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

Understanding exogenous factors and biological mechanisms for cognitive frailty: A multidisciplinary scoping review

Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research.

Sarcopenia is associated with increased major adverse cardiovascular event incidence in maintenance hemodialysis patients: a prospective cohort study and mediation analysis

Background

Few studies have investigated the relationship between sarcopenia and the incidence of major adverse cardiovascular events (MACE), which are common complications in maintenance hemodialysis (MHD) patients. This study thus explored the association between sarcopenia and MACE in a prospective cohort with mediation analysis.

Methods

Adult MHD patients in Jiangdu People's Hospital in December 2019 were screened. The exposure was sarcopenia, as defined by the 2019 Asian Working Group. The primary endpoint was the occurrence of MACE, defined as the composite of all-cause mortality or hospital admission with a primary diagnosis of acute myocardial infarction, stroke, or heart failure during a 3-year follow-up period. Multivariate Cox regression analyses were used to test the association between sarcopenia and subsequent MACE incidence. Mediation analyses were used to investigate whether potential mediators influenced the association between sarcopenia and MACE.

Results

Of the 230 patients enrolled, 57% were male, with a median age of 57 years (interquartile range [IQR]: 50 to 66), and a median dialysis vintage of 67 months (IQR: 32 to 119). The prevalence of sarcopenia was 45.2%. The presence of sarcopenia was significantly correlated with age (Spearman's r = 0.47, p < 0.001), C-reactive protein (Spearman's r = 0.13, p = 0.044), serum albumin (Spearman's r = -0.22, p < 0.001), 25(OH) vitamin D (Spearman's r = -0.26, p < 0.001), and coronary artery calcification score (Spearman's r = 0.20, p = 0.002). Over the 3-year follow-up period, MACE were observed in 59/104 (56.7%) patients with sarcopenia and 38/126 (30.2%) patients without sarcopenia (log-rank p < 0.001). After accounting for potential confounders, patients with sarcopenia presented a 66% (4-168%, p = 0.035) increase in their risk of MACE incidence as compared to non-sarcopenic individuals. However, adjusted mediation analyses did not detect any indication of a causal mediation pathway linking the effects of sarcopenic status on coronary artery calcification score, C-reactive protein, serum albumin, or 25(OH) vitamin D levels to MACE outcomes. Conversely, sarcopenia exhibited a potential direct effect (average direct effect range: -1.52 to -1.37, all p < 0.05) on MACE incidence.

Conclusion

These results revealed that the presence of sarcopenia was associated with a higher incidence of MACE in MHD patients. The putative effects of sarcopenia on this cardiovascular endpoint are possibly not mediated by any causal pathways that include vascular calcification, inflammation, hypoalbuminemia, or vitamin D.

Unlocking the potential of exercise: harnessing myokines to delay musculoskeletal aging and improve cognitive health

Objectives

This review aims to summarize the common physiological mechanisms associated with both mild cognitive impairment (MCI) and musculoskeletal aging while also examining the relevant literature on how exercise regulation influences the levels of shared myokines in these conditions.

Methods

The literature search was conducted via databases such as PubMed (including MEDLINE), EMBASE, and the Cochrane Library of Systematic Reviews. The searches were limited to full-text articles published in English, with the most recent search conducted on 16 July 2024. The inclusion criteria for this review focused on the role of exercise and myokines in delaying musculoskeletal aging and enhancing cognitive health. The Newcastle‒Ottawa Scale (NOS) was utilized to assess the quality of nonrandomized studies, and only those studies with moderate to high quality scores, as per these criteria, were included in the final analysis. Data analysis was performed through narrative synthesis.

Results

The primary outcome of this study was the evaluation of myokine expression, which included IL-6, IGF-1, BDNF, CTSB, irisin, and LIF. A total of 16 studies involving 633 older adults met the inclusion criteria. The current exercise modalities utilized in these studies primarily consisted of resistance training and moderate-to high-intensity cardiovascular exercise. The types of interventions included treadmill training, elastic band training, aquatic training, and Nordic walking training. The results indicated that both cardiovascular exercise and resistance exercise could delay musculoskeletal aging and enhance the cognitive functions of the brain. Additionally, different types and intensities of exercise exhibited varying effects on myokine expression.

Conclusion

Current evidence suggests that exercise mediates the secretion of specific myokines, including IL-6, IGF-1, BDNF, CTSB, irisin, and LIF, which establish self-regulatory circuits between the brain and muscle. This interaction enhances cognitive function in the brain and improves skeletal muscle function. Future research should focus on elucidating the exact mechanisms that govern the release of myokines, the correlation between the intensity of exercise and the secretion of these myokines, and the distinct processes by which myokines influence the interaction between muscle and the brain.

Development of a prediction model for cognitive impairment of sarcopenia using multimodal neuroimaging in non-demented older adults

INTRODUCTION

Despite prior research on the association between sarcopenia and cognitive impairment in the elderly, a comprehensive model that integrates various brain pathologies is still lacking.

METHODS

We used data from 528 non-demented older adults with or without sarcopenia in the Catholic Aging Brain Imaging (CABI) database, containing magnetic resonance imaging scans, positron emission tomography scans, and clinical data. We also measured three key components of sarcopenia: skeletal muscle index (SMI), hand grip strength (HGS), and the five times sit-to-stand test (5STS).

RESULTS

All components of sarcopenia were significantly correlated with global cognitive function, but cortical thickness and amyloid-beta (Aβ) retention had distinctive relationships with each measure. In the path model, brain atrophy resulting in cognitive impairment was mediated by Aβ retention for SMI and periventricular white matter hyperintensity for HGS, but directly affected by the 5STS.

DISCUSSION

Treatments targeting each sub-domain of sarcopenia should be considered to prevent cognitive decline.

HIGHLIGHTS

We identified distinct impacts of three sarcopenia measures on brain structure and Aβ. Muscle mass is mainly associated with Aβ and has an influence on the brain atrophy. Muscle strength linked with periventricular WMH and brain atrophy. Muscle function associated with cortical thinning in specific brain regions. Interventions on sarcopenia may be important to ease cognitive decline in the elderly.

Performance of digital technologies in assessing fall risks among older adults with cognitive impairment: a systematic review

Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, there is an interest in using objective technology-based fall risk assessment tools to assess falls within this population. This systematic review aims to evaluate the features and performance of technology-based fall risk assessment tools for older adults with CI. A systematic search was conducted across several databases such as PubMed and IEEE Xplore, resulting in the inclusion of 22 studies. Most studies focused on participants with dementia. The technologies included sensors, mobile applications, motion capture, and virtual reality. Fall risk assessments were conducted in the community, laboratory, and institutional settings; with studies incorporating continuous monitoring of older adults in everyday environments. Studies used a combination of technology-based inputs of gait parameters, socio-demographic indicators, and clinical assessments. However, many missed the opportunity to include cognitive performance inputs as predictors to fall risk. The findings of this review support the use of technology-based fall risk assessment tools for older adults with CI. Further advancements incorporating cognitive measures and additional longitudinal studies are needed to improve the effectiveness and clinical applications of these assessment tools. Additional work is also required to compare the performance of existing methods for fall risk assessment, technology-based fall risk assessments, and the combination of these approaches.

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model

BACKGROUND

Understanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its positive effect on the well-being of older adults. This study aimed to explore the association between smartphone ownership and frailty in community-dwelling older adults and its underlying mechanism.

