Interrelation between Sarcopenia and the Number of Motor Neurons in Patients with Parkinsonian Syndromes

Sarcopenia in patients with isolated rapid eye movement sleep behavior disorder

OBJECTIVES

Evaluating of sarcopenia is important for promoting healthy aging, preventing functional decline, reducing the risk of falls and fractures, and improving overall quality of life. This study aimed to investigate sarcopenia in patients with isolated rapid eye movement sleep behavior disorder (RBD) using temporal muscle thickness (TMT) measurement.

METHODS

This investigation was retrospectively conducted at a single tertiary hospital. We recruited patients diagnosed with isolated RBD confirmed by polysomnography and clinical history and healthy participants as controls. Patients with isolated RBD and healthy controls underwent brain MRI scans, including three-dimensional T1-weighted imaging. We measured TMT, a radiographic marker of sarcopenia, based on the T1-weighted imaging. We compared the TMT between the groups and performed receiver operating characteristic (ROC) curve analysis to evaluate how well the TMT differentiated patients with isolated RBD from healthy controls. We also conducted a correlation analysis between the TMT and clinical factors.

RESULTS

Our study included 28 patients with isolated RBD and 30 healthy controls. There was a significant difference in the TMT of both groups. The TMT was reduced in patients with isolated RBD than in healthy controls (11.843 vs. 10.420 mm, p = 0.002). In the ROC curve analysis, the TMT exhibited good performance in differentiating patients with isolated RBD from healthy controls, with an area under the curve of 0.708. Furthermore, age was negatively correlated with TMT in patients with isolated RBD (r = -0.453, p = 0.015).

CONCLUSION

We demonstrate that TMT is reduced in patients with isolated RBD compared with healthy controls, confirming sarcopenia in patients with isolated RBD. The result suggests an association between neurodegeneration and sarcopenia. TMT can be used to evaluate sarcopenia in sleep disorders.

The prevalence of sarcopenia in Parkinson's disease and related disorders- a systematic review

BACKGROUND

The prevalence of sarcopenia (reduced skeletal muscle strength and mass), Parkinson's disease (PD) and Parkinson's related disorders (PRD) all increase with age. They also share risk factors and pathogenetic features. An increased prevalence of sarcopenia in PD and PRD than the general population was thus postulated.

METHODS

Four databases were searched using predefined literature search strategies. Studies conducted in participants with PD or PRD reporting the prevalence of sarcopenia and those providing data to compute the prevalence were included. Pre-sarcopenia, probable/possible sarcopenia and confirmed sarcopenia were defined according to the main sarcopenia working groups. Risk of bias was assessed using the AXIS tool.

RESULTS

1978 studies were identified; 97 assessed in full; 14 met inclusion criteria. The median study quality score was 15/20. The range of probable sarcopenia was 23.9 to 66.7%, and it did not change after excluding PRD participants. The prevalence of confirmed sarcopenia in participants with any parkinsonian disorder ranged from 2 to 31.4%. Including just PD participants, the range was 10.9 to 31.4%. In studies with controls, sarcopenia was more prevalent in PD and PRD. There was a positive non-significant trend between severity of motor symptoms and prevalence of sarcopenia or components of sarcopenia. High heterogeneity precluded meta-analysis, therefore there was insufficient evidence to conclude whether sarcopenia is more prevalent in PD or PRD.

CONCLUSIONS

Probable and confirmed sarcopenia are common in PD and PRD and they may be associated with disease severity. This co-occurrence supports the value of screening for sarcopenia in parkinsonian populations.

The value of ultrasound measurement of muscle thickness at different sites and shear wave elastography in Parkinson's disease with sarcopenia: a pilot study

Background

Patients with Parkinson's disease (PD) and sarcopenia often exhibit resilience, frailty, disability, and depression, highlighting the complex and interrelated nature of these conditions.

Objective

Despite the presence of clinical manifestations of muscle atrophy in both PD and sarcopenia, accurately discerning the coexistence of sarcopenia in PD patients remains a challenging task with significant implications for treatment strategies and prognostic assessments. This study aims to elucidate the specific ultrasonic diagnostic parameters associated with PD accompanied by sarcopenia through a comparative analysis of muscle ultrasound parameters in patients with PD, thereby presenting a novel approach for rapid identification of this condition.

