Abstract
BackgroundThe 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.MethodsThis 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.ResultsAmong 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).ConclusionsGlobal 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.
Highlights
Dementia is characteristic of progressive cognitive decline involving one or more of the cognitive domains
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The study participants were selected according to the following criteria: age ≥ 65 years, Clinical Dementia Rating (CDR) ≥ 0.5, no difficulty performing basic activities of daily living (ADL), no active treatment for cancer in the prior 3 years, and only cases with no hematoma, brain tumor, acute stroke, or postinfarction encephalomalacia resulting in mass effect or asymmetry affecting the ventricular system shape or subarachnoid space volume [39]
Summary
Dementia is characteristic of progressive cognitive decline involving one or more of the cognitive domains. The coexistence of sarcopenia, cognitive impairment, and brain atrophy in aging populations may indicate shared common risk factors and pathophysiological pathways [8]. Other studies suggest sarcopenia and low muscle mass are linked to cognitive impairment/dementia and brain atrophy [10,11,12,13]. Evidence of an association between sarcopenia/low muscle mass and cognitive impairment/dementia among the elderly remains inconsistent and lacking [14]. Accumulating evidence indicates that non-pharmacological treatments such as optimized nutrition and physical activity can be valuable countermeasures to both sarcopenia/low muscle mass and dementia/mild cognitive impairment (MCI) in terms of treatment and prevention [17,18,19,20,21,22]. This study aimed to evaluate the relationship between brain atrophy and low lean mass in the elderly with impaired cognitive function
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