METHODS

We used data from the Korean Frailty and Aging Cohort Study and analyzed 2,469 older adults aged 72-86 years. Frailty, health literacy, and social support were assessed by Fried's frailty phenotype, the Behavioral Risk Factor Surveillance System health literacy module, and the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, respectively. The mediation model and moderated mediation model were estimated, where the mediator was health literacy and the moderator was social support, to explore the relationship between smartphone ownership and frailty.

RESULTS

Of our study participants, 58.9% owned smartphones, and 10.9% were classified as frail. Smartphone ownership was negatively associated with frailty (β = -0.623, p < 0.001). Health literacy mediated the relationship between smartphone ownership and frailty (β = -0.154, boot confidence interval [CI] = - 0.222, - 0.096), and social support moderated the mediation effect (β = -0.010, Boot CI = - 0.016, - 0.004).

CONCLUSIONS

Owning smartphones among older adults could reduce the risk of frailty. Promoting health literacy and social support among older adults with smartphones would be effective to prevent frailty.

The bidirectional associations between sarcopenia-related traits and cognitive performance

While many studies have sought to explore the degree to which sarcopenia-related traits are associated with cognitive performance, these studies have yielded contradictory results without any clear indication of the causality of such relationships. In efforts to better understand associations between sarcopenia-related traits and cognitive ability, a series of multivariate linear regression assessments were carried out upon datasets derived through the National Health and Nutrition Examination Survey (NHANES). Of these, cognitive performance was assessed by the Digit Symbol Substitution Test (DDST), the Consortium to Establish a Registry for Alzheimer's Disease Immediate Recall Test (CERAD-IR), Delayed Recall Test (CERAD-DR) and Animal Fluency Test (AFT). Causal relationships between the two were further inferred via a two-sample Mendelian randomization (MR) analysis approach. Sarcopenia-related traits considered in these assessments included walking speed, appendicular skeletal muscle mass (ASM), and hand grip strength (HGS). Walking speed, ASM, and HGS were all significantly independently related to cognitive scores following adjustment for covariates. MR assessments also identified that each 1-SD higher walking speed and appendicular lean mass were causally and respectively associated with a 0.34 [standard error (SE) = 0.09; p < 0.001)] standardized score higher and a 0.07 (SE = 0.01; p < 0.001) standardized score higher cognitive score, whereas a higher hand grip strength was positively associated with a better cognitive performance. Reverse MR assessments also yielded similar findings. These data suggest that lower walking speed, muscle strength, and muscle mass were all closely related to lower cognitive performance irrespective of gender, and that there may be a mutually reinforcing relationship among these variables.

Advanced liver fibrosis is associated with decreased gait speed in older patients with chronic liver disease

This study investigated whether the progression of liver fibrosis affects the prevalence of sarcopenia and incidence of decreased gait speed in older patients with chronic liver disease (CLD). Patients with CLD aged ≥ 60 years were classified into low, intermediate, and high fibrosis 4 (FIB-4) index groups according to the degree of liver fibrosis. The prevalence of sarcopenia and incidence of decreased gait speed (< 1.0 m/s) were compared among the three groups. Logistic regression analysis was performed to investigate factors affecting the risk of decreased gait speed. No significant difference was observed in the prevalence of sarcopenia among the three groups, but the incidence of decreased gait speed significantly differed (p = 0.029). When analyzed individually, a significant difference in decreased gait speed incidence was observed between the high and low FIB-4 index groups (p = 0.014). In logistic regression analysis, the progression of liver fibrosis (odds ratio: 1.32, 95% confidence interval: 1.13-1.55) and lower extremity muscle strength (LEMS) (odds ratio: 0.92, 95% confidence interval: 0.88-0.97) were significantly associated with decreased gait speed. As liver fibrosis progresses in older patients with CLD, it becomes important to focus on not only skeletal muscle mass and grip strength, but also gait speed and LEMS.

One-year change in sarcopenia was associated with cognitive impairment among haemodialysis patients

BACKGROUND

Our study aimed to evaluate change in sarcopenia, its defining components over 1 year follow-up and investigate associations with subsequent cognitive decline, incident mild cognitive impairment (MCI) and dementia among patients undergoing haemodialysis (HD).

METHODS

In the multicentre, longitudinal study, 1117 HD patients aged 56.8 ± 14.3 years (654 men; and 463 women) from 17 dialysis centres in Guizhou Province, China, were recruited in 2019 and followed up for 1 year in 2020. Sarcopenia was diagnosed with Asian Working Group for Sarcopenia criteria using appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Body composition was measured using body composition monitor; body water, weight, and height were corrected to calculate ASMI. HGS was measured by mechanical handgrip dynamometer. Cognitive function was measured with Mini Mental State Examination. Multivariate linear, logistic regression models and subgroup analyses were employed to examine the associations of changes in sarcopenia, ASMI, and HGS with Mini Mental State Examination score change, and incident MCI, dementia.

RESULTS

Four hundred fourteen (37.1%) patients had sarcopenia at baseline; during 1 year follow-up, 257 (23.0%) developed MCI and 143 (12.8%) developed dementia. According to changes in sarcopenia, patients were stratified into four groups: non-sarcopenia; non-sarcopenia to sarcopenia; sarcopenia; and sarcopenia to non-sarcopenia. HD patients in sarcopenia and non-sarcopenia to sarcopenia groups had higher risk of MCI (34.8%, 32.0%, vs. 17.4%) and dementia (20.6%, 19.8%, vs. 8.7%), compared non-sarcopenia group (P < 0.001). Multivariate linear regression analyses showed that sarcopenia [regression coefficients (β) -1.098, 95% confidence interval (CI) -1.872, -0.324, P = 0.005] and non-sarcopenia to sarcopenia (β -1.826, -2.441, -1.212, P < 0.001) were associated with faster cognitive decline compared to non-sarcopenia. HGS decline (β 0.046, 0.027-0.064, P < 0.001) and ASMI decline (β 0.236, 0.109-0.362, P < 0.001) were both positively associated with cognitive decline. Multivariate logistic regression analyses demonstrated that patients with sarcopenia and non-sarcopenia to sarcopenia were both at increased risk of developing MCI [odds ratio (OR) 1.788, 95% CI 1.115-2.870, P = 0.016 and OR 1.589, 95% CI 1.087-2.324, P = 0.017, respectively], but only non-sarcopenia to sarcopenia was at increased risk of dementia (OR 1.792, 95% CI 1.108-2.879, P = 0.017). Both greater change of ASMI and HGS had lower risk of MCI with adjusted ORs of 0.857 (0.778-0.945, P = 0.002) and 0.976 (0.963-0.989, P < 0.001). Robust associations were found among female individuals, aged >60 years, and with low educational level.

CONCLUSIONS

Longitudinal associations were observed between new-onset, persistent sarcopenia, and cognitive impairment. Early detection and intervention should be implemented to delay the onset of sarcopenia and improve cognitive health among HD patients.

