Sarcopenia. Geriatric Medice
Transcript of Sarcopenia. Geriatric Medice
-
7/26/2019 Sarcopenia. Geriatric Medice
1/21
Sarcopenia
-
7/26/2019 Sarcopenia. Geriatric Medice
2/21
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#$$m away She has problem with balance %uringthe "isit she also e&press feeling of sadness andthat life is "ery hard for her She has had noweight loss 'o loss or increased app(tit
-
7/26/2019 Sarcopenia. Geriatric Medice
3/21
)besity *++$ kg
%- type ./
G0 le"els is normal, in the lower border
)steoporosis
0ypertension Generally "ery inacti"e for the most of here
life
-
7/26/2019 Sarcopenia. Geriatric Medice
4/21
%i1 %iagnosis
Cancer
'eurological disease
%epression
-
7/26/2019 Sarcopenia. Geriatric Medice
5/21
%e2nition
n +43+, Critchley noted that with aging there wasa loss of muscle mass which was most marked inthe hands and feet
n +454, rwin 6osenberg proposed the termsarcopenia/ *Greek sar&/ or 8esh 9 penia/ or lossto describe this agerelated decrease of musclemass Sarcopenia has since been de2ned as theloss of skeletal muscle mass and strength that
occurs with ad"ancing age 0owe"er, a widelyaccepted de2nition of sarcopenia suitable for usein research and clinical practice is still lacking
-
7/26/2019 Sarcopenia. Geriatric Medice
6/21
;hat is sarcopenia;GS)P *>uropean working group onsarcopenic in older people recommends
using the presence of both low muscle massand low muscle function *strength orperformance for the diagnosis ofsarcopenia
-
7/26/2019 Sarcopenia. Geriatric Medice
7/21
>pidemiology
Sarcopenia is "ery common in older personswith a pre"alence from # to +3? in personsaged @$ to 7$ years and of ++ to #$? in persons
o"er 5$ years of age
Sarcopenia is appro&imately twice as commonas frailty n the nited States, it can beestimated that there are roughly 3@ millionpersons with frailty
!he healthcare costs of sarcopenia in the SA in.$$$ were estimated to be B+5# billion
-
7/26/2019 Sarcopenia. Geriatric Medice
8/21
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
-
7/26/2019 Sarcopenia. Geriatric Medice
9/21
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
-
7/26/2019 Sarcopenia. Geriatric Medice
10/21
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
-
7/26/2019 Sarcopenia. Geriatric Medice
11/21
Symptoms
Weakness
Loss of stamina which interferes with physical
activityreduce muscle mass further.
Inability to perform daily activities
Depression
-
7/26/2019 Sarcopenia. Geriatric Medice
12/21
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
-
7/26/2019 Sarcopenia. Geriatric Medice
13/21
>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
-
7/26/2019 Sarcopenia. Geriatric Medice
14/21
>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
-
7/26/2019 Sarcopenia. Geriatric Medice
15/21
-
7/26/2019 Sarcopenia. Geriatric Medice
16/21
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
-
7/26/2019 Sarcopenia. Geriatric Medice
17/21
%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
-
7/26/2019 Sarcopenia. Geriatric Medice
18/21
-
7/26/2019 Sarcopenia. Geriatric Medice
19/21
!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
-
7/26/2019 Sarcopenia. Geriatric Medice
20/21
!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
-
7/26/2019 Sarcopenia. Geriatric Medice
21/21