Aging. It is unavoidable unless you consider the other option: death. Most of us are in our younger, non-elderly years and living life to its fullest, or at least that is my hope. But there is a somewhat newer area of research in aging, not focused exclusively on the cognitive decline but rather a functional decline. The area of research I want to talk about is sarcopenia.
Sarcopenia is a cumulative loss of muscle mass and function, meaning not only is the amount of muscle low, but the strength of the remaining muscle is low as well. Multiple high-quality studies from the US and Europe have demonstrated that sarcopenia is associated with fall risk, fracture risk, impaired activities of daily living, cardiopulmonary disease, lower quality of life, loss of independence, and yes, cognitive impairment. Severe sarcopenia is associated with a higher risk of death.
Newer studies have identified loss of muscle strength as an even stronger predictor of functional decline. Several screening modalities have been described, including measuring skeletal mass by DEXA, grip strength, sit-to-stand tests, questionnaires, and gait speed. However, there is little consensus on how to accurately diagnosis sarcopenia given that there are no guidelines currently in existence. Some researchers have studied the use of MRI, ultrasound, and specific biomarkers, but all have inherent problems associated with their use.
While this is an exciting area of clinical research, we will have to see how this information is translated into clinical practice. In the meantime, what are we to do? First, we should start talking to our patients about the importance of maintaining muscle strength. We have focused on cardiac conditioning for years, and while still absolutely essential, patients should start incorporating some type of muscle-strengthening exercise regimen. Second, I think we should be on the look-out for newer studies and possibly some evidence-based guidelines in the near future. And last, we need to take care of ourselves. All of us should be incorporating some muscle-building exercise into our regimens.