Nutrition in Alzheimer's disease: a review of an underappreciated pathophysiological mechanism

Alzheimer's disease (AD) is the leading cause of dementia in older individuals and is an escalating challenge to global public health. Pharmacy therapy of AD is one of the well-funded areas; however, little progress has been made due to the complex pathogenesis. Recent evidence has demonstrated that modifying risk factors and lifestyle may prevent or delay the incidence of AD by 40%, which suggests that the management should pivot from single pharmacotherapy toward a multipronged approach because AD is a complex and multifaceted disease. Recently, the gut-microbiota-brain axis has gained tremendous traction in the pathogenesis of AD through bidirectional communication with multiple neural, immune, and metabolic pathways, providing new insights into novel therapeutic strategies. Dietary nutrition is an important and profound environmental factor that influences the composition and function of the microbiota. The Nutrition for Dementia Prevention Working Group recently found that dietary nutrition can affect cognition in AD-related dementia directly or indirectly through complex interactions of behavioral, genetic, systemic, and brain factors. Thus, considering the multiple etiologies of AD, nutrition represents a multidimensional factor that has a profound effect on AD onset and development. However, mechanistically, the effect of nutrition on AD is uncertain; therefore, optimal strategies or the timing of nutritional intervention to prevent or treat AD has not been established.Thus, this review summarizes the current state of knowledge concerning nutritional disorders, AD patient and caregiver burden, and the roles of nutrition in the pathophysiology of AD. We aim to emphasize knowledge gaps to provide direction for future research and to establish optimal nutrition-based intervention strategies for AD.

Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex

OBJECTIVES

This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later.

DESIGN

Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS).

SETTING AND PARTICIPANTS

A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men.

METHODS

PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used.

RESULTS

The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015).

CONCLUSIONS AND IMPLICATIONS

Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.

Cognitive Impairment Predicts Sarcopenia 9 Years Later Among Older Adults

OBJECTIVE

To assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults.

DESIGN

Nine-year observational prospective study.

SETTING AND PARTICIPANTS

A total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study.

METHODS

Sarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up.

RESULTS

The mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older (odds ratio [OR], 4.62; 95% CI, 1.38-15.48; P = .013), being under- and overweight (OR, 0.29; 95% CI, 0.11-0.76; P = .012, and OR, 5.12; 95% CI, 2.18-12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18-5.04; P = .016) at baseline predicted sarcopenia after 9 years.

CONCLUSION AND IMPLICATIONS

Cognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.

Chinese expert consensus on prevention and intervention for elderly with sarcopenia (2023)

Sarcopenia is the age-related loss of skeletal muscle mass and muscle strength or physical function. It is most common in elderly individuals. Due to its high incidence, insidious onset, and extensive impact on the body, it has a huge impact on the family medical burden and the social public health expenditure in China. The understanding of sarcopenia in China is still lacking, and the recommendations for prevention, control, and intervention are not clear and unified. The purpose of this consensus report is to standardize the prevention, control, and intervention methods for sarcopenia in elderly patients in China; improve the efficacy of intervention; reduce complications during the intervention process; and reduce the risk of falls, fractures, disability, hospitalization, and even death in elderly individuals.

The Relationship Between Sarcopenia, Cognitive Impairment, and Cerebral White Matter Hyperintensity in the Elderly

Purpose

To explore the relationship between sarcopenia-related indices, cognitive impairment and cerebral white matter hyperintensities.

Patients and methods

Ninety-five hospitalized older adults aged 60 years and older were used in this study. Three sarcopenia-related indicators were measured: hand grip strength (Measured with a spring-type dynamometer), gait speed (6m step speed method), and appendicular skeletal muscle mass (ASM, bioelectrical impedance). Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. Cognitive function was assessed using Montreal Cognitive Assessment (MoCA). Cerebral white matter hyperintensity was assessed using 3.0T superconducting magnetic resonance imaging.

Results

In both men and women, these three indices of sarcopenia were significantly and negatively correlated with WMH grades, except for appendicular skeletal muscle mass and WMH grades in women. Scores on the MoCA scale were significantly positive correlated with grip strength, and ASM, both in men and women. After adjusting for confounders and WMHs, regression analyses showed an increased incidence of cognitive impairment in patients with sarcopenia relative to those without sarcopenia.

Conclusion

Lower sarcopenia-related indices were significantly associated with cognitive impairment. WMHs may be one of the factors linking sarcopenia and cognitive function.

Association of Sarcopenia and Its Defining Components with the Degree of Cognitive Impairment in a Memory Clinic Population

BACKGROUND

Sarcopenia and cognitive impairment are two leading causes of disabilities.

OBJECTIVE

The objective was to examine the prevalence of sarcopenia and investigate the association between sarcopenia diagnostic components (muscle strength, muscle mass, and physical performance) and cognitive impairment in memory clinic patients.

METHODS

368 patients were included (age 59.0±7.25 years, women: 58.7%), displaying three clinical phenotypes of cognitive impairments, i.e., subjective cognitive impairment (SCI, 57%), mild cognitive impairment (MCI, 26%), and Alzheimer's disease (AD, 17%). Sarcopenia was defined according to diagnostic algorithm recommended by the European Working Group on Sarcopenia in Older People. Components of sarcopenia were grip strength, bioelectrical impedance analysis, and gait speed. They were further aggregated into a score (0-3 points) by counting the numbers of limited components. Multi-nominal logistic regression was applied.

RESULTS

Probable sarcopenia (i.e., reduced grip strength) was observed in 9.6% of the patients, and 3.5% were diagnosed with sarcopenia. Patients with faster gait speed showed less likelihood of MCI (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.06-0.90) and AD (OR: 0.12, 95% CI: 0.03-0.60). One or more limited sarcopenia components was associated with worse cognitive function. After adjusting for potential confounders, the association remained significant only for AD (OR 4.29, 95% CI 1.45-11.92).

CONCLUSION

The results indicate a connection between the sarcopenia components and cognitive impairments. Limitations in the sarcopenia measures, especially slow walking speed, were related to poorer cognitive outcomes. More investigationsare required to further verify the causal relationship between sarcopenia and cognitive outcomes.

Association between Sarcopenia and Cognitive Trajectories among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

The relationship between sarcopenia and cognitive function has been extensively studied, but is usually explored at a single time point. We used repeatedly measured cognitive data to examine the relationship between sarcopenia and cognitive trajectories over time among middle-aged and older Chinese adults.

DESIGN

A nationally representative cohort study.

SETTING AND PARTICIPANTS

Data were from three waves (2011, 2013 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8963 participants with complete baseline data (wave 1) and at least two cognitive function tests (waves 1-3) were enrolled in this study.

MEASUREMENTS

Sarcopenia was diagnosed at baseline (wave 1). The wave 1-3 data were used to analyze cognitive trajectories over time by constructing a latent class trajectory model (LCTM). Logistic regression model was used to analyze the association between sarcopenia and cognitive trajectories.

RESULTS

Among 8693 participants, we identified two trajectories of cognitive function development, including a persistent low trajectory (n= 4856, 55.86%) and a persistent high trajectory (n= 3837, 44.14%). Sarcopenia was associated with persistently low cognitive trajectory of global cognitive (OR: 1.248, 95%CI: 1.046-1.490) after adjustment for other covariates. This association was still observed when stratified by age, gender, educational level, marital status, social activity, smoking status and drinking status. Mediation analysis showed that body mass index (BMI) mediated efficacy accounting for 42.32% of the relationship.

CONCLUSIONS

Our study showed two trajectory groups of global cognitive function. Sarcopenia was associated with a persistent low trajectory over time and BMI mediated the relationship between sarcopenia and cognitive trajectories among middle-aged and older Chinese adults.

Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study

PURPOSE

To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment.

METHODS

Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire.

RESULTS

Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group.

CONCLUSIONS

Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.