Methods

A total of 110 participants were enrolled in this study, including patients with PD and control subjects. Demographic data, clinical characteristics, physical performance tests, appendicular skeletal muscle mass index (ASMI), bioelectrical impedance analysis and muscle ultrasound measurements were collected from all participants. The muscle ultrasound measurements encompassed assessments of muscle thickness, pennation angle and shear wave elastography at various anatomical sites.

Results

Parkinson's disease patients exhibited decreased muscle strength and physical performance, and increased shear wave elastography value. In PD patients with sarcopenia, body circumference, including calf circumference, mid-arm circumference, Waist-to-Hip Ratio and body mass index (BMI) were all significantly decreased. Biceps brachii muscle thickness (MT) and gastrocnemius MT decreased in PD patients with sarcopenia and low ASMI. Binary logistic regression analysis revealed that male PD patients, BMI and gastrocnemius MT were predictive factors for ASMI in PD patients.

Conclusion

Biceps brachii MT and gastrocnemius MT are important indicators for distinguishing whether PD patients have sarcopenia. Male patients, low BMI and gastrocnemius MT were identified as valid predictors of low ASMI in PD patients. The findings of this study provide important insights into the use of muscle ultrasound in the diagnosis of PD with sarcopenia.

Association between preoperative diagnosis of sarcopenia and postoperative pneumonia in resectable esophageal squamous cell carcinoma patients: a retrospective cohort study

Background

Postoperative outcomes for patients suffering from resectable esophageal squamous cell carcinoma (ESCC) are related to sarcopenia. In patients with resectable ESCC, this study investigated the link between sarcopenia and postoperative pneumonia.

Methods

The McKewon procedure was the only one used to treat resectable ESCC patients from January 2018 to December 2021 in this retrospective analysis. Sarcopenia was assessed using skeletal muscles at L3 and planning CT scans. It was defined when PMI was below 6.36 cm²/m² and 3.92 cm²/m² for men and women, separately. Analyses of multivariate and univariate logistic regression were applied for identifying the risk factors for postoperative pneumonia.

Results

The study included 773 patients with resectable ESCC in total. Sarcopenia was an independent risk factor for postoperative pneumonia in individuals with resectable ESCC based on univariate and multivariate analysis (P < 0.05). The stratified analysis indicated that neither of the clinical outcomes in the logistic regression model were affected by gender, age, BMI, smoking, or pre-albumin (P for interaction > 0.006).

Conclusion

Following the McKewon procedure, patients with resectable ESCC who were sarcopenic had a higher postoperative pneumonia rate. To prevent the development of postoperative pneumonia during the perioperative period, it may be important to control the incidence of sarcopenia.

Potential of Food Protein-Derived Bioactive Peptides against Sarcopenia: A Comprehensive Review

Sarcopenia is an age-related progressive muscle disorder characterized by accelerated loss of muscle mass, strength, and function, which are important causes of physiological dysfunctions in the elderly. At present, the main alleviating method includes protein supplements to stimulate synthesis of muscle proteins. Food protein-derived peptides containing abundant branched-chain amino acids have a remarkable effect on the improvement of sarcopenia. Understanding the underlying molecular mechanism and clarifying the structure-activity relationship is essential for the mitigation of sarcopenia. This present review recaps the epidemiology, pathogenesis, diagnosis, and treatment of sarcopenia, which facilitates a comprehensive understanding of sarcopenia. Moreover, the latest research progress on food-derived antisarcopenic peptides is reviewed, including their antisarcopenic activity, molecular mechanism as well as structural characteristics. Food-derived bioactive peptides can indeed alleviate/mitigate sarcopenia. These antisarcopenic peptides play a pivotal role mainly by activating the PI3K/Akt/mTOR and MAPK pathways and inhibiting the ubiquitin-proteasome system and AMPK pathway, thus promoting the synthesis of muscle proteins and inhibiting their degradation. Antisarcopenic peptides alleviate sarcopenia via specific peptides, which may be absorbed into the circulation and exhibit their bioactivity in intact forms. The present review provides a theoretical reference for mitigation and prevention of sarcopenia by food protein-derived bioactive peptides.

