplementation. The experimental groups were: (i) ME plus BCAA supplementation (ME+BCAA); (ii) ME; (iii) BCAA supplementation (BCAA), and (iv) control group (CG). Fried's phenotype was used to assess frailty prevalence. Geriatric Depression Scale (GDS), Profile of Mood State (POMS), Mini-Mental State Examination (MMSE), were used to access mental health and cognition. The Short Physical Performance Battery (SPPB) was used to access functional capacity. Salivary testosterone levels (ST) were also determined to access the anabolic effects of the intervention.

RESULTS

Exercise was effective in improving functional capacity and prevented the increase in frailty that occurred in the non-exercising CG, where the frailty scores increased over time (p < 0.01). BCAAs supplement alone had no impact on functional fitness, but in a short time (16 weeks) contributed to diminishing frailty and combined with exercise may have the potential to reduce the effect of a detraining period on functional capacity. Salivary testosterone levels correlated with handgrip strength and could be a useful indicator of susceptibility to frailty. No effects were found for mood states, cognition, and depression.

CONCLUSION

This study showed that a long-term exercise program, independent of being multicomponent or strength elastic band-based, was effective in improving functional capacity and prevented an increase in frailty in frail and pre-frail older persons living in residential care homes.

Cognitive and behavioral factors associated to probable sarcopenia in community-dwelling older adults

Background: Sarcopenia has a high prevalence in older adults and is associated with chronic aggravations to health, so therefore it is important to identify older adults who are affected by sarcopenia in order to establish preventative strategies or early interventions.Objective: To estimate the prevalence of probable sarcopenia and verify its association with cognitive impairment, fear of falling, depressive symptoms and health self-perception in community-dwelling older adults.Methods: A cross-sectional study with simple random sampling including 306 older adults of both genders. The outcome variable was probable sarcopenia evaluated by the Five times sit-to-stand test (5XSST) considering probable sarcopenia when the measured time was > 15 seconds, following the recommendation of the European Working Group on Sarcopenia in Older People. The predictor variables were cognitive impairment, fear of falling, depressive symptoms and self-perception of health. Multivariate Logistic Regression was performed to verify associations between the variables.Results: The prevalence of probable sarcopenia was 50.00%. The older adults had significantly higher chances of presenting probable sarcopenia when displaying cognitive impairment (OR 2.49; 95%CI 1.46-4.24), fear of falls (OR 4.23; 95%CI 2.51-7.12), depressive symptoms (OR 2.20; 95%CI 1.32-3.67), poor (OR 2.48; 95%CI 1.19-5.16) and fair self-perception of health (OR 2.11; 95%CI 1.22-3.63) when compared to those who did not have the same conditions.Conclusion: The prevalence of probable sarcopenia in this study was 50.00%, and was associated with the presence of depressive symptoms, cognitive impairment, fear of falls and negative self-perception of health.

Apelin/APJ system: A novel therapeutic target for locomotor system diseases

Apelin is an endogenous ligand of G protein-coupled receptor APJ. Apelin/APJ system is widely expressed in abundant tissues, especially bone, joint and muscle tissue. This review focus on the effects of apelin/APJ system on locomotor system. An increasing number of evidence suggests that apelin/APJ system plays a crucial role in many physiological and pathological processes of locomotor system. Physiologically, apelin/APJ system promotes bone formation, muscle metabolism and skeletal muscle production. Pathologically, apelin/APJ system exacerbates osteoarthritis pathogenesis, whereas it alleviates osteoporosis. Besides, the level of apelin expression is regulated by different training modes, including continuous aerobic exercise, high-intensity interval training and resistance exercises. More importantly, exercise-induced apelin may be a potent pharmacological agent for the treatment of diseases and the regulation of physiological processes. Considering the pleiotropic effects of apelin on locomotor system, apelin/APJ system may be an important therapeutic target for locomotor system diseases.

