Neurocognitive Disorders

The Link, Potential Mechanism Between Sarcopenia and Motoric Cognitive Risk Syndrome

Avatar photoSheila Jacobs
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In the transition from RRMS to SPMS, inflammation that occurs early in the disease process slowly decreases over time, but a gradual worsening of symptoms occurs. The challenge for clinicians is to determine whether worsening symptoms are from the last relapse, or whether the patient has progressed to SPMS. A careful history of changes in a patient’s symptoms, neurologic examination, and MRI can help determine whether the transition has occurred. Interferon beta (Avonex, Betaseron, Extavia and Rebif), Aubagio (teriflunomide), Gilenya (fingolimod), Tecfidera (dimethyl fumarate), and Tysabri (natalizumab) are approved by the FDA for use in relapsing forms of MS, including SPMS. Many of those who progress to SPMS continue using these medications unless they are no longer adequately controlling disease activity. In this case, patients may transition to Novantrone (mitoxantrone), the only medication approved by the FDA specifically for SPMS, as well as worsening relapsing MS.

In the transition from RRMS to SPMS, inflammation that occurs early in the disease process slowly decreases over time, but a gradual worsening of symptoms occurs. The challenge for clinicians is to determine whether worsening symptoms are from the last relapse, or whether the patient has progressed to SPMS. A careful history of changes in a patient’s symptoms, neurologic examination, and MRI can help determine whether the transition has occurred.

Interferon beta (Avonex, Betaseron, Extavia and Rebif), Aubagio (teriflunomide), Gilenya (fingolimod), Tecfidera (dimethyl fumarate), and Tysabri (natalizumab) are approved by the FDA for use in relapsing forms of MS, including SPMS. Many of those who progress to SPMS continue using these medications unless they are no longer adequately controlling disease activity. In this case, patients may transition to Novantrone (mitoxantrone), the only medication approved by the FDA specifically for SPMS, as well as worsening relapsing MS.

Using an established moderated mediation model, researchers investigated the association and potential pathways between sarcopenia and motoric cognitive risk syndrome in older adults.

A moderated mediation model has been established to reveal the underlying association between the mechanism of sarcopenia and motoric cognitive risk (MCR) syndrome in a study published in the journal BMC Geriatrics.

Sarcopenia is a recognized risk factor for cognitive impairment, whereas MCR syndrome is a recently defined predementia syndrome. The relationship between the 2 conditions remains unknown. The researchers sought to explore the association and potential pathways between sarcopenia and MCR syndrome in a community of individuals aged 60 years and older by establishing a moderated mediation model.

The analysis was conducted between May 2021 and September 2021 in Xuzhou, China. A total of 846 community residents were recruited for the current study and underwent a comprehensive geriatric assessment. A diagnosis of sarcopenia was based on criteria issued in 2019 by the Asian Working Group for Sarcopenia. The presence of MCR syndrome was identified as subjective cognitive decline and a slow gait. The Apathy Evaluation Scale (AES) and the International Physical Activity Questionnaire (IPAQ) were utilized to evaluate symptoms of apathy and level of physical activity, respectively.

Overall, 7.1% (60 of 846) of the participants had MCR syndrome. Following adjustment, sarcopenia (odds ratio [OR], 3.81; 95% CI, 1.69 to 8.60; P =.001), AES score (OR, 1.09; 95% CI, 1.04 to 1.14; P <.001), and IPAQ level (OR, 0.43; 95% CI, 0.28 to 0.66; P <.001) were all significantly associated with MCR syndrome.

The relationship between sarcopenia and MCR syndrome was mediated partially by the presence of apathy. Additionally, the level of physical activity only significantly moderated the sarcopenia-apathy path, thus demonstrating that an increase in physical activity can lessen the indirect effects of sarcopenia on MCR syndrome.

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Study limitations included the fact that it only preliminarily discussed the mechanism of sarcopenia on MCR syndrome, based on its cross-sectional study design; the reverse connection between MCR syndrome and sarcopenia also can exist. Further, some major variables in the study, including apathy, physical activity, and subjective cognitive decline, relied heavily on participants’ self-reports and were thus not objective in nature.

The researchers concluded that “These findings suggest that attention should be paid to the management of apathy and physical activity in the context of sarcopenia to prevent early dementia actively. Further validation is needed in future longitudinal studies.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  

Reference  

Zhang T, Zhang Y, Lv Z, Xiang J. Sarcopenia and motoric cognitive risk syndrome: a moderated mediation model. BMC Geriatr. Published online February 19, 2022. doi:10.1186/s12877-022-02802-4

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