A Non-Randomized Combined Program of Walking and Low-Load Resistance Exercise Improves Cognitive Function and Cardiometabolic Risk Factors in Community-Dwelling Elderly Women

Background: This study examines whether changes in cardiometabolic risk factors, functional fitness, and depressive symptoms following a six-month exercise intervention were associated with cognitive function in Korean women aged 65 years and older. Methods: A non-randomized study design was used to compare post-intervention changes in measured variables between control (n = 30) and exercise (n = 30) groups. The exercise intervention consisted of three days of low-load resistance exercise and two days of walking. Cognitive function and depressive symptoms were assessed with the Korean version of the Mini−Mental State Examination and the Korean version of the Geriatric Depression Scale, respectively. Functional fitness was measured using a senior fitness test battery. Results: The exercise group showed a significant improvement in cognitive function (p < 0.001) in conjunction with significant decreases in blood glucose (p = 0.052), triglycerides (p = 0.011), insulin (p = 0.002), tumor necrosis factor-α (p = 0.043), and depressive symptoms (p = 0.006) and an increase in interleukin-10 (p = 0.037), compared with the control group. Multivariate stepwise regression showed that changes in depressive symptoms (p < 0.001), insulin resistance (p < 0.001), and upper body muscle strength (p = 0.003) were positively associated with cognitive function. Conclusion: A six-month exercise intervention consisting of walking and low-load/high-repetition elastic band resistance exercise has the potential to improve cognitive function, as well as physical function and cardiometabolic risk factors, and to decrease depressive symptoms in older women.

Prevalence and associated factors of possible sarcopenia and sarcopenia: findings from a Chinese community-dwelling old adults cross-sectional study

Purpose

To describe the prevalence and analyse the associated factors of possible sarcopenia and sarcopenia among community-dwelling old adults in China, in order to provide effective strategies for early prevention and treatment of sarcopenia.

Methods

This cross-sectional study evaluated community-dwelling old adults aged over 60 years. The basic information, morphological indices, body composition, physical activities were collected and assessed. Possible sarcopenia and sarcopenia were diagnosed by the criteria of Asian Working Group for Sarcopenia (AWGS) in 2019. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia and sarcopenia.

Results

In total 729 old adults from Tianjin were included in this study. Eighty-one participants were diagnosed with possible sarcopenia (prevalence of 11.11%). Seventy-five participants were diagnosed with sarcopenia (prevalence of 10.29%). Age (odds ratio (OR):1.047, 95% confidence interval (CI): 1.055–1.090) and lower physical activities (low level OR:4.171, 95% CI:1.790–9.720; medium level OR:2.634, 95% CI:1.352–5.132) were significantly associated with possible sarcopenia. Age (OR:1.187, 95% CI:1.124–1.253), higher body fat percentage (OR:1.225, 95% CI:1.140–1.317), lower BMI (OR:0.424, 95% CI:0.346–0.519), lower mini-mental state examination (MMSE) scores (OR:0.865,95% CI:0.781–0.958) and low physical activities (OR:4.638, 95% CI:1.683–12.782) were significantly associated with sarcopenia.

Conclusion

Possible sarcopenia and sarcopenia are prevalent among community-dwelling old adults in China. Ageing and lower physical activities were both associated with possible sarcopenia and sarcopenia. Old adults with sarcopenia more likely have higher body fat percentage, lower BMI and lower cognitive function compared with those without this condition.

Association of Low Muscle Mass With Cognitive Function During a 3-Year Follow-up Among Adults Aged 65 to 86 Years in the Canadian Longitudinal Study on Aging

IMPORTANCE

Cross-sectional studies have shown that combined low muscle mass and strength are associated with cognitive impairment. Whether low muscle mass, reflective of physiologic reserve, is independently associated with faster cognitive decline remains unknown.

OBJECTIVE

To investigate the associations between low muscle mass and cognitive decline in 3 distinct domains among adults aged at least 65 years.

DESIGN, SETTING, AND PARTICIPANTS

The Canadian Longitudinal Study on Aging is a prospective population-based cohort study of community-dwelling adults. Enrollment occurred from 2011 to 2015 with a 3-year follow-up. Analyses for this study were conducted on those aged at least 65 years from April 24 to August 12, 2020.

EXPOSURE

Appendicular lean soft tissue mass (ALM) was assessed by dual energy x-ray absorptiometry. Low ALM was identified using the sex-specific Canadian cut points.

MAIN OUTCOMES AND MEASURES

Memory was assessed using the Rey auditory verbal learning test. Executive function was assessed using the mental alternation test, Stroop high interference (words/dot) test, the animal fluency test, and the controlled oral word association test. Psychomotor speed was assessed using computer-administered choice reaction time. Composite scores by domain were created.

RESULTS

Of 8279 participants, 4003 (48%) were female, 8005 (97%) were White, and the mean (SD) age was 72.9 (5.6) years. A total of 1605 participants (19.4%) had low ALM at baseline. Participants with low ALM were older, had lower body mass index and physical activity level. The presence of low ALM at baseline was associated with faster 3-year cognitive decline in executive functions and psychomotor speed from multiple linear regressions. After adjusting for covariates including age, level of education, percentage body fat, and handgrip strength, low ALM remained independently associated with executive function decline (standardized β: -0.032; P = .03) only. Low ALM was not associated with memory.

CONCLUSIONS AND RELEVANCE

This cohort study found longitudinal associations between low ALM and cognition in aging. Identification of older adults with low muscle mass, a targetable modifiable factor, may help estimate those at risk for accelerated executive function decline. Further longer-term investigation of associations is warranted.

Association between sarcopenia and cognitive impairment in the older people: a meta-analysis

PURPOSE

The effects of sarcopenia on the older people are profound, increasing the risk of adverse outcomes for older patients. Although the substantial impact of sarcopenia on maintaining functional independence and adverse health outcomes has been described many times in the past, the link between sarcopenia and cognitive impairment in older adults remains lacking in evidence and controversial. Therefore, we conducted a comprehensive search of available national and international databases and carried out a meta-analysis to examine the association between sarcopenia in older people and cognitive impairment.

METHODS

Relevant experiments had been recognized via looking out electronic databases and conference sessions. The present study included case-control, cohort, or cross-sectional studies of the association between sarcopenia and cognitive impairment in the older people.

RESULTS

The meta-analysis included 26 articles and 18,788 participants were involved after assessment of eligibility. The results of this meta-analysis showed that the risk of developing cognitive impairment was significantly higher in patients with sarcopenia than in those without sarcopenia [OR = 1.75; 95% CI = 1.57, 1.95; P < 0.00001], MMSE score of sarcopenia group was lower than that of non-sarcopenia group, the difference was statistically significant [OR = - 2.23; 95% CI = - 2.48, - 1.99; P < 0.00001].

CONCLUSION

Overall, this meta-analysis showed an association between sarcopenia and cognitive impairment in the older people, demonstrating a significant association between sarcopenia and cognitive impairment. This suggested that providing comprehensive sarcopenia screening and active prevention for the older people with cognitive decline has certain clinical value for improving the quality of life of the older people.