Bidirectional Associations between Handgrip Strength and Depressive Symptoms: A Longitudinal Cohort Study

OBJECTIVES

This study aimed to examine the bidirectional associations between handgrip strength and depressive symptoms in a nationally representative sample.

DESIGN

Cohort study with a 4-year follow-up.

SETTING AND PARTICIPANTS

A total of 13,208 participants from the China Health and Retirement Longitudinal Study were included in the analyses.

METHODS

Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies-Depression Scale. Separate generalized estimating equations were used to analyze the cross-sectional and longitudinal associations between handgrip strength and depressive symptoms. Restricted cubic spline models were performed to explore the shape of the dose-response relationship.

RESULTS

Decreased handgrip strength was related to subsequent increased risk of depressive symptoms, such that participants in the lowest quartile of handgrip strength were found to have an approximately 36% increased in their risk of depressive symptoms compared with those in the highest quartile [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.17, 1.58]. There was a linear dose-response relationship between handgrip strength and risk of depressive symptoms (P_nonlinearity = .25), in that a 5-unit increment in handgrip strength may lead to an 11% decrease in the risk of depressive symptoms (OR 0.89, 95% CI 0.85, 0.92). Conversely, depressive symptoms were prospectively associated with subsequent decreased handgrip strength (β = -0.84, 95% CI -1.13, -0.55). An approximatively L-shaped dose-response pattern was found for the association between depressive symptoms level and handgrip strength (P_nonlinearity = .02).

CONCLUSIONS AND IMPLICATIONS

The present study identified bidirectional associations between handgrip strength and depressive symptoms, and the associations were found to have a dose-response pattern. It provides important insights into integrated mental and physical health intervention strategies that simultaneously promote handgrip strength and depressive symptoms.

Does skeletal muscle morphology or functional performance better explain variance in fast gait speed in older adults?

BACKGROUND

Fast gait speed is being increasingly recognized as an important clinical tool in older adults. However, the underlying muscular and functional contributors to fast gait speed performance remain poorly understood.

AIM

We sought to determine predictors of fast gait speed in older adults. We hypothesized that lower-extremity skeletal muscle size and quality would be strong predictors.

METHODS

Ninety community-dwelling older adults (33 men, 57 women; mean ± SD age = 74 ± 6 years) participated. B-mode ultrasonography was used to capture images of the vastus lateralis, rectus femoris, and gastrocnemius in the transverse plane. Each participant performed 30-second chair stand, heel-rise, functional reach, and grip strength tests. Fast gait speed was measured using the NIH Toolbox 4-Meter Walk Test. ImageJ software was used to quantify cross-sectional area (CSA), subcutaneous tissue thickness, and echo intensity. Two separate stepwise regression analyses were performed, one using muscle morphology variables as independent variables, and another including the functional outcomes.

RESULTS

The ultrasound variables exhibited weak-to-moderate correlations with fast gait speed (|r| range = 0.168-0.416). The initial regression analysis indicated that the combination of medial gastrocnemius CSA and subcutaneous tissue thickness explained 22.8% of the variance in fast gait speed. The secondary analysis indicated that 30-second chair stand, heel-rise, and grip strength performance explained 45.5% of the variance.

CONCLUSION

While medial gastrocnemius morphology is important, measures of upper and lower-extremity muscle function are better predictors of fast gait speed. These results highlight a dissociation between skeletal muscle morphology and fast gait speed.

Are Sarcopenia and Cognitive Dysfunction Comorbid after Stroke in the Context of Brain-Muscle Crosstalk?

Stroke is a leading cause of death and disability and is responsible for a significant economic burden. Sarcopenia and cognitive dysfunction are common consequences of stroke, but there is less awareness of the concurrency of these conditions. In addition, few reviews are available to guide clinicians and researchers on how to approach sarcopenia and cognitive dysfunction as comorbidities after stroke, including how to assess and manage them and implement interventions to improve health outcomes. This review synthesises current knowledge about the relationship between post-stroke sarcopenia and cognitive dysfunction, including the physiological pathways, assessment tools, and interventions involved.