Prevalence of sarcopenia in Parkinson's disease: A systematic review and meta-analysis

We meta-analysed the sarcopenia prevalence among patients with Parkinson´s disease (PD) in comparison to a control group and tested the effects of age, sex, sarcopenia assessments, and PD progression in the sarcopenia prevalence. The literature search was performed using five databases in March 2022. The prevalence of sarcopenia in patients with PD was 3 times higher than in the control group (OR 3.98). Subgroup analyses showed that among individuals aged ≥ 70 years the higher prevalence of sarcopenia in PD compared to controls (OR 5.32, P=0.08) tended to be higher (P=0.08) than the group < 70 years. Regarding PD progression, the prevalence of sarcopenia was not different between individuals scoring < 2.5 and ≥ 2.5 in the Hoehn and Yahr scale. Patients with PD have a higher probability of developing sarcopenia when compared with the control group and older PD patients trended to have even higher chance of sarcopenia than their older controls.

Different assessment tools to detect sarcopenia in patients with Parkinson's disease

Introduction

Sarcopenia and Parkinson's disease are closely related diseases of the elderly population leading to progressive disability and nursing-dependent care.

Objective

The aim of this study was to estimate the prevalence of sarcopenia in PD patients with three different approaches: (1) the screening tool SARC-F, (2) EWGSOP-1 criteria, and (3) EWGSOP-2 criteria. Moreover, we aimed to evaluate the diagnostic accuracy of the screening tool SARC-F to detect sarcopenia according to the updated EWGSOP-2 criteria.

Methods

Eighty-one patients with Parkinson's disease aged 65 years and above were interviewed in a cross-sectional study at a tertiary referral center. All patients were screened with the SARC-F questionnaire and were evaluated for motor and non-motor symptoms, exercise, quality of life, and frailty. Muscle mass was assessed with bioelectrical impedance analysis, handgrip strength with a dynamometer, and gait speed was assessed with the 8-m walk test. EWGSOP-2 criteria were considered the gold standard to diagnose sarcopenia in our study.

Results

Eighty-one patients were evaluated (mean age: 73.82; SD 5.30). The prevalence of sarcopenia was 28.4% according to the EWGSOP-2 criteria. The concordance between EWGSOP-2 and EWGSOP-1 was poor (weighted kappa of 0.361[95% 0.164–0.557]). The sensitivity of the SARC-F screening test for detecting sarcopenia was 60.9%. The corresponding AUC in the ROC curve analysis showed 0.598 (0.462, 0.734 CI). The item assessing strength was found to have the highest sensitivity (69.6%).

Conclusion

Sarcopenia prevalence in patients with PD in Tirol, Austria is higher with EWGSOP-1 criteria compared to EWGSOP-2 criteria. The sensitivity and specificity of the SARC-F scale to detect sarcopenia in this population are poor.

A Bioelectrical Impedance Analysis for the Assessment of Muscle Atrophy in Patients with Chronic Inflammatory Demyelinating Polyneuropathy

Objective Muscle atrophy is observed in a subset of patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Its manifestation is associated with a poor functional prognosis and poor response to immunomodulatory therapies. We evaluated muscle atrophy in patients with CIDP using a bioelectrical impedance analysis (BIA). Methods We enrolled 12 patients with CIDP for a BIA of muscle atrophy. Of these 12 patients, 10 were diagnosed with typical CIDP, 1 with multifocal acquired demyelinating sensory and motor neuropathy, and 1 with distal acquired demyelinating symmetric neuropathy. All 12 patients underwent a series of assessments and evaluations, including a BIA and computed tomography (CT). A correlation was found between the skeletal muscle mass determined by the BIA and that found using CT of the muscles. Results The BIA provided values for each patient's skeletal muscle mass index (SMI) ranging from 4.1 to 8.1 kg/m². Four of the patients with CIDP had SMI values below the threshold for sarcopenia. CT of the patients' muscles provided scores indicating grades of muscle atrophy in the upper and lower extremities. A comparison of the outcomes from these two measures showed a good correlation between their muscle atrophy ratings (p <0.05). Conclusions We found that a BIA and muscle CT provided muscle atrophy assessments of equivalent accuracy. Therefore, a BIA can be a simple alternative to muscle CT that is suitable for regular use in daily clinical practice as a reliable tool for assessing muscle atrophy in patients with CIDP.

