Gabor Abellan van Kan

Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia

Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is ≤ 7.23 kg/m(2) in men and ≤ 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.

Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l'OSteoporose) Study

BACKGROUND In elders, decreased muscle mass (sarcopenia) and increased fat mass (obesity) may contribute to difficulties with physical function. OBJECTIVE The objective was to examine the association of obesity, sarcopenia, and their combination (sarcopenic-obesity) with self-reported difficulties performing physical function in a cohort of community-dwelling elderly women. DESIGN We assessed muscle and fat mass by dual-energy X-ray absorptiometry and self-reported difficulties with physical function in 1308 healthy women aged > or =75 y. Sarcopenia was defined as an appendicular skeletal muscle mass < or =2 SD below the mean in a young female reference group. Obesity was defined as a percentage body fat above the 60th percentile. Thirty-six sarcopenic-obese, 90 purely sarcopenic, 435 purely obese, and 747 women with a healthy body composition were studied. Anthropometric measures, health status, lifestyle habits, and self-reported difficulties with 6 different physical functions were obtained. RESULTS Compared with women with a healthy body composition and after adjustment for confounders, purely sarcopenic women had no increased odds of having difficulties for all of the physical functions assessed, purely obese women had a 44-79% higher odds of having difficulties with most of the physical functions assessed (P < 0.05), and sarcopenic-obese women had a 2.60 higher odds of having difficulty climbing stairs and a 2.35 higher odds of having difficulty going down stairs (all P < 0.05). CONCLUSIONS Sarcopenia is not associated with physical difficulties in the absence of obesity. However, in the presence of obesity, sarcopenia tends to add difficulty for some physical functions.

Frailty: Toward a Clinical Definition

high rd in vulllow eted hod While most clinicians believe they can recognize a older person, there is a lack of consensus as to what frailty and how it should be diagnosed clinically. 1,2 For this reason, a Geriatric Advisory Panel of the International A emy of Nutrition and Aging has postulated a new approa defining frailty and a case-finding tool. 3 The major agreemen of the group was that for frailty to be a useful clinical tion, it should be considered a predisability state. T stressed that, conceptually, frailty should exclude persons w disability (ie, physical impairment that interferes with ability to perform activities of daily living). Most definitions of frailty have considered it to be a where there is increased vulnerability to stressors. 1,4,5,6 When a frail individual is exposed to a stressor, it is postulate they are at increased risk of developing disability or adverse outcomes (like death, hospitalization, or instituti alization). Thus, the frailty syndrome is part of a contin situated between the normal physiological changes of a and the final state of disability and death. Commonly used definitions of frailty include the F criteria. These criteria, which have been widely embrac include exhaustion (fatigue), weight loss, measured g strength and walking speed, and low energy expenditure. lack of standards for some of the measurements, the diffi in performing these tests in frail older persons especially i nursing home, 8 and the failure of this group to exclude ability have limited the incorporation of these evidence-b criteria into general clinical practice. Rockwood and colleagues 9 have created a frailty ind based on disability and illnesses. It appears to be predict death and institutionalization. 10 It may also predict po outcomes in the nursing home. The Short Physical Performance Battery (gait speed, peated chair stands, and tandem balance) was found t predictive of disability in nondisabled community living

Physical Activity and Alzheimer's Disease: From Prevention to Therapeutic Perspectives

A number of factors, including physical activity, may contribute to prevention of cognitive decline and delay the onset of dementia. In addition to its convincing multiple benefits, an increasing body of evidence suggests that an active life has a protective effect on brain functioning in elders. Physical activity may also slow down the course of Alzheimers disease. These hypotheses have led to increasing research in this specific area during the past decade. This review systematically analyzes the current literature on Alzheimers disease and the effect of physical activity. Epidemiological studies, short-term randomized controlled trials (RCTs) in nondemented participants, and biological research suggest that physical activity improves cognitive function in older subjects. The limitations of these works are discussed. No RCTs have yet demonstrated that regular physical activity prevents dementia. Additional challenging clinical interventional studies are needed to demonstrate this relationship, but accumulating evidence from biological research is available. Defining the optimal preventive and therapeutic strategies in terms of type, duration, and intensity of physical activity remain an open question. In the future, the prevention of Alzheimers disease may be based on rules governing lifestyle habits such as diet, cognitive activity, and physical activity.