Dynapenia and Low Cognition: A Cross-Sectional Association in Postmenopausal Women

Dynapenia is a key contributor to physical frailty. Cognitive impairment and dementia accompany frailty, yet links between skeletal muscle and neurocognition are poorly understood. We examined the cross-sectional relationship between lower limb muscle strength and global cognitive function. Participants were 127 women aged 51–87 years, from the Geelong Osteoporosis Study. Peak eccentric strength of the hip-flexors and hip abductors was determined using a hand-held dynamometer, and dynapenia identified as muscle strength t-scores < −1. Cognition was assessed using the Mini-Mental State Examination (MMSE), and MMSE scores below the median were rated as low. Associations between dynapenia and low cognition were examined using logistic regression models. Hip-flexor dynapenia was detected in 38 (71.7%) women with low cognition and 36 (48.7%) with good cognition (p = 0.009); for hip abductor dynapenia, the pattern was similar (21 (39.6%) vs. 9 (12.2%); p < 0.001). While the observed difference for hip-flexor strength was attenuated after adjusting for age and height (adjusted Odds Ratio (OR) 1.95, 95%CI 0.86–4.41), low cognition was nearly 4-fold more likely in association with hip abductor dynapenia (adjusted OR 3.76, 95%CI 1.44–9.83). No other confounders were identified. Our data suggest that low strength of the hip abductors and low cognition are associated and this could be a consequence of poor muscle function contributing to cognitive decline or vice versa. As muscle weakness is responsive to physical interventions, this warrants further investigation.

Comorbid Depressive Symptoms, Visual Impairment, and Sarcopenia among Middle-Aged and Older Women: Findings from the West China Health and Aging Trend study

Previous reports have described close relationships between sarcopenia and either visual impairment or depression, but there have been few analyses investigating the association between sarcopenia and the coexistence of both visual impairment and depression. Herein, we sought to explore the associations between sarcopenia and comorbid depressive symptoms and visual impairment among older females. A cross-sectional analysis of females between the ages of 50 and 95 (n = 2454) from the West China Health and Aging Trend (WCHAT) study was conducted. Patient muscle mass was assessed via a bioimpedance-based approach using an InBody 770 device, while muscle strength was estimated based on handgrip strength as quantified with a digital grip strength dynamometer. Depressive systems were evaluated with the 15-item Geriatric Depression Scale (GDS-15), and a questionnaire was employed to evaluate patient visual functionality. Associations between sarcopenia and comorbid depressive status and visual impairment were explored through logistic regression analyses. Comorbid depressive symptoms and visual impairment were observed in 6.2% of the women included in this study, while 18.9% suffered from sarcopenia. Following adjustment for covariates, relative to normal controls, study subjects with only depression (OR=1.45, 95%CI=1.04-2.02), only visual impairment (OR=1.69, 95%CI=1.27-2.26), or comorbid depression and visual impairment (OR=1.76, 95% CI=1.16-2.67) exhibited a higher risk of sarcopenia. These results suggest that comorbid depression and visual impairment are linked to the prevalence of sarcopenia in older Chinese women. As such, further efforts to screen older women for these two comorbid conditions may thus be necessary.

Association Between Upper-Extremity Health Condition and Depressive Status in an Elderly General Population

