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Sarcopenia has a significant impact on falls, physical function, activities of daily living, and quality of life in older adults, and its prevention and treatment are becoming increasingly important as the global population ages. In addition to primary age-related sarcopenia, activity-related sarcopenia, disease-related sarcopenia, and nutrition-related sarcopenia have been proposed as secondary sarcopenia. Polypharmacy and potentially inappropriate medication based on multiple diseases cause health problems in older patients. In some cases, drugs used for therapeutic or preventive purposes act on skeletal muscle as adverse drug reactions and induce sarcopenia. Although sarcopenia caused by these adverse drug reactions may be more common in older patients, in particular those taking many medications, drug-related sarcopenia has not yet received much attention. This review summarizes drugs that may induce sarcopenia and emphasizes the importance of drug-related sarcopenia as a secondary sarcopenia. Geriatr Gerontol Int 2024; 24: 195-203., (© 2023 Japan Geriatrics Society.)

Werner syndrome is an adult-onset progeria syndrome that results in various complications. This study aimed to clarify the profile and secular variation of the disease. Fifty-one patients were enrolled and registered in the Werner Syndrome Registry. Their data were collected annually following registration. A cross-sectional analysis at registration and a longitudinal analysis between the baseline and each subsequent year was performed. Pearson's chi-squared and Wilcoxon signed-rank tests were used. Malignant neoplasms were observed from the fifth decade of life (mean onset: 49.7 years) and were observed in approximately 30% of patients during the 3-year survey period. Regarding renal function, the mean estimated glomerular filtration rate calculated from serum creatinine (eGFRcre) and eGFRcys, which were calculated from cystatin C in the first year, were 98.3 and 83.2 mL/min/1.73 m 2 , respectively, and differed depending on the index used. In longitudinal analysis, the average eGFRcre for the first and fourth years was 74.8 and 63.4 mL/min/1.73 m 2 , showing a rapid decline. Secular changes in Werner syndrome in multiple patients were identified. The prevalence of malignant neoplasms is high, and renal function may decline rapidly. It is, therefore, necessary to carry out active and detailed examinations and pay attention to the type and dose of the drugs used.

Objectives: Muscle ultrasound is a non-invasive technique that enables identification of the quantity and quality of muscle tissue. It has been used not only for diagnosis of sarcopenia but also for prediction of outcomes in clinical practice. There is now increasing awareness that muscle changes detected during acute hospitalization indicate acute sarcopenia leading to worse outcomes. However, to our knowledge, few studies have investigated this in hospitalized older adults. The aim of this study was to determine whether muscle changes on muscle ultrasound can predict poor outcomes in acute hospitalized older adults., Methods: This prospective, observational cohort study involved 145 acute hospitalized older adults. Bilateral anterior thigh thickness (BATT), echo intensity (EI), and corrected EI of the quadriceps were assessed on admission and 7 d later. The primary outcome was mortality, and the secondary outcomes were hospital-associated complications and decline in activities of daily living (ADLs) at 3 mo after discharge., Results: Changes in BATT, EI, and corrected EI at 7 d after admission were found in 0.2%, 0.0%, and 0.2% of cases, respectively. The respective rates for mortality, hospital-associated complications, and ADL decline were 8.7%, 52.8%, and 43%, respectively. Multivariable logistic regression analysis showed that the BATT value at admission tended to be associated with mortality. Changes in BATT, EI, and collected EI were not associated with adverse outcomes., Conclusions: Acute muscle changes on muscle ultrasound were not associated with mortality, ADL decline, or hospital-associated complications in acute hospitalized older adults. More research in various settings is needed to clarify the value of muscle ultrasound in clinical practice., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Skeletal muscle mass and function losses in aging individuals are associated with quality of life deterioration and disability. Mesenchymal stromal cells exert immunomodulatory and anti-inflammatory effects and could yield beneficial effects in aging-related degenerative disease., Methods and Results: We investigated the efficacy of umbilical cord-derived mesenchymal stromal cells (UC-MSCs) on sarcopenia-related skeletal muscle atrophy and dysfunction in senescence-accelerated mouse prone 10 (SAMP10) mice. We randomly assigned 24-week-old male SAMP10 mice to a UC-MSC treatment group and control group. At 12 weeks post-injection, the UC-MSC treatment had ameliorated sarcopenia-related muscle changes in performance, morphological structures, and mitochondria biogenesis, and it enhanced the amounts of proteins or mRNAs for myosin heavy chain, phospho-AMP-activated protein kinase, phospho-mammalian target of rapamycin, phospho-extracellular signal-regulated kinase1/2, peroxisome proliferator-activated receptor-γ coactivator, GLUT-4, COX-IV, and hepatocyte growth factor in both gastrocnemius and soleus muscles, and it reduced the levels of proteins or mRNAs for cathepsin K, cleaved caspase-3/-8, tumor necrosis factor-α, monocyte chemoattractant protein-1, and gp91 phox mRNAs. The UC-MSC treatment retarded mitochondria damage, cell apoptosis, and macrophage infiltrations, and it enhanced desmin/laminin expression and proliferating and CD34 + /Integrin α 7 + cells in both types of skeletal muscle of the SAMP10 mice. In vitro, we observed increased levels of HGF, PAX-7, and MoyD mRNAs at the 4th passage of UC-MSCs., Conclusions: Our results suggest that UC-MSCs can improve sarcopenia-related skeletal muscle atrophy and dysfunction via anti-apoptosis, anti-inflammatory, and mitochondrial biogenesis mechanisms that might be mediated by an AMPK-PGC1-α axis, indicating that UC-MSCs may provide a promising treatment for sarcopenia/muscle diseases., (© 2022. The Author(s).)

