Altered body composition, sarcopenia, frailty, and their clinico-biological correlates, in Parkinson's disease

Tan, Ai Huey; Hew, Yin Cheng; Lim, Shen‐Yang; Ramli, Norlisah; Kamaruzzaman, Shahrul Bahyah; Tan, Maw Pin; Grossmann, Mathis; Ang, Ban Hong; Tan, Jully; Manap, Mohamad Addin Azhan A.; Tay, T.K.; Tan, S.L.; New, R.P.; Fadzli, Farhana; Yee, Eng Jui; Moy, Foong Ming; Mahadeva, Sanjiv; Lang, Anthony E.

doi:10.1016/j.parkreldis.2018.06.020

Cited by 76 publications

(84 citation statements)

References 29 publications

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“…These findings suggest that sarcopenia in PD patients exhibits a tendency toward higher percentage of fat loss than percentage of muscle loss. Interestingly, this result is similar to a recent study which reveals that fat mass index is reduced in PD patients, and reduced fat is associated with higher risk of motor complications in PD [17], corresponding with the higher UPDRS III score of the PDSa patients in this study. Although the pathophysiology of this finding is unclear, higher BMI, fat mass, and lean body mass in elders have a positive association with better cognitive performance, especially in executive function [18,19].…”

Section: Discussionsupporting

confidence: 92%

Correlation between Executive Network Integrity and Sarcopenia in Patients with Parkinson’s Disease

Lee

Chen

et al. 2019

IJERPH

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Background: Sarcopenia is critically associated with morbidity and mortality in the progression of Parkinson's disease (PD). However, analyses of clinical severity and brain changes, such as white matter (WM) alterations in PD patients with sarcopenia are limited. Further understanding of the factors associated with sarcopenia may provide a focused screen and potential for early intervention in PD patients. Methods: 52 PD patients and 19 healthy participants accepted dual-energy X-ray absorptiometry to measure the body composition. Using diffusion tensor imaging, the difference of WM integrity was measured between PD patients with sarcopenia (PDSa) and without sarcopenia (PDNSa). Multivariate analysis was performed to explore the relationships between clinical factors, WM integrity, and sarcopenia in PD patients. Results: 21 PD patients (40.4%) had sarcopenia. PDSa had a higher Unified Parkinson's Disease Rating Scale (UPDRS III) score, lower body mass index (BMI) and lower fat weight compared with the PDNSa. Additionally, PDSa patients exhibited lower fractional anisotropy accompanied by higher radial diffusivity and/or higher mean diffusivity in the fronto-striato-thalamic circuits, including bilateral cingulum, left superior longitudinal fasciculus, left genu of corpus callosum, and right anterior thalamic radiation, which participate in the executive function. In addition, decreased muscle mass was associated with worse WM integrity in these regions. Multiple linear regression analysis revealed that WM integrity in the left cingulum, right anterior thalamic radiation, together with gender (male) significantly predicted muscle mass in PD patients. Conclusions: WM alterations in the executive network, such as the fronto-striato-thalamic circuits, may indicate a risk factor for ongoing sarcopenia in PD patients. The effectiveness of using executive function to serve as a prodromal marker of sarcopenia in PD patients should be evaluated in future studies.

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Section: Discussionsupporting

confidence: 92%

Correlation between Executive Network Integrity and Sarcopenia in Patients with Parkinson’s Disease

Lee

Chen

et al. 2019

IJERPH

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“…is data does not support the sarcopenic obesity theory proposed previously in PD [21], where PD patients exhibit greater body fat mass and a decrease in muscle and bone masses. Recently similar findings were reported [33], assuming that this could be due to inflammation, hyperinsulinemia, or increased sympathetic activity. Regardless that the unintentional weight loss is stated in approximately 37.5% of PD patients, the musculoskeletal mass did not show statistical differences between PD patients and control subjects and was slightly higher in PD patients (26.2 kg) than in controls (25.5 kg).…”

Section: Discussionsupporting

confidence: 79%

“…Notwithstanding the increasing evidence regarding weight changes in PD, its causes are still not well understood, and body composition characteristics of PD patients are not yet well established. Some studies suggest that body composition changes in PD patients are due to the loss of body fat tissue [33], preserving musculoskeletal mass [34], while others propose that this weight loss could be related to the redistribution of muscle to fat [21]. In this fashion, an excess of adiposity associated with a lean body mass depletion (sarcopenic obesity) has been described in advanced stages of the disease [21,22,35].…”