Background: This study was designed to investigate whether psychological status is associated with upper-extremity health status in an elderly general population. Methods: Using Quick Disabilities of the Arm, Shoulder, and Hand of the Japanese Society for Surgery of the Hand (QuickDASH-JSSH), we evaluated 200 Japanese elderly people (76 men, 124 women; mean age, 71.6 years, 60-98 years) to assess their upper-extremity-specific health status. Each had completed a self-administered questionnaire including gender and dominant hand items. As an indicator of hand muscle function, we measured their bilateral hand grip. Study participants were assessed for depressive symptoms using the Geriatric Depression Scale Short-Japanese Version (GDS-S-J). Statistical analyses were applied to clarify associations between self-assessed upper-extremity dysfunction and screening results for depressive symptoms in an elderly general population. Results: Those reporting no complaint of an upper extremity were 72 (36 men and 36 women) (36.0%). The GDS-J score was found to have significant positive correlation with age (r = 0.20, P= 0.0045) and the QuickDASH score (r = 0.25, P = 0.0004). The GDS-J score was found to have significant negative correlation with dominant grip (r = −0.15, P = 0.04) and non-dominant grip strength (r = −0.21, P = 0.004). For all participants, multiple regression analysis revealed the QuickDASH score as associated with the GDS-J score. Conclusion: Self-administered upper-extremity health condition as assessed using QuickDASH is correlated with depressive symptoms in elderly people. Objective pathophysiology and subjective illness behavior must be identified in daily clinical practice. A biopsychosocial approach must be used when advising and treating patients.

Skeletal Muscle Health and Cognitive Function: A Narrative Review

Sarcopenia is the loss of skeletal muscle mass and function with advancing age. It involves both complex genetic and modifiable risk factors, such as lack of exercise, malnutrition and reduced neurological drive. Cognitive decline refers to diminished or impaired mental and/or intellectual functioning. Contracting skeletal muscle is a major source of neurotrophic factors, including brain-derived neurotrophic factor, which regulate synapses in the brain. Furthermore, skeletal muscle activity has important immune and redox effects that modify brain function and reduce muscle catabolism. The identification of common risk factors and underlying mechanisms for sarcopenia and cognition may allow the development of targeted interventions that slow or reverse sarcopenia and also certain forms of cognitive decline. However, the links between cognition and skeletal muscle have not been elucidated fully. This review provides a critical appraisal of the literature on the relationship between skeletal muscle health and cognition. The literature suggests that sarcopenia and cognitive decline share pathophysiological pathways. Ageing plays a role in both skeletal muscle deterioration and cognitive decline. Furthermore, lifestyle risk factors, such as physical inactivity, poor diet and smoking, are common to both disorders, so their potential role in the muscle-brain relationship warrants investigation.

Obesity and muscle may have synergic effect more than independent effects on brain volume in community-based elderly

OBJECTIVE

To evaluate the individual and combined effects of obesity and muscle mass on brain volume in a community-dwelling healthy older population.

METHODS

One thousand two hundred nine participants (M:F = 574:635, mean age 63.6 ± 6.9 years) were included. The cross-sectional area of visceral fat (VF), the height-adjusted appendicular skeletal muscle mass (ASM/height²), and the ratio of thigh muscle to visceral fat (TM/VF) represented obesity, muscle mass, and their integrated value, respectively. Linear regression analysis was performed to establish associations between 215 brain compartment volumes and VF, ASM/height², and TM/VF after adjusting for covariates.

RESULTS

On regression analysis, TM/VF had a positive correlation to the volumes of temporal lobe and cerebellum. TM/VF was associated with volumes of 10 subcompartments. TM/VF was positively correlated with the volumes of left entorhinal cortex, right temporal pole and inferior temporal gyrus related to cognition (p < 0.05, respectively), and the volumes of cerebellum and right pallidum related to movement (p < 0.05, respectively). However, VF had a negative correlation to temporal lobe volume and ASM/height² had no significant correlation to any of the brain lobes. VF and ASM/height² were correlated with volumes of 5 subcompartments and one subcompartment, respectively, CONCLUSIONS: TM/VF reflects the integrated effect of obesity and muscle mass and is associated with the volume of more brain regions compared to indices of obesity or muscle mass alone. The positive effect of muscle mass and the negative effect of obesity change the volumes of brain regions related to cognition and movement which were not significantly affected by obesity or muscle mass alone.