Longitudinal Association between Sarcopenia and Cognitive Impairment among Older Adults in Rural Malaysia

Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using bioelectrical impedance analysis. Generalized estimating equation (GEE) was used to determine the longitudinal association between sarcopenia and cognitive impairment, presented as relative risk (RR) and its 95% confidence interval. The prevalence of sarcopenia was 5.0% (95% CI 4.00–5.90), and severe sarcopenia was 3.60% (95% CI 2.84–4.31). Upon adjusting for covariates, older adults with sarcopenia have an 80 per cent increased risk of cognitive impairment compared to those without (RR 1.80; 95% CI 1.18–2.75). Similarly, severe sarcopenia was found to significantly increase the risk of cognitive impairment by 101 per cent in the adjusted model (RR 2.01; 95% CI 1.24–3.27). Our study showed that sarcopenia, severe sarcopenia, low physical activity, depressive symptoms, hearing impairment and chronic pain were associated with a higher risk of cognitive impairment among community-dwelling older adults. Therefore, early intervention to prevent sarcopenia, depressive symptoms, hearing impairment, chronic pain, and higher physical activity among older adults is recommended.

Associations Between Muscle Quality and Cognitive Function in Older Men: Cross-Sectional Data From the Geelong Osteoporosis Study

Sarcopenia-related declines appear to be adversely associated with cognition in the elderly. Poor muscle quality is a marker for sarcopenia, yet little research has examined the concurrence of poor muscle quality and poor cognition. The aim of this study was to investigate the association between muscle quality and cognitive function, overall and in specific domains, in older men. This study involved 342 men from the Geelong Osteoporosis Study (ages 60-96 years). Handgrip strength (HGS, kg) was measured by dynamometry (Vernier, LoggerPro3), and lean mass of arms (kg) and appendicular lean mass (ALM, kg) by dual-energy X-ray absorptiometry (Lunar). Muscle quality was expressed as HGS/(arm lean mass) (kg/kg) as well as HGS/ALM (kg/kg). Cognitive function was assessed in 4 domains: visual attention, psychomotor function, working memory and visual learning. Overall cognitive function scores were calculated. Higher scores represent poorer cognitive performance in attention, psychomotor function and working memory, but better performance for visual memory/learning and overall cognitive function. Additionally, cognitive impairment was determined by the mini-mental state exam (score ≤ 24). Linear regression analyses and logistic regression were performed. There were age-related declines observed for all measures relating to muscle and cognition. Muscle quality (HGS/arm lean mass) was associated with all cognition assessments before and after adjusting for age, except for age-adjusted working memory. Muscle quality (HGS/arm lean mass) was associated with psychomotor function (B -0.01, 95% CI -0.02, -0.005) and overall cognitive function (b + 0.07, 95% CI 0.03, 0.11) after adjusting for age and education. Greater muscle quality was also associated with the likelihood of cognitive impairment OR 0.64 (95%CI 0.46-0.88) after adjusting for age; associations with attention and visual memory/learning were attenuated after further adjustment for confounders. Similar patterns were observed when muscle quality was determined as HGS/ALM. Our data support an association between muscle quality and cognitive function. Further research is needed to examine temporal changes between the Two.

The Inverse Association of Sarcopenia and Protein-Source Food and Vegetable Intakes in the Korean Elderly: The Korean Frailty and Aging Cohort Study

The aging population contributes to increasing economic and social burden worldwide. Sarcopenia, an age-related degenerative disease and progressive disorder, is characterized by a reduction in skeletal muscle mass and function. This study aims to assess the association between dietary factors and sarcopenia in the Korean elderly using nationwide data. A total of 801 subjects aged 70–84 years were included in this analysis. Subjects were divided into two groups: sarcopenic and nonsarcopenic groups according to the sarcopenia criteria established by the Asian Working Group for Sarcopenia. Nutrient and food intakes were assessed using a 24-h recall method. Logistic regression analysis was used to assess the association between sarcopenia and food group and nutrient intakes. In the multivariable models, the meat/fish/egg/legume food group, vegetable group, and total food intake were inversely associated with the prevalence of sarcopenia. The high intakes of energy, carbohydrate, protein, fiber, zinc, carotene, and vitamin B₆ were associated with the lower prevalence of sarcopenia. Therefore, consuming sufficient nutrients through various protein source foods and vegetables will help prevent sarcopenia in the Korean elderly.

Interventions to Improve Physical Capability of Older Adults with Mild Disabilities: A Case Study

Ageing is related to changes in physical health, including loss of mobility and muscle function. It can lead to impaired physical capability and reduced quality of life. The purpose of this study was to investigate whether a physical activity rehabilitation program (PARP) could improve range of joint motion (ROM), grip strength, and gait speed of older adults with mild disabilities. Forty older adults in a long-term care center in Taiwan joined as human participants and were split into control and experimental groups. The participants in the experimental group joined a PARP for eight weeks. The ROM of bodily joints, grip strength, and gait speed of all participants were measured both before and after the eight-week period. The results showed that all the ROMs, grip strength, and gait speed of the participants in the experimental group increased significantly after attending the program. The improvement of the ROMs for male and female participants in the experimental group ranged from 3.8% to 71% and from 7.8% to 75%, respectively. Male participants had greater improvement on gait speed (50%) than their female counterparts (22.9%). Female participants, on the other hand, had greater improvement on grip strength (25.4%) than their male counterparts (20.3%). The ROM, grip strength, and gait speed of the control group, on the other hand, did not change significantly during the same period. The results showed that the PARP adopted in this study was effective in increasing the ROM, grip strength, and gait speed of those who had joined the PARP. This study shows that an eight-week PARP without the use of gym machines was beneficial in reducing sarcopenia in elderly people with mild disabilities.

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.

Factors affecting executive function performance of Brazilian elderly in the Stroop test

Aging is related to a decrease in physiological abilities, especially cognitive functions. To unravel further evidence of age-related cognitive decline, we analyzed which physical and functional variables are predictors of cognitive performance in a sample of 498 Brazilian elderly (67.26% women). To do so, we used the Stroop test as a tool to evaluate executive functions and the General functional fitness index (GFFI) to evaluate the functional fitness of the participants. A linear regression analysis revealed that female sex (β=-0.097; t=-2.286; P=0.023), younger age (β=0.205; t=4.606; P<0.0001), more years of education (β=-0.280; t=-6.358; P<0.0001), and higher GFFI (β=-0.101; t=-2.347; P<0.02) were predictors of better cognitive performance. Body mass index (kg/m²) and nutritional status (underweight, eutrophic, overweight, or obese) were not predictors of cognitive performance. Interestingly, among the GFFI tasks, muscle strength influenced the test execution time, both in upper and lower limbs (elbow flexion: β=-0.201; t=-4.672; P<0.0001; sit-to-stand: β=-0.125; t=-2.580; P<0.01). Our findings showed that: 1) women performed the Stroop test faster than men; 2) the older the person, the lower was the cognitive performance; 3) the higher the education, the better the test execution time; and 4) higher scores in the GFFI were associated with a better performance in the Stroop test. Therefore, gender, age, education, and functional fitness and capacity were predictors of cognitive performance in the elderly.

Common and different characteristics among combinations of physical frailty and sarcopenia in community-dwelling older adults: The Korean Frailty and Aging Cohort Study

AIM

Physical frailty and sarcopenia are geriatric syndromes associated with adverse health outcomes. However, the common and different conditions associated with physical frailty and sarcopenia remain unclear. This study aimed to compare the clinical characteristics of older adults with physical frailty and sarcopenia.

METHODS

This cross-sectional study analyzed 2028 community-dwelling older adults, aged 70-84 years (mean age 75.9 ± 4.0 years; 50.1% men). Physical frailty was defined using the Fried frailty phenotype, whereas sarcopenia was defined using the Asian Working Group for Sarcopenia 2014 and 2019 criteria.