Section: Introductionmentioning

confidence: 99%

Altered Body Composition and Increased Resting Metabolic Rate Associated with the Postural Instability/Gait Difficulty Parkinson’s Disease Subtype

Femat-Roldán

Palau

Castilla‐Cortázar

et al. 2020

Parkinson's Disease

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Background. Weight loss in Parkinson’s disease (PD) patients is a common but poorly understood manifestation. Several studies have reported that weight changes could be related to motor symptoms, drug side effects, dysphagia, depression, and/or dementia. Weight loss in PD is not a benign phenomenon and it has several clinical and prognostic implications with increased morbidity and mortality. Thus, it is crucial to determine nutritional changes in PD patients in order to prevent malnutrition and improve their quality of life. Objective. To compare body composition and resting metabolic rates between PD patients and controls. Methods. A total of 64 PD patients and 52 controls were studied. The Hoehn-Yahr scale was used to determine the disease stage, clinical and epidemiological data were recorded from verbal questionnaire, Inbody S10® was used to collect corporal parameters, and FitMate system was used to assess the resting metabolic rate. Results. No significant differences were found between both experimental groups in age, gender, height, cholesterol levels, and the presence of hypertension, diabetes, and hypo/hyperthyroidism. However, the PD group showed lower body fat mass, whole-body fat percentage, and greater resting metabolic rate compared to controls (p<0.05), with no significant differences in musculoskeletal mass. Parkinson’s disease postural instability/gait difficulty (PD-PIGD) subtype showed lower body fat parameters, increased fat-free mass, and higher resting metabolic rates. Conclusions. These results suggest that PD patients present an increased resting metabolic rate associated with the postural instability/gait difficulty PD subtype, allowing a selective decrease of body fat mass and not musculoskeletal mass. Of note, several disease-related factors may contribute to this weight loss in PD patients, being a complex and multifactorial consequence. Our findings could likely be one of the many contributing factors. However, present findings may further add to our understanding of the phenomenon of weight loss in patients with PD.

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“…In the study of Barichella et al [10], muscle mass was measured with BIA and calculated by the same regression formula that we used; they found almost the same SMI (i.e., 9.5 vs. 9.3 kg/m 2 in our study; Table 1) in 364 patients with PS. An Asian cohort of 98 iPD patients (from Malaysia) also had a higher muscle mass than their spouse/sibling controls, although the difference was not significant [11]. These authors used DXA for muscle mass measurement and it was an Asian cohort, so a comparison of absolute values should be avoided.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction: Pathogenesis in a subgroup of sarcopenic patients seems to be based on a reduced number of motor neurons. This study aimed at investigating the overlap between sarcopenia and neurodegeneration, as reflected by a low number of motor neurons in patients with Parkinsonian syndromes (PS). Methods: The motor unit number index (MU-NIX) of the hypothenar muscle was used to assess the number and size (MUSIX) of motor units (MUs) in patients with idiopathic Parkinson disease (iPD, n = 53), patients with atypical Parkinsonian syndrome (aPS, n = 21), and a control group (n = 30). Mean age of participants was 70.3 years and 54.1% were female. Skeletal muscle mass by bioelectrical impedance analysis, hand-grip strength and gait speed were measured. Based on these assessments, sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People. Results: Sarcopenia criteria were met by 10 patients with PS (13.5%). The study group had significantly lower MUNIX values than the control group (109 [SD ±39.1] vs. 129 [SD ±45.1]; p = 0.020) even after adjustment for age and sex. Three of the 5 sarcopenic iPD patients (75%) had pathological low MUNIX values (< 80). Discussion/Conclusion: Sarcopenia is a frequent comorbidity in PS. The pathologically low MUNIX values found in 75% of our sarcopenic iPD patients provides further support for the existence of a neurodegenerative overlap syndrome with a reduced number of MUs potentially leading to sarcopenia. This finding warrants further evaluation.

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Altered body composition, sarcopenia, frailty, and their clinico-biological correlates, in Parkinson's disease

Cited by 76 publications

References 29 publications

Correlation between Executive Network Integrity and Sarcopenia in Patients with Parkinson’s Disease

Correlation between Executive Network Integrity and Sarcopenia in Patients with Parkinson’s Disease

Altered Body Composition and Increased Resting Metabolic Rate Associated with the Postural Instability/Gait Difficulty Parkinson’s Disease Subtype

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

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