Aim: This study performed anthropometric measurements for Werner syndrome (WS) using bioelectrical impedance analysis and compared them with the Japanese reference data., Methods: The analytical sample included nine participants with WS (four men, five women, 49.6 ± 9.3 years, SD). The height-corrected appendicular skeletal muscle mass index (SMI), upper- and lower-limb muscle mass index (USMI/LSMI) of the patients with WS were compared with the Japanese reference data (40-79 years). The body mass index, SMI, height-corrected fat mass index (FMI) and fat-free mass index (FFMI) were compared with the reference data of Japanese older adults (65-94 years). The SMIs of WS were also compared with the diagnostic criteria for sarcopenia., Results: The SMI and USMI/LSMI of all participants with WS were lower than the Japanese reference data corresponding to gender and age, and the rate of decrease was more pronounced for USMI than for LSMI. The body mass index, SMI and FFMI for all the WS cases were lower than those for the older Japanese, while the FMI was higher in men with WS but lower in women than the reference data of the older Japanese. The SMI was below the cut-off value for the diagnosis of sarcopenia in all patients with WS., Conclusion: The SMI for WS is comparable with that for sarcopenia and significantly lower than that for healthy individuals of the same age and older adults. The USMI was significantly lower than LSMI in patients with WS, and FMI was higher in male patients with WS and lower in women than in healthy older people. Geriatr Gerontol Int 2022; 22: 75-80., (© 2021 Japan Geriatrics Society.)

Older adults have physical and metabolic characteristics, and there are many differences in nutritional outcomes from middle-aged adults. In addition, there are many factors that cause malnutrition peculiar to the older adults, which are not seen in middle-aged adults, and it is easy for them to lose weight and become malnourished. Therefore, nutritional management needs to take into account the age of each subject. Uniform nutritional management can even cause poor health outcomes. The concept of frailty, especially phenotype frailty, and sarcopenia, which have been advocated with the aging of the population and the extension of life expectancy around the world, is very important in considering the extension of healthy life expectancy. In other words, in the super-aged society, frailty and sarcopenia have been emphasized as factors of functional decline, physical dysfunction, and the need for long-term care in addition to the well-known diseases such as cardiovascular disease, malignant tumors, and infectious disease. In fact, these two conditions are strongly associated with the increased risk of new disease development, falls, fractures, disability, hospitalization and death in the older adults. These two conditions are primarily associated with malnutrition and decreased dietary protein intake, and may recover to robustness again with appropriate interventions such as nutritional therapy. Therefore, undernutrition measures are more important for prevention of frailty and sarcopenia than measures for obesity against metabolic syndrome in the older adults, especially in the late-stage older people.

