Abstract
Background: Sarcopenia is frequently seen in patients with mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD). While appetite loss and physical inactivity, which are also frequently seen in dementia, appear to contribute to sarcopenia, to date, no study has investigated this association.Objective: The aim of this study was to examine factors associated with sarcopenia, including appetite and physical activity, in patients with MCI and early-stage AD.Methods: The study subjects comprised 205 outpatients (MCI, n = 151; early-stage AD, n = 54) who were being treated at the Memory Clinic, National Center for Geriatrics, and Gerontology and had a Mini-Mental State Examination (MMSE) score of 21 or higher. All subjects were assessed for appetite by using the Council on Nutrition Appetite Questionnaire (CNAQ). Confounding variables assessed included physical activity, activities of daily living, mood, body mass index (BMI), nutritional status, and medications. Sarcopenia was defined as low muscle mass and low handgrip strength or slow gait speed. Multivariate logistic regression analyses were performed with adjustment for age, gender, education, and confounding variables to examine the association of sarcopenia with physical activity and appetite. Furthermore, sub-analyses were also conducted to clarify the relationship between CNAQ sub-items and sarcopenia.Results: The prevalence of sarcopenia among the subjects was 14.6% (n = 30). Patients with sarcopenia had lower CNAQ scores (those with sarcopenia, 26.7 ± 3.5; those without, 29.1 ± 2.5). Multivariate analysis showed that BMI (odds ratio [OR], 0.675; 95% confidence interval [CI], 0.534–0.853), polypharmacy (OR, 4.489; 95% CI, 1.315–15.320), and CNAQ (OR, 0.774; 95% CI, 0.630–0.952) were shown to be associated with sarcopenia. Physical activity was not associated with sarcopenia. Of the sub-items of the CNAQ, appetite (OR, 0.353; 95% CI, 0.155–0.805), feeling full (OR, 0.320; 95% CI = 0.135–0.761), and food tastes compared to when younger (OR, 0.299; 95% CI, 0.109–0.818) were shown to be associated with sarcopenia.Conclusions: These results suggest that appetite could be a modifiable risk factor for sarcopenia in patients with MCI and early-stage AD. A comprehensive approach to improving appetite may prove effective in preventing sarcopenia.
Highlights
Frailty is construed as a consequence of age-related decline in many physiological systems, resulting in vulnerability to sudden adverse changes in health status triggered by minor stressor events [1]
Physical activity was not associated with sarcopenia in our study subjects with mild cognitive impairment (MCI) and early-stage Alzheimer’s disease (AD)
Low vitality appears to affect both appetite and physical activity, our study demonstrated that appetite was associated with sarcopenia, but physical activity as evaluated based on the presence or absence of exercise habits was not
Summary
Frailty is construed as a consequence of age-related decline in many physiological systems, resulting in vulnerability to sudden adverse changes in health status triggered by minor stressor events [1]. Frailty is thought to represent a combination of problems in different domains of human functioning, such as physical, psychological, and social domains [2]. Since frailty is known to be associated with adverse outcomes [1], prevention of onset of frailty, as well as care of the elderly with frailty, remains the most urgent of challenges in clinical practice. Factors associated with sarcopenia are multifaceted and include aging, inappropriate nutrition, low physical activity, chronic inflammation, and sex hormones [3]. In particular, nutrition and exercise are known to be important modifiable risk factors. While appetite loss and physical inactivity, which are frequently seen in dementia, appear to contribute to sarcopenia, to date, no study has investigated this association
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