The Assessment of Frailty in Older Adults

No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes.

The frailty phenotype and the frailty index: different instruments for different purposes

The integration of frailty measures in clinical practice is crucial for the development of interventions against disabling conditions in older persons. The frailty phenotype (proposed and validated by Fried and colleagues in the Cardiovascular Health Study) and the Frailty Index (proposed and validated by Rockwood and colleagues in the Canadian Study of Health and Aging) represent the most known operational definitions of frailty in older persons. Unfortunately, they are often wrongly considered as alternatives and/or substitutables. These two instruments are indeed very different and should rather be considered as complementary. In the present paper, we discuss about the designs and rationals of the two instruments, proposing the correct ways for having them implemented in the clinical setting.

Healthy Brain Aging: Role of Exercise and Physical Activity

There is increasing evidence to suggest that physical activity has a protective effect on brain functioning in older people. To date, no randomized controlled trial (RCT) has shown that regular physical activity prevents dementia, but recent RCTs suggests an improvement of cognitive functioning in persons involved in aerobic programs, and evidence is accumulating from basic research. Future prevention of Alzheimer disease may depend on lifestyle habits such as physical activity.

Cachexia versus sarcopenia.

Purpose of reviewThe review summarizes and discusses the proposed new definitions for sarcopenia and cachexia. It also highlights the overlapping of both conditions and the fact that these conditions frequently occur in elderly patients. Recent findingsSarcopenia is now recognized as a multifactorial geriatric syndrome. Cachexia is defined as a metabolic syndrome in which inflammation is the key feature and so cachexia can be an underlying condition of sarcopenia. Recently, cachexia has been defined as ‘a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle mass with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults’. Different recommendations have been proposed for the diagnosis of sarcopenia. At present, all definitions combine an assessment of muscle mass and muscle function (strength or physical performances such as gait speed). However, the relevance and the validation of these evolving definitions need to be assessed in future studies. SummaryAlthough the recent definitions of sarcopenia and cachexia boost research in the field and define distinct entities, the cause behind the loss of muscle mass (whether cachexia or sarcopenia) may, however, be indistinguishable in clinical practice. Therefore, new therapeutic approaches, alone or in combination, could be targeted on both conditions.

Treatment Strategies for Sarcopenia and Frailty

Sarcopenia is the key feature of frailty in older people and a major determinant of adverse health outcomes such as functional limitations and disability. Resistance training and adequate protein and energy intake are the key strategies for the management of sarcopenia. Management of weight loss and resistance training are the most relevant protective countermeasures to slow down the decline of muscle mass and muscle strength. The quality of amino acids in the diet is an important factor for stimulating protein synthesis. Vitamin D deficiency should be treated, and new pharmacologic approaches for sarcopenia are currently assessed.

Sarcopenia and cognitive impairment in elderly women: results from the EPIDOS cohort

BACKGROUND common pathophysiological pathways are shared between age-related body composition changes and cognitive impairment. OBJECTIVE evaluate whether current operative sarcopenia definitions are associated with cognition in community-dwelling older women. DESIGN cross-sectional analyses. SUBJECTS a total of 3,025 women aged 75 years and older. MEASUREMENTS body composition (assessed by dual energy X-ray absorptiometry) and cognition (measured by short portable mental status questionnaire) were obtained in all participants. Multivariate logistic regression models assessed the association of six operative definitions of sarcopenia with cognitive impairment. Gait speed (GS, measured over a 6-meter track at usual pace) and handgrip strength (HG, measured by a hand-held dynamometer) were considered additional factors of interest. RESULTS a total of 492 (16.3%) women were cognitively impaired. The prevalence of sarcopenia ranged from 3.3 to 18.8%. No sarcopenia definition was associated with cognitive impairment after controlling for potential confounders. To proof consistency, the analyses were performed using GS and HG, two well-established predictors of cognitive impairment. Low GS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.72-3.40] and low HG (OR: 1.81, 95% CI: 1.33-2.46) were associated with cognitive impairment. CONCLUSION no significant association was evidenced between different operative sarcopenia definitions and cognitive impairment. The study suggests that the association between physical performance and cognitive impairment in not mediated by sarcopenia.