KEY POINTS

• If obesity and muscle mass were considered together, we could find more significant brain volume changes which were not found in obesity or muscle alone. • The ratio of thigh muscle to visceral fat was positively correlated with the volumes of entorhinal cortex, temporal pole, and inferior temporal gyrus related to cognition. • The ratio of thigh muscle to visceral fat was positively correlated with the volumes of cerebellum and pallidum related to movement.

Muscle strength and gait speed rather than lean mass are better indicators for poor cognitive function in older men

We aimed to examine muscle strength, function and mass in relation to cognition in older men. This cross-sectional data-set included 292 men aged ≥60 yr. Handgrip strength (kg) was measured by dynamometry, gait speed by 4-metre walk (m/s) and appendicular lean mass (kg) by dual-energy x-ray absorptiometry. Cognition was assessed across four domains: psychomotor function, attention, visual learning and working memory. Composite scores for overall cognition were calculated. Bivariate analyses indicated that handgrip strength and gait speed were positively associated with cognitive function. After accounting for confounders, positive associations between individual muscle (or physical) measures and cognitive performance were sustained for handgrip strength and psychomotor function, gait speed and psychomotor function, gait speed and attention, handgrip strength and overall cognition, and gait speed and overall cognition. In multivariable models, handgrip strength and gait speed independently predicted psychomotor function and overall cognition. No associations were detected between lean mass and cognition after adjusting for confounders. Thus, low muscle strength and slower gait speed, rather than low lean mass, were associated with poor cognition in older men.

Normative data and associated factors of hand grip strength among elderly individuals: The Yilan Study, Taiwan

Weak grip strength is associated with subsequent mortality in elderly populations. The normative data and associated factors of HGS in community-dwelling elderly Taiwanese populations require further evaluation. From February 2012 until the end of 2016, all residents of Yilan City, Taiwan aged 65 years or older were randomly selected for a population-based community health survey. A total of 2,470 older adults were enrolled in this study. The relationships between HGS and various anthropometric and sociodemographic correlates were examined. The results showed that HGS was higher in men than in women. The mean HGS exhibited a decreasing trend with advanced age in both men and women. HGS was significantly associated with height, weight, and exercise habits. The physical as well as the mental component summary measures of health-related quality of life (HRQoL) were positively associated with HGS. After HRQoL was integrated into the regression model, female sex, age, waist circumference, and diabetes mellitus were significantly negatively associated with HGS. In conclusion, HGS significantly decreased with advanced age. among community-dwelling Taiwanese elderly people, Various factors had different effects on HGS.

The Prevalence of Sarcopenia in Bipolar Disorder

BACKGROUND

Sarcopenia (SP) is a syndrome described as generalized and progressive loss of muscle mass and strength that may cause fall, fractures, disability and death. Oxidative stress might be a probable etiologic factor in SP as well. SP is a comorbid syndrome that is seen in chronic illnesses. If these two considerations are taken together, one may also think that SP could be also seen in bipolar disorder (BD), because it is a chronic disorder and oxidative stress was related to both illnesses. In our study, we proposed to investigate the prevalence of SP in BD patients.

METHODS

We recruited 111 consecutive BD patients who registered in Mood Disorders Unit of Çukurova University. Blood tests were taken from patients to exclude the possible confounding factor related to SP. Socio-demographic variable forms were filled out. Every patient underwent physical mass, strength, and performance tests for the diagnosis of SP, which was determined by the criteria of European consensus.

RESULTS

The mean age of the patients was 38.00 ±11.44 years (18-68). Among the participants 69 (62.2%) were female, and 42 (37.8%) were male. Pre-SP was 6.3% (n=7), SP was 9.0% (n=10), and severe SP was 1.8% (n=2) in BD patients. The prevalence of pre-SP, SP and severe SP in BD patients was 7.1%, 16.7% and 2.4% in men and 5.8%, 4.3% and 1.4% in women, respectively. Although it was not marginally significant, a difference was observed in SP patients as they had more median psychotic features and median number of episodes per year for BD.