Background: Hospital-associated complications are associated with adverse outcomes after discharge, and a method to help predict the occurrence of these complications needs to be established. Sarcopenia is thought to be one of the factors associated with hospital-associated complication, but sarcopenia assessment in hospitalized patients is often difficult. Focus has recently been placed on morphological and qualitative evaluation of muscle by ultrasound as an index of sarcopenia. Therefore, in this study, we sought to clarify the association of hospital-associated complication with muscle thickness or echo intensity measured by ultrasound and with commonly used sarcopenia-related parameters., Methods: This is a prospective observational cohort study with 156 hospitalized older patients recruited over a year. Bilateral thigh muscle thickness of rectus femoris and vastus intermedius, echo intensity and corrected echo intensity of rectus femoris were measured by ultrasound. Also measured were the sarcopenia-related parameters of handgrip strength, skeletal muscle index, and maximum calf circumference. Hospital-associated complication was defined as the occurrence of any of the following complications: delirium, functional decline, incontinence, falls, pressure injuries, and nosocomial infections., Results: Of 156 patients enrolled at admission, hospital-associated complication was observed in 70 (54.3%). With-hospital-associated complication group had a higher prevalence of emergency admission and a higher corrected echo intensity than without-hospital-associated complication group. Multivariate logistic regression analysis showed that only higher corrected echo intensity was associated with hospital-associated complication (odds ratio 1.036; 95% confidence interval, 1.001-1.072), while handgrip strength, bilateral thigh muscle thickness, skeletal muscle index, and maximum calf circumference were not., Conclusions: Corrected echo intensity might be a useful parameter to help predict hospital-associated complication in acute hospitalized older patients and might contribute to establishing a strategy to prevent hospital-associated complication., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: Sarcopenia is defined as a condition that combines decreased skeletal muscle mass with weakness or decreased physical function. It is well known that in older adults, the presence of sarcopenia is a risk of frailty, falls and physical dysfunction. Patients with Werner syndrome are characterized by visceral fat accumulation and thin limbs, but the prevalence of sarcopenia in patients with Werner syndrome has not been investigated., Methods: A literature search was conducted using Werner syndrome and skeletal muscle as keywords. We also analyzed data from our 7 Werner syndrome patients., Results: A literature search on the relationship between Werner syndrome and skeletal muscle yielded only one article reported from Japan. According to this paper, a decrease in skeletal muscle mass (appendicular skeletal muscle index) was observed in all 9 Werner syndromes investigated. On the other hand, in our 7 Werner syndrome patients, their appendicular skeletal muscle indexes were below the standard value except for one male patient who had continued resistance exercise., Conclusion: The decrease in skeletal muscle mass frequently occurs in patients with Werner syndrome. However, resistance exercise may prevent the appearance of sarcopenia and requires early intervention in patients with Werner syndrome. Geriatr Gerontol Int 2021; 21: 139-141., (© 2020 Japan Geriatrics Society.)

Background: Mild hyponatremia (serum sodium 130-135 mEq/L) is a common electrolyte disorder in the elderly. However, its association with both sarcopenia and cognitive function remains to be clarified. Therefore, here we investigated the association of mild hyponatremia with skeletal muscle mass, physical function, and cognitive function in the elderly., Methods: We enrolled 75 participants with mild hyponatremia and 2907 with normonatremia (serum sodium, 136-145 mEq/L) aged ≥70 years who visited the Memory Disorder Outpatient Center of Japan's National Center for Geriatrics and Gerontology. Skeletal muscle mass index (SMI), grip strength (GS), walking speed (WS), one-leg standing (OLS) test times, and neuropsychological test scores were determined., Results: One-way analysis of covariance showed that elderly participants with mild hyponatremia had lower SMI (7.1 ± 0.2, 7.2 ± 0.2 kg/m 2 , p = 0.04), weaker GS (19.1 ± 1.9 vs 21.4 ± 1.8 kg, p = 0.01), slower WS (0.9 ± 0.1 vs 1.1 ± 0.1 m/s, p = 0.001), and higher GDS- 15 score (6.4 ± 0.9 vs 5.2 ± 0.9, p = 0.002) than those with normonatremia. Multiple logistic regression analysis indicated that mild hyponatremia was independently associated with sarcopenia (odds ratio [OR]: 2.2, p = 0.02), slower WS (OR: 5.3, p = 0.04) and shorter OLS time (OR: 2.5, p = 0.02) as well as with severe depressive mood (OR: 2.6 p = 0.006) but not with SMI (OR: 1.6, p = 0.2) or GS (OR: 1.9, p = 0.09)., Conclusions: Our results suggest that elderly people with even mild hyponatremia had physical function impairment and depressive mood.

Background: Homocysteine is a common risk factor for cognitive impairment and sarcopenia. However, very few studies have shown an association between sarcopenia and serum homocysteine levels after adjustment for cognitive function., Objective: The purpose of this study was to investigate the relationship between homocysteine and sarcopenia in memory clinic patients., Methods: This cross-sectional study investigated outpatients in a memory clinic. We enrolled 1,774 participants (≥65 years old) with measured skeletal muscle mass index (SMI), hand grip strength (HGS), and homocysteine. All participants had undergone cognitive assessments and were diagnosed with dementia, mild cognitive impairment, or normal cognition. Patient characteristics were compared according to sarcopenia presence, SMI level, or HGS. Multivariate logistic regression analysis was performed to determine the association of homocysteine with sarcopenia, low SMI, or low HGS. Next, linear regression analysis was performed using HGS as a continuous variable., Results: Logistic regression analysis showed that low HGS was significantly associated with homocysteine levels (p = 0.002), but sarcopenia and low SMI were not. In linear regression analysis, HGS was negatively associated with homocysteine levels after adjustment for Mini-Mental State Examination score (β= -2.790, p < 0.001) or clinical diagnosis of dementia (β= -3.145, p < 0.001). These results were similar for men and women., Conclusion: Our results showed a negative association between homocysteine and HGS after adjustment for cognitive function. Our findings strengthen the assumed association between homocysteine and HGS. Further research is needed to determine whether lower homocysteine levels lead to prevent muscle weakness.

