sarcopenia. geriatric medice

7/26/2019 Sarcopenia. Geriatric Medice

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Sarcopenia


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Case:

A 73 year old Patient is in the GP clinic because ofongoing muscle pain, weakness !his has slowlyprogress the last decade She now has problem

walking up the stairs She needs support gettingout of the car She feels generally weak and feelsthat she some how o"er the last decade has slowlylost her stamina She noticed this because she nowhas big problem with walking to the supermarket#$$m away She has problem with balance %uringthe "isit she also e&press feeling of sadness andthat life is "ery hard for her She has had noweight loss 'o loss or increased app(tit


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)besity *++$ kg

%- type ./

G0 le"els is normal, in the lower border

)steoporosis

0ypertension Generally "ery inacti"e for the most of here

life


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%i1 %iagnosis

Cancer

'eurological disease

%epression


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%e2nition

n +43+, Critchley noted that with aging there wasa loss of muscle mass which was most marked inthe hands and feet

n +454, rwin 6osenberg proposed the termsarcopenia/ *Greek sar&/ or 8esh 9 penia/ or lossto describe this agerelated decrease of musclemass Sarcopenia has since been de2ned as theloss of skeletal muscle mass and strength that

occurs with ad"ancing age 0owe"er, a widelyaccepted de2nition of sarcopenia suitable for usein research and clinical practice is still lacking


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;hat is sarcopenia;GS)P *>uropean working group onsarcopenic in older people recommends

using the presence of both low muscle massand low muscle function *strength orperformance for the diagnosis ofsarcopenia


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>pidemiology

Sarcopenia is "ery common in older personswith a pre"alence from # to +3? in personsaged @$ to 7$ years and of ++ to #$? in persons

o"er 5$ years of age

Sarcopenia is appro&imately twice as commonas frailty n the nited States, it can beestimated that there are roughly 3@ millionpersons with frailty

!he healthcare costs of sarcopenia in the SA in.$$$ were estimated to be B+5# billion


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Sarcopenia

categories Sarcopenia can be considered primary/ *or age

related when no other cause is e"ident but ageingitself

Sarcopenia can be considered secondary/ when oneor more other causes are e"ident

n many older people, the etiology of sarcopenia ismultifactorial so that it may not be possible tocharacterise each indi"idual as ha"ing a primary orsecondary condition !his situation is consistent withrecognising sarcopenia as a multifaceted geriatricsyndrome


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Secondary

sarcopenia Acti"ityrelated sarcopenia: Can result from bed rest,

sedentary lifestyle, deconditioning or erogra"ityconditions

%iseaserelated sarcopenia: Associated withad"anced organ failure *heart, lung, li"er, kidney,brain, in8ammatory disease, malignancy orendocrine disease

'utritionrelated sarcopenia: 6esults frominade=uate dietary intake of energy andDor protein,as with malabsorption, gastrointestinal disorders oruse of medications that cause anore&ia


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Sarcopenia staged

Sarcopenia staging, which re8ects the se"erity of the condition,is a concept that can help guide clinical management of thecondition >;GS)P suggests a conceptual staging aspresarcopenia/, sarcopenia/ and se"ere sarcopenia/

!he presarcopenia stage is characterised by low musclemass without impact on muscle strength or physicalperformance !he sarcopenia stage is characterised by lowmuscle mass, plus low muscle strength or low physicalperformance Severe sarcopeniais the stage identi2ed whenall three criteria of the de2nition are met *low muscle mass, low

muscle strength and low physical performance

6ecognising stages of sarcopenia may help in selectingtreatments and setting appropriate reco"ery goals


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Symptoms

Weakness

Loss of stamina which interferes with physical

activityreduce muscle mass further.

Inability to perform daily activities

Depression


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Physiology

Atrophy and loss of skeletal muscle, mainly type IIfibers (fast twitch)

Increased type I fibers reinervates type II fibersless efficient motor unit

Less precise movements

Less force

Less coordination

Loss of balance and speed


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>tiology

Physical inacti"ity

Agerelated reduction in ner"e cells responsible forsending signals from the brain to the muscles to initiate

mo"ement

A decrease in the concentrations of some hormones,including growth hormone, testosterone, and insulinlikegrowth factor

ncreased cytokine production in in8ammation *F@,!'H F@ and !'Hresult in muscle cell death*ubi=uitin proteasome system resulting in muscleatrophy, decreased strenght and functional decline


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>tiology cont

A decrease in the bodyIs ability tosynthesie protein

nade=uate intake of calories andDor proteinto sustain muscle mass

Chronic disease

nsulin resistance J leads to increasedincorporation of fat into muscle and adecrease in protein synthesis


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Conse=uences

%ecreased muscle strength

Problems with mobility

railty

)steoporosis

alls and fractures

%iabetes

%ecreased acti"ity le"els J can gi"e lifestyle disease

Foss of physical function and independence


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%iagnosis

!he diagnosis of sarcopenia is di1icult as there are no commonlyaccepted clinical guidelines 0owe"er there are suggested cuto1 points for diagnosing sarcopenia including measurements ofmuscle mass, muscle strength and physical performance, aspublished by the >uropean ;orking Group on Sarcopenia in)lder People

!hree imaging techni=ues ha"e been used for estimating musclemass or lean body massKcomputed tomography *C! scan,magnetic resonance imaging *-6 and dual energy Lrayabsorptiometry *%LA

Mioimpedance analysis *MA estimates the "olume of fat and leanbody mass


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!reatment

Pre"ention by staying acti"e and e&ercise Can bepartiallly re"ersible by e&ercise and correct diet*a"oid weight loss

>ndurance

6esistance

Malance

Posture

le&ibility

;atere&ercise e1ecti"e in patients with arthritis


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!reatment cont

rocortin J increase AC!0, pro"en to increasemuscle mass in rats

0ormone 6eplacement !herapy *06!

Nit % J min 5$$ , low le"els of "it % are associatedwith low muscle mass

f pt has htn, C0 or %- use AC>i because theseagents appear to increase muscle strenght

Anabolic steroids J increase anabolism and stimulatesatelitte cell production and iinhibits adipocyteproduction


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sarcopenia. geriatric medice

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