RESULTS

The prevalence of physical frailty was 5.5%, whereas that of sarcopenia, using the Asian Working Group for Sarcopenia 2014 and 2019, was 9.1% and 17.5%, respectively. The concordance of physical frailty with sarcopenia was higher in the Asian Working Group for Sarcopenia 2019 criteria than in 2014. Frail-only participants had a higher incidence of disability, cognitive dysfunction, poor self-perceived health, and depressive symptoms than the sarcopenic-only participants. Frail-and-sarcopenic participants showed a lower body mass index (≥23 kg/m² ) than frail-only participants. Furthermore, in frail-and-sarcopenic participants, recurrent falls (16.9% vs 5.5%) were higher than in the neither-frail-nor-sarcopenic participants; falls with fracture (11.5% vs 1.7%) and fear of falling (59.0% vs 36.7%) were higher in frail-and-sarcopenic participants than in sarcopenic-only participants.

CONCLUSIONS

This study showed significant differences between physical frailty and sarcopenia among community-dwelling older adults. Older adults with physical frailty and sarcopenia were more likely to have higher fall-related outcomes than the others. Geriatr Gerontol Int 2021; ••: ••-••.

Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery

BACKGROUND

Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD.

METHODS

Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient's functional status at discharge, using the Cumulated Ambulation Score.

DISCUSSION

This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.

Association between osteosarcopenia and cognitive frailty in older outpatients visiting a frailty clinic

PURPOSE

Osteosarcopenia and cognitive frailty are both risk factors for falls and fractures. The purpose of this study was to determine the association between osteosarcopenia and cognitive frailty.

MATERIALS AND METHODS

This was a cross-sectional secondary data analysis of the Frailty Registry Study with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. Osteoporosis was defined as a bone mineral density < 70% of the young adult mean. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Cognitive frailty was defined as the coexistence of physical frailty and mild cognitive impairment. Physical frailty was evaluated according to Japanese Cardiovascular Health Study criteria, whereas mild cognitive impairment was defined as a Mini-Mental State Examination score ≥ 24 points and a score ≤ 25 points on the Japanese version of the Montreal Cognitive Assessment. We performed multivariable logistic regression analysis to investigate the association between osteosarcopenia and cognitive frailty.

RESULTS

The data of 432 patients were analysed. The prevalence of osteosarcopenia and cognitive frailty was 10.2% and 20.8%, respectively. Logistic regression analysis revealed that osteosarcopenia was independently associated with cognitive frailty with a higher odds ratio than osteoporosis or sarcopenia alone. Lost points in visuospatial abilities/executive functions and orientation were significantly associated with osteosarcopenia.

CONCLUSIONS

Combination of osteoporosis and sarcopenia is more likely to be associated with physical and cognitive decline than osteoporosis and sarcopenia alone. The mechanism by which osteosarcopenia is associated with decreased visuospatial abilities/executive functions and orientation needs to be addressed.

A Cumulative Muscle Index and Its Parameters for Predicting Future Cognitive Decline: Longitudinal Outcomes of the ASPRA Cohort

Sarcopenia and cognitive decline share the major risk factors of physical inactivity; previous studies have shown inconsistent associations. We aimed to identify the association of sarcopenia and its parameters with cognitive decline. The 3-year longitudinal outcomes of 1327 participants from the Aging Study of the Pyeongchang Rural Area (ASPRA) cohort were analyzed. Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE), and sarcopenia was defined by the following: the original and revised Asian Working Group for Sarcopenia (AWGS), the original and revised European Working Group on Sarcopenia in Older People (EWGSOP), and the Cumulative Muscle Index (CMI), a novel index based on the number of impaired domains of sarcopenia. Approximately half of the participants showed meaningful cognitive decline. Sarcopenia by the original EWGSOP and the CMI were associated with cognitive decline. Only the CMI showed consistent predictability for cognitive impairment even with different criteria of the MMSE score (OR 1.23 [1.04-1.46]; OR 1.34 [1.12-1.59]; OR 1.22 [1.01-1.49], using the 1, 2, and 3 cut-off value, respectively). Of the CMI parameters, gait speed was satisfactorily predictive of 3-year cognitive impairment (OR 0.54 [0.30-0.97]). In conclusion, sarcopenia based on the CMI may be predictive of future cognitive impairment. Gait speed was the single most important indicator of cognitive decline.

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.

A Simple Bedside Exercise Method to Enhance Lower Limb Muscle Strength in Moderate Alzheimer's Disease Patients with Sarcopenia

Background: Alzheimer’s disease (AD) is known to accelerate muscle loss in the elderly due to reduced physical performance, increasing the prevalence and severity of sarcopenia. This study was undertaken to determine whether simple bedside exercise training may facilitate muscle growth and strengthening in moderate-degree AD patients. Methods: This study was conducted on 26 prospectively recruited women admitted to a nursing hospital, who had moderate AD and sarcopenia. They were randomly and evenly divided into the control and exercise groups. For five sessions per week, those in the exercise group underwent 30 min of therapist-supervised exercise by simply kicking a balloon connected to the ceiling by a piece of string while lying on a bed. Additional exercise was encouraged, and isometric maximal voluntary contraction (MVC) and skeletal muscle mass index (SMI) were measured and calculated after 12 weeks. Results: Through simple exercise training for 12 weeks, MVCs for hip flexion and knee extension significantly increased in the exercise group. However, no significant differences in SMI were found between the two groups. Conclusions: We believe that our simple exercise method can be applied to patients with AD for maintaining and enhancing the strength of the muscles of the lower extremities.

Receptor-Mediated Muscle Homeostasis as a Target for Sarcopenia Therapeutics

Sarcopenia is a disease characterized by age-related decline of skeletal muscle mass and function. The molecular mechanisms of the pathophysiology of sarcopenia form a complex network due to the involvement of multiple interconnected signaling pathways. Therefore, signaling receptors are major targets in pharmacological strategies in general. To provide a rationale for pharmacological interventions for sarcopenia, we herein describe several druggable signaling receptors based on their role in skeletal muscle homeostasis and changes in their activity with aging. A brief overview is presented of the efficacy of corresponding drug candidates under clinical trials. Strategies targeting the androgen receptor, vitamin D receptor, Insulin-like growth factor-1 receptor, and ghrelin receptor primarily focus on promoting anabolic action using natural ligands or mimetics. Strategies involving activin receptors and angiotensin receptors focus on inhibiting catabolic action. This review may help to select specific targets or combinations of targets in the future.

Association Between Sarcopenia and Quality of Life in Patients with Early Dementia and Mild Cognitive Impairment

BACKGROUND

Cognitive impairment is linked to decreased quality of life (QOL), but few studies have investigated the impact of comorbid sarcopenia.

OBJECTIVE

The aim of this study was to elucidate the association of sarcopenia with QOL in patients with early dementia and mild cognitive impairment.

METHODS

Individuals with a Clinical Dementia Rating of 0.5 or 1 and a Mini-Mental State Examination score of 20-30 underwent a battery of neuropsychological assessments administered by a group of well-trained clinical psychologists. The EQ-5D was completed by both the patients and their main caregivers. EQ-5D utility and visual analog scale scores were measured. Sarcopenia was defined according to the criteria published in the 2019 consensus update by the Asian Working Group for Sarcopenia.

RESULTS

Patients with sarcopenia had significantly lower scores on the Digit Symbol Substitution Test and Trail Making Test Part A. There was a significant negative association between sarcopenia and both self- and proxy-rated EQ-5D utility scores independent of potential confounding factors. However, there was no association between QOL visual analog scale scores and sarcopenia.