Sarcopenia and nervous system disorders

Sarcopenia has an insidious start that can induce physical malfunction, raise the risk of falls, disability, and mortality in the old, severely impair the aged persons' quality of life and health. More and more studies have demonstrated that sarcopenia is linked to neurological diseases in recent years. This review examines the advancement of sarcopenia and neurological illnesses research.

Similarities, differences and overlaps between frailty and Parkinson's disease

Parkinson's disease is a neurodegenerative disorder clinically characterized by bradykinesia, rest tremor, rigidity, and postural and gait disturbances, which are frequently observed in older people. It also shows non-motor symptoms, such as depression, anxiety, cognitive impairment and dementia. The number of patients is gradually increasing worldwide. Aging is a risk factor for the onset of Parkinson's disease, and various physiological effects of aging influence its progression. Frailty is a geriatric syndrome in which the reversible and vulnerable status between robustness and disability is affected by various physiological stressors with aging. Frailty consists of physical, psychological and social aspects. Furthermore, sarcopenia, a syndrome characterized by the loss of muscle mass, strength and function, is also significantly associated with frailty. To maintain the quality of life of older people, frailty, including sarcopenia, should be quickly and appropriately managed. Polypharmacy is an important factor causing the progression of frailty in geriatric syndrome. Although Parkinson's disease and frailty have similar symptoms, and are considered to affect each other, the clinical features and mechanisms of both largely remain unclear. Nevertheless, little literature on the relationship between frailty and Parkinson's disease is currently available. This narrative review aims to clarify the relationships between Parkinson's disease and frailty, not only on the physical, but also on the mental, cognitive, and social aspects and issues regarding polypharmacy in Parkinson's disease explored by previous studies. Geriatr Gerontol Int 2022; 22: 259-270.

Temporalis Muscle Thickness as an Indicator of Sarcopenia Is Associated With Long-term Motor Outcomes in Parkinson's Disease

BACKGROUND

To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson's disease (PD).

METHODS

We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up > 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia, wearing-off, and freezing of gait and a linear mixed model for the longitudinal increases in levodopa-equivalent dose per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed.

RESULTS

TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p < .001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing levodopa-induced dyskinesia, wearing-off, or freezing of gait during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in levodopa-equivalent dose per body weight in male PD patients, but not in female PD patients.

CONCLUSIONS

This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.

Myostatin and Follistatin-New Kids on the Block in the Diagnosis of Sarcopenia in IBD and Possible Therapeutic Implications

Sarcopenia, which is a decrease in muscle strength and quality of muscle tissue, is a common disorder among patients suffering from inflammatory bowel disease. This particular group of patients often presents with malnutrition and shows low physical activity, which increases the risk of sarcopenia. Another important factor in the development of sarcopenia is an imbalanced ratio of myostatin and follistatin, which may stem from inflammation as well as genetic factors. Currently, research in this area continues, and is aimed at identifying an effective medication for the treatment of this condition. Additionally, we still have no sarcopenia markers that can be used for diagnosis. In this paper, we address the role of myostatin and follistatin as potential markers in the diagnosis of sarcopenia in patients with Crohn’s disease and ulcerative colitis, particularly in view of the genetic and biological aspects. We also present data on new perspectives in the pharmacotherapy of sarcopenia (i.e., myostatin inhibitors and gene therapy). Nevertheless, knowledge is still scarce about the roles of follistatin and myostatin in sarcopenia development among patients suffering from inflammatory bowel disease, which warrants further study.

Age-Related Changes in Shear Wave Elastography Parameters of the Gastrocnemius Muscle in Association with Physical Performance in Healthy Adults

BACKGROUND/AIMS

to investigate new indicators for early recognition of physical performance decline. Shear wave elastrography, a new ultrasound technique, was discussed in this study.

METHODS

Gastrocnemius muscle thickness and muscle stiffness were detected by traditional ultrasound and shear wave elastrography in 108 Chinese aged 20-85 years, and then analyzed with physical performance together.