The coronavirus disease 2019 (COVID-19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID-19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID-19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 9999: n/a-n/a., (© 2020 Japan Geriatrics Society.)

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m 2 in men and <5.4 kg/m 2 in women; and bioimpedance, <7.0 kg/m 2 in men and <5.7 kg/m 2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Cognitive impairment is linked to decreased quality of life (QOL), but few studies have investigated the impact of comorbid sarcopenia., Objective: The aim of this study was to elucidate the association of sarcopenia with QOL in patients with early dementia and mild cognitive impairment., Methods: Individuals with a Clinical Dementia Rating of 0.5 or 1 and a Mini-Mental State Examination score of 20-30 underwent a battery of neuropsychological assessments administered by a group of well-trained clinical psychologists. The EQ-5D was completed by both the patients and their main caregivers. EQ-5D utility and visual analog scale scores were measured. Sarcopenia was defined according to the criteria published in the 2019 consensus update by the Asian Working Group for Sarcopenia., Results: Patients with sarcopenia had significantly lower scores on the Digit Symbol Substitution Test and Trail Making Test Part A. There was a significant negative association between sarcopenia and both self- and proxy-rated EQ-5D utility scores independent of potential confounding factors. However, there was no association between QOL visual analog scale scores and sarcopenia., Conclusion: Given that sarcopenia is often found in individuals with cognitive impairment, early detection by timely screening and effective intervention may help to maintain or improve QOL in this population. However, this study could not determine whether reduced QOL is a direct consequence of sarcopenia.

Aim: The aim of the present study was to examine the relationship between depressive mood and diagnostic components of sarcopenia., Methods: The study used baseline data of participants in the Toyota Prevention Intervention for Cognitive Decline and Sarcopenia study. Participants in this cross-sectional study were 432 older adults (46.5% women, mean age 72.5 ± 4.7 years). We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia, and all participants were classified into a sarcopenia or healthy control group. The skeletal muscle mass was measured by bioelectrical impedance. Depressive mood was assessed using the Geriatric Depression Scale-15 (range 0-15)., Results: Among the 432 participants, 9.5% were classified as having sarcopenia. The mean ± SD Geriatric Depression Scale-15 scores in the control and sarcopenia groups were significantly different at 3.9 ± 2.8 and 5.3 ± 3.3, respectively (P = 0.003). Furthermore, depressive mood was significantly more prevalent in the sarcopenia group (P = 0.011). Multiple linear regression analysis showed that the Geriatric Depression Scale score was associated with grip strength (β = -0.23, P = 0.004) and walking speed (β = -0.15, P = 0.006), but not skeletal muscle mass index (β = -0.16, P = 0.142), after controlling for demographic factors, chronic diseases, inflammatory markers and physical activity., Conclusions: Sarcopenia was associated with depressive mood. In terms of the diagnostic components of sarcopenia, depressive mood was not associated with decreased muscle mass, but was associated with low muscle strength and low physical performance. Geriatr Gerontol Int 2019; 19: 508-512., (© 2019 Japan Geriatrics Society.)

Frailty is an aging-related medical syndrome which contains the decline in physiological, cognitive, and social reserves abilities. It has been known to be important to early identify and prevent reversible frailty. On the other hand, sarcopenia, the aging-related loss of muscle mass and strength or function is major determinant of the quality of life of elderly and frailty. Recently, the accumulating evidence of the physical frailty concept suggested that it is as a risk factor for the long-term care, leading to be important to extend the healthy lifespan. However, the diagnosis of frailty is not necessarily unified, the molecular mechanism underlying the onset of sarcopenia is not clear, and clinical treatment strategy has not been established. Therefore, the searching and identifying of the biomarkers of the frailty and sarcopenia is very important for the prevention as well as the treatment of the muscle disease, and the further studies will be needed to investigate these issues.

The historical change in the concept of frailty has been observed from 1980s, and even now there are major two models of frailty, phenotype model and deficit accumulation model. Furthermore besides physical frailty, psychological frailty, which encompasses cognitive and mood components, and social frailty, which includes the lack of participation in social networks and perceived lack of contacts and support, have been proposed, although there is no consensus regarding the definition as well as criteria of these frailty. In super-aged society, Japan, from the viewpoint of healthy life expectancy, the concept of phenotype model of frailty is important.