CONCLUSION

Given that sarcopenia is often found in individuals with cognitive impairment, early detection by timely screening and effective intervention may help to maintain or improve QOL in this population. However, this study could not determine whether reduced QOL is a direct consequence of sarcopenia.

Associations of sarcopenia and its defining components with cognitive function in community-dwelling oldest old

BACKGROUND

This study aimed to investigate the associations of sarcopenia and its defining components with cognitive function in community-dwelling oldest old (over 80 years old) in China.

METHODS

Sarcopenia was diagnosed by the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Logistic and linear regression models were used to explore the associations of sarcopenia and its defining components with risk of mild cognitive impairment (MCI), and performance on multiple cognitive domains among 428 adults aged 80 years and older.

RESULTS

The overall prevalence of sarcopenia was 35.5%, with 40.34% for men and 32.14% for women. The prevalence of MCI was higher among sarcopenic oldest old than non-sarcopenic oldest old (28.95% vs. 17.39%, p = 0.005). Multivariate logistic regression analyses showed that sarcopenia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.04-3.33], low handgrip strength (HS) [OR = 2.33, 95% CI: 1.40-3.87] and slow gait speed (GS) [OR = 2.31, 95% CI: 1.13-4.72] were significantly and independently associated with risk of MCI. Multivariate linear regression analyses showed that low HS was associated with worse performance in global cognitive function, visuospatial and executive function, naming and delayed recall.

CONCLUSIONS

Sarcopenia, low HS and low GS was significantly associated with MCI in community-dwelling oldest old. The associations between sarcopenia and its defining components with different cognitive subdomains could be further explored in the future.

Patterns of Nutrient Intake in Relation to Sarcopenia and Its Components

Background: Despite the associations between individual nutrients and sarcopenia, we are aware of no information about the link between patterns of nutrient intake and odds of sarcopenia and its components. The present study aimed to examine the association between nutrient-based dietary patterns and sarcopenia and its components among the Iranian adult population. Methods: In this population-based, cross-sectional study, we enrolled 300 elderly adults (150 men and 150 women) aged ≥55 years by using a cluster random sampling method. Dietary intakes of the study population were assessed using a validated food frequency questionnaire. Principal component analysis was conducted to derive nutrient patterns based on a daily intake of 33 nutrients. Muscle mass, muscle strength, and gait speed were measured according to standard methods. Sarcopenia and its components were defined based on the European Working Group on Sarcopenia. Results: Three major nutrient-based dietary patterns were identified: (1) the "pro-vit pattern" that was high in pantothenic (B5), cobalamin (B12), calcium, protein, phosphor, riboflavin (B2), zinc, cholesterol, saturated fat, folate, niacin (B3), selenium, vitamin D, vitamin K, and vitamin A; (2) the "anti-inflammatory" pattern, which was rich in polyunsaturated fat, monounsaturated fat, copper, vitamin E, omega-3, magnesium, iron, pyridoxine (B6), sodium, and caffeine; and (3) the "carbo-vit" patternm which is characterized by high intake of fructose, glucose, dietary fiber, biotin, potassium, thiamin (B1), vitamin C, and chromium. After adjusting for confounders, subjects in the top tertile of the anti-inflammatory pattern had lower odds of sarcopenia (OR 0.25; 95% CI 0.10-0.63) and low muscle strength (OR: 0.46; 95% CI: 0.22-0.96) than those in the bottom tertile. Greater adherence to the carbo-vit pattern was inversely associated with the odds of low gait speed (OR: 0.46; 95% CI: 0.235-0.93). Conclusion: Major nutrient-based dietary patterns were significantly associated with sarcopenia and its components. Further studies are required to confirm our findings.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.

SPPB reference values and performance in assessing sarcopenia in community-dwelling Singaporeans - Yishun study

Background

The Short Physical Performance Battery (SPPB) is an established test of physical performance. We provide reference values for SPPB and determine SPPB performance and cut-offs in assessing sarcopenia for Asian community-dwelling older adults.

Methods

Five hundred thirty-eight (57.8% women) community-dwelling adults aged 21–90 years were recruited. SPPB and its subtest scores and timings (8 ft. gait speed (GS), five-times repeated chair sit-to-stand (STS) and balance) were determined. Appendicular lean mass divided by height-squared, muscle strength (handgrip) and physical performance (6 m GS, STS and SPPB) were assessed to define sarcopenia for various Asian criteria. Area under the ROC curve (AUC) was used to assess performance of SPPB and subtests in discriminating sarcopenia in adults aged ≥60 years. Optimal SPPB and GS subtest cut-offs for each sarcopenia criterion were determined by maximizing sensitivity and specificity.

Results

The mean SPPB score was 11.6(SD 1.1) in men and 11.5(SD1.2) in women. Majority of participants(≥50%) aged 21–80 years achieved the maximum SPPB score. SPPB total and subtest scores generally decreased with age (all p < 0.001), but did not differ between sex. Among older adults (≥60 years), SPPB and GS subtest had varied performance in assessing sarcopenia (AUC 0.54–0.64 and 0.51–0.72, respectively), and moderate-to-excellent performance in assessing severe sarcopenia (AUC 0.69–0.98 and 0.75–0.95, respectively), depending on sarcopenia definitions. The optimal cut-offs for discriminating sarcopenia in both sexes were SPPB ≤11points and GS subtest ≤1.0 m/s. The most common optimal cut-offs for discriminating severe sarcopenia according to various definitions were SPPB ≤11points in both sexes, and GS ≤0.9 m/s in men and ≤ 1.0 m/s in women.

Conclusions

Population-specific normative SPPB values are important for use in diagnostic criteria and to interpret results of studies evaluating and establishing appropriate treatment goals. Performance on the SPPB should be reported in terms of the total sum score and registered time to complete the repeated-chair STS and 8-ft walk tests. The performance of GS subtest was comparable to SPPB and could be a useful, simple and accessible screening tool for discriminating severe sarcopenia in community-dwelling older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02147-4.

Renal dysfunction is associated with decline of cognitive function in community-dwelling older adults: Korean frailty and aging cohort study

Background

Cognitive decline is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly population. We conducted this study to clarify the relationship between renal dysfunction and decline of cognitive function in community-dwelling elderly population.

Methods

A cross-sectional analysis was performed using data from the Korean Frailty and Aging Cohort Study, a nationwide cohort study. Total 2847 (1333 men, 1514 women) eligible participants were enrolled for this study. The estimated glomerular filtration rate (eGFR, mL/min/1.73m²) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Global cognitive function was assessed with the Mini-mental State Examination-Korean version. Other domains of cognitive function were tested with the Consortium to Establish a Registry for Alzheimer’s disease and the Frontal Assessment Battery.

Results

The mean age of all participants was 76.0 ± 3.9 years and eGFR (all in mL/min/1.73 m²) was 77.5 ± 14.3. And the mean eGFR was 91.7 ± 3.2 in quartile 1, 84.9 ± 1.8 in quartile 2, 76.1 ± 3.7 in quartile 3, and 57.2 ± 10.8 in quartile 4. In baseline characteristics, participants with lower eGFR tend to have lower cognitive function scores than participant with higher eGFR. In linear regression analysis, eGFR was correlated with the word list memory (β = 0.53, P = 0.005), word list recall (β = 0.86, P < 0.001), and word list recognition (β = 0.43, P = 0.030) after adjustment of confounding variables. Moreover, after multivariate adjustment the association with cognitive impairment in quartile 2 was stronger (adjusted OR: 1.535, 95% CI: 1.111–2.120, P = 0.009), and the ORs of cognitive impairment were 1.501 (95% CI: 1.084–2.079, P = 0.014) in quartile 3 and 1.423 (95% CI: 1.022–1.983, P = 0.037) in quartile 4.