CONCLUSION

This is the first study that investigated SP in BD patients. Sarcopenia was found more frequently in BD patients than in the general population.

Prognosis and Interplay of Cognitive Impairment and Sarcopenia in Older Adults Discharged from Acute Care Hospitals

Sarcopenia and cognitive impairment are associated with an increased risk of negative outcomes, but their prognostic interplay has not been investigated so far. We aimed to investigate the prognostic interaction of sarcopenia and cognitive impairment concerning 12-month mortality among older patients discharged from acute care wards in Italy. Our series consisted of 624 patients (age = 80.1 ± 7.0 years, 56.1% women) enrolled in a prospective observational study. Sarcopenia was defined following the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Cognitive impairment was defined as age- and education-adjusted Mini-Mental State Examination (MMSE) score < 24 or recorded diagnosis of dementia. The study outcome was all-cause mortality during 12-month follow-up. The combination of sarcopenia and cognitive ability was tested against participants with intact cognitive ability and without sarcopenia. Overall, 159 patients (25.5%) were identified as having sarcopenia, and 323 (51.8%) were cognitively impaired. During the follow-up, 79 patients (12.7%) died. After adjusting for potential confounders, the combination of sarcopenia and cognitive impairment has been found associated with increased mortality (HR = 2.12, 95% CI = 1.05-4.13). Such association was also confirmed after excluding patients with dementia (HR = 2.13, 95% CI = 1.06-4.17), underweight (HR = 2.18, 95% CI = 1.03-3.91), high comorbidity burden (HR = 2.63, 95% CI = 1.09-6.32), and severe disability (HR = 2.88, 95% CI = 1.10-5.73). The co-occurrence of sarcopenia and cognitive impairment may predict 1-year mortality in older patients discharged from acute care hospitals.

Gait, balance, mobility and muscle strength in people with anxiety compared to healthy individuals

BACKGROUND

Anxiety disorders are the most common mental disorders. Changes in psychomotor behavior can be observed in gross motor skills, with gait disturbances thought to reflect defective brain functions in psychiatric conditions. While balance deficits are well documented in anxiety, only little is known about gait characteristics of people with anxiety.

OBJECTIVE

This study wishes to examine the existence of differences in gait, balance, mobility and muscle strength between people with anxiety and healthy individuals, and to investigate the relationship between level of anxiety and motor characteristics.

METHODS

An observational study was conducted in a psychiatric out-patient unit at a large Israeli general hospital. The sample consisted of 93 participants, ages 18-65: 48 of them (27 female, 21 male) categorized as having anxiety, and 45 (25 female, 20 male) without anxiety. Participants were divided into two groups of various ages and both genders, and completed two questionnaires and four physical tests: objective anxiety assessment (Hamilton Anxiety Rating Scale); spatiotemporal gait parameters (10-meter walking test); balance function (Unipedal Stance Test); muscle strength evaluation, and mobility (Time Up and Go Test). No attempt was made to correlate between the anxiety and control groups based on age and/or gender.

RESULTS

Participants with anxiety (both genders) were characterized by slower walking speed, shorter step length, and fewer steps per minute (p < 0.001), as well as balance deficiency and mobility dysfunction (p < 0.001), compared to the control group. Muscle strength in women with anxiety was found to be significantly lower than in healthy women.

CONCLUSIONS

To the best of our knowledge, this study is the first of its kind to examine spatiotemporal gait components in patients with anxiety. Based on the findings, there is room to consider implementing gait analysis into the physical examination of patients with anxiety, as well as muscle strength, balance, and mobility function. Correct assessment and proper treatment of these aspects might contribute to the well-being of patients with anxiety.

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.

Relationships between hand-grip strength, socioeconomic status, and depressive symptoms in community-dwelling older adults

BACKGROUND

Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults.

METHOD

Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level.

RESULTS

Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta =  -0.162, P < 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms.

CONCLUSION

Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.

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.