RESULTS

After 70 years old, the decline rate of muscle stiffness under contractive state was significantly faster than that of muscle thickness, muscle relaxed stiffness, and physical performance indicators. The correlation analysis showed that gastrocnemius contractive stiffness was positively related with handgrip strength, step length, and fast gait speed after adjusted by age and gender. Among physical performance variants, step length had closer relationship with muscle strength than repeated chair stands.

CONCLUSIONS

The detection of gastrocnemius muscle by shear wave elastography reflected the change of lower-limb muscle stiffness with aging. Muscle contractive stiffness and step length measurement supplied novel ways for muscle performance and motor function assessment.

Sarcopenia in Patients With Parkinson's Disease: A Systematic Review and Meta-Analysis

Background: Parkinson's disease (PD) and sarcopenia are two common diseases in aging people. To date, the prevalence of sarcopenia in PD patients and the relationship between clinical features and sarcopenia in PD patients are not clear. The aim of the study was to (1) assess the prevalence of sarcopenia in PD patients and (2) reveal the clinical features between PD patients with and without sarcopenia. Method: A systematic review was carried out through screening PubMed, EMBASE, and Cochrane database in May 2020. All study designs (case-control, cohort, and cross-sectional studies) were eligible for meta-analysis. Data of patients' characteristics, sarcopenia criteria, sarcopenia prevalence, and sarcopenia measures were retrieved. The primary outcome was estimated prevalence of sarcopenia by a pooled prevalence (%) and its 95% confidence interval (CI), using a random-effects model. The secondary outcome was the differences in clinical features between PD patients with and without sarcopenia by meta-analysis. Included articles were assessed for risk of bias. Potential sources of variation were investigated by using subgroup analyses and meta-regression. Result: Ten studies were included in the review. Among them, nine were cross-sectional studies, and one was a prospective cohort study. Age of participants with PD in the studies ranged from 51.1 to 80.7 years. The estimated prevalence of sarcopenia ranged from 6 to 55.5%. The random-effects pooled prevalence was 29% (95% CIs: 0.18-0.40). When only studies at low risk of bias were considered, pooled prevalence decreased to 17% (95% CIs: 0.02-0.33), with still high heterogeneity. The incidence of falls in PD patients with sarcopenia was higher than that in PD patients without sarcopenia. There was no difference in sex ratio between PD patients with and without sarcopenia. Conclusion: Sarcopenia seems to be common in patients with PD. Early assessment of sarcopenia should be implemented in PD to avoid fall and disability.

SARC-F and SARC-CalF in screening for sarcopenia in older adults with Parkinson's disease

INTRODUCTION

Few studies have investigated the performance of screening tools in truly sarcopenic individuals, especially subgroups of this population, or in comparison to previous and current criteria for the definition of sarcopenia.

OBJECTIVES

Evaluate the performance of SARC-F and SARC-CalF in screening for sarcopenia in patients with Parkinson's disease (PD) in comparison to the diagnostic criteria proposed by the 2010 (1) and 2019 (2) European Working Group on Sarcopenia in Older People (EWGSOP).

METHODS

A methodological, cross-sectional study was conducted involving male and female patients ≥60 years of age diagnosed with PD in outpatient care. The risk of sarcopenia was assessed using the SARC-F and SARC-CalF questionnaires, the latter of which includes the calf circumference as an additional item.

RESULTS

Sixty patients were evaluated (mean age: 68.9 ± 6.5 years). The prevalence of sarcopenia was 21.7% according to EWGSOP-2 and 55.0% according to EWGSOP-1. Positive screening for sarcopenia was 30% according to the SARC-F and 36.7% according to SARC-CalF. The sensitivity of the SARC-F for the detection of sarcopenia was 27.2% and 23.1% using the criteria of the 2010 and 2019 consensuses, respectively. The comparative analysis of the SARC-CalF revealed a better performance in the diagnostic discrimination with the addition of calf circumference, with sensitivity ranging from 53.8 to 54.5%. Higher sensitivity was found on items addressing the ability to stand up from a chair and climb stairs (69.2%) and the occurrence of falls (76.9%) compared to the use of the complete questionnaire.

CONCLUSION

Relatively low sensitivity and an underestimation of sarcopenia were found in the analysis of the SARC-F as a screening tool for sarcopenia. Thus, a significant number of sarcopenic patients would not be identified using this screening tool alone. The SARC-CalF performed better than the SARC-F.