Conclusion

In older adults, the immediate, recent memory, and recognition domains were significantly related to renal function. Also, the mild renal dysfunction was independently associated with impairment of global cognitive function. These results suggest that the early stages of renal dysfunction could be an effective target to prevent worsening of cognitive impairment. Therefore, regular monitoring and early detection of mild renal dysfunction in elderly population might be needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01862-8.

Reference Values of Gait Speed and Gait Spatiotemporal Parameters for a South East Asian Population: The Yishun Study

Background

Age-related slowing of gait has been reported to start as early as the fifth decade and accelerate beyond the seventh decade of life. A single cut-off for slow gait may not be appropriate for men and women of different ages. We aimed to report reference values for gait speed and spatiotemporal gait parameters of adult age groups in a South East Asian population.

Methods

A total of 507 community-dwelling adults, aged 21-90 years were recruited into the study through random sampling, filling quotas of 20-40 participants in each sex and age group (10-year age groups between 21 and 60 years; 5-year age groups beyond age 60 years). Demographic data, height, weight and information on comorbidities were recorded. Habitual gait speed and spatiotemporal parameters were measured, and the average of three trials was recorded using the GAITRite system.

Results

Gait speed peaked in their 40s for both men and women, but the trajectories differed slightly across age groups. Although similar for men in their 50s and 60s, gait speed was significantly slower among those aged 71 years and older. For women beyond 50 years old, gait slowed with age. After adjusting for height, women were found to walk significantly faster and with a longer step length than men. Women also walked with a significantly narrower stride width and less external rotation of the feet. The lowest quintile for gait speed in our study cohort was 0.9m/s, below the recommended cut-off of 1.0m/s.

Conclusion

We established the reference values as well as the quintiles for gait speed and spatiotemporal gait parameters across adult age groups in a multi-ethnic Asian population. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.

Kinematic Changes in a Mouse Model of Penetrating Hippocampal Injury and Their Recovery After Intranasal Administration of Endometrial Mesenchymal Stem Cell-Derived Extracellular Vesicles

Locomotion speed changes appear following hippocampal injury. We used a hippocampal penetrating brain injury mouse model to analyze other kinematic changes. We found a significant decrease in locomotion speed in both open-field and tunnel walk tests. We described a new quantitative method that allows us to analyze and compare the displacement curves between mice steps. In the tunnel walk, we marked mice with indelible ink on the knee, ankle, and metatarsus of the left and right hindlimbs to evaluate both in every step. Animals with hippocampal damage exhibit slower locomotion speed in both hindlimbs. In contrast, in the cortical injured group, we observed significant speed decrease only in the right hindlimb. We found changes in the displacement patterns after hippocampal injury. Mesenchymal stem cell-derived extracellular vesicles had been used for the treatment of several diseases in animal models. Here, we evaluated the effects of intranasal administration of endometrial mesenchymal stem cell-derived extracellular vesicles on the outcome after the hippocampal injury. We report the presence of vascular endothelial growth factor, granulocyte–macrophage colony-stimulating factor, and interleukin 6 in these vesicles. We observed locomotion speed and displacement pattern preservation in mice after vesicle treatment. These mice had lower pyknotic cells percentage and a smaller damaged area in comparison with the nontreated group, probably due to angiogenesis, wound repair, and inflammation decrease. Our results build up on the evidence of the hippocampal role in walk control and suggest that the extracellular vesicles could confer neuroprotection to the damaged hippocampus.

Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia

Sarcopenia is a clinical condition mainly affecting the elderly that can be associated in a long run with severe consequences like malnutrition and frailty. Considering the progressive ageing of the world population and the socio-economic impact of this disease, much effort is devoted and has to be further focused on an early and accurate diagnostic assessment of muscle loss. Currently, several radiological techniques can be applied for evaluating sarcopenia. If dual-energy X-ray absorptiometry (DXA) is still considered the main tool and it is even recommended as reference by the most current guidelines of the European working group on sarcopenia in older people (EWGSOP), the role of ultrasound (US), computed tomography (CT), peripheral quantitative CT (pQCT), and magnetic resonance imaging (MRI) should not be overlooked. Indeed, such techniques can provide robust qualitative and quantitative information. In particular, regarding MRI, the use of sequences like diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS) and mapping that could provide further insights into the physiopathological features of sarcopenia, should be fostered. In an era pointing to the quantification and automatic evaluation of diseases, we call for future research extending the application of organ tailored protocols, taking advantage of the most recent technical developments.

Association between Walking Pace and Diabetes: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Walking pace is a well-known indicator of physical capability, but it is also a strong predictor of type 2 diabetes (T2D). However, there is a lack of evidence on the association between walking pace and T2D, specifically, within developing countries such as Chile.

AIM

To investigate the association between self-reported walking pace and T2D in the Chilean adult population.

METHODS

5520 Chilean participants (aged 15 to 90 years, 52.1% women) from the Chilean National Health Survey 2016-2017 were included in this cross-sectional study. Both walking pace (slow, average, and brisk) and diabetes data were collected through self-reported methods. Fasting blood glucose (reported in mg/dl) and glycosylated haemoglobin A (HbA1c) scores were determined via blood exams.

RESULTS

In the unadjusted model, and compared to people who reported a slow walking pace, those with average and brisk walking pace had lower blood glucose levels (β = -7.74 mg/dL (95% CI: -11.08 to -4.40) and β = -11.05 mg/dL (95% CI: -14.36 to -7.75), respectively) and lower HbA1c (β = -0.34% (95% CI: -0.57 to -0.11) and β= -0.72% (95% CI: -0.94 to -0.49)), respectively. After adjusting for sociodemographic, Body Mass Index and lifestyle factors, the association between glycaemia and HbA1c remained only for brisk walkers. Both the average and brisk walker categories had lower odds of T2D (OR: 0.59 (95% CI: 0.41 to 0.84) and (OR 0.48 (95% CI: 0.30 to 0.79), respectively).

CONCLUSION

Brisk walkers were associated with lower blood glucose and HbA1c levels. Moreover, average to brisk walking pace also showed a lower risk for T2D.

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.

Age-related differences in bimanual coordination performance

Purpose. The purpose of this article was to determine how characteristics of bimanual coordination tasks affect the quality of performance and to determine the impact of these characteristics on muscular activation of the upper limbs, with consideration of age-related differences. Methods. The research was carried out on two groups consisting of 25 people aged 20-30 and 60-67 years. The subjects performed seven tasks that varied in coordination mode, tracking mode and outline-tracing. The main measures of task performance were calculated on the basis of the difference between the position of the target and tracing cursors. Cohen's d value was calculated to show differences in measures between groups. Results. There were higher values of error and variability measures for elderly people compared to young. Complex tasks showed the largest difficulty, which suggests that, when performed, such tasks have the greatest potential to improve coordination skills. Tasks during which both limbs contribute to the movement of one cursor proved the most appropriate. Conclusion. The tracking mode is of great importance for the quality of performance in motor coordination tasks, while the performance of tasks with imposed speed is much more strongly age-sensitive than performance with a freely chosen speed.

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.