Lauretani Fulvio, Meschi Tiziana, Ticinesi Andrea, Maggio Marcello
Internal Medicine and Critical Subacute Care Unit, Cognitive and Motoric Ambulatory, Geriatric-Rehabilitation Department, Parma University-Hospital, Parma, Italy.
Department of Clinical and Experimental Medicine, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
Aging Clin Exp Res. 2017 Dec;29(6):1305-1311. doi: 10.1007/s40520-017-0729-4. Epub 2017 Feb 23.
The imperative action of the geriatric medicine is to prevent disability in older persons. Many epidemiological studies have been conducted in the last decades for improving knowledge of the aging process and their interactions with age-related diseases, especially for the identification of the relationship between sarcopenia and loss of mobility. Factors influencing muscle integrity can be classified into six main physiologic subsystems, but the central nervous system certainly plays a crucial role for maintaining muscle integrity in older persons. Recent data show that the reduced muscle strength and not muscle mass could be considered the core of the fragility in predicting changes of gait velocity and mobility and conferring a higher risk of mortality in older persons. Sarcopenia and cognitive decline could, therefore, produce slow gait velocity in older persons, with devastating effect and consequences. Perhaps the most notorious corollary is falling, which is often caused by an underlying gait problem. Injuries caused by accidental falls range from relatively innocent bruises to major fractures or head trauma. Another important consequence is reduced mobility, which leads to loss of independence. This immobility is often compounded by a fear of falling, which further immobilises patients and affects their quality of life and physical performance.
When we search the association between brain pathology and muscle function in older persons, we amazingly find that established composite measure of physical frailty is associated with brain pathology. Sarcopenia, which produces muscle dysfunction, slow gait velocity and cognitive decline, could share a strong bidirectional relationship, and this suggests the coexistence of both cognitive and motor dysfunctions in older persons to characterize a new syndrome characterized by slow gait and cognitive complaints, the motoric-cognitive risk syndrome (MRC).
In this review, we want to emphasize the relationship between memory complaints with muscle function integrating cognitive and physical evaluation, even with amyloid PET study, to identify older patients at high risk of cognitive and physical decline.
老年医学的当务之急是预防老年人失能。在过去几十年里，已经开展了许多流行病学研究，以增进对衰老过程及其与年龄相关疾病相互作用的了解，特别是为了确定肌肉减少症与行动能力丧失之间的关系。影响肌肉完整性的因素可分为六个主要生理子系统，但中枢神经系统在维持老年人肌肉完整性方面肯定起着关键作用。最近的数据表明，在预测老年人步态速度变化和行动能力以及赋予更高死亡风险方面，肌肉力量下降而非肌肉质量减少可被视为虚弱的核心。因此，肌肉减少症和认知衰退可能导致老年人步态速度减慢，产生毁灭性的影响和后果。也许最广为人知的结果是跌倒，这通常由潜在的步态问题引起。意外跌倒造成的伤害范围从相对轻微的瘀伤到严重骨折或头部创伤。另一个重要后果是行动能力下降，这会导致失去独立性。这种行动不便往往因害怕跌倒而加剧，这进一步使患者行动受限，影响他们的生活质量和身体表现。
当我们研究老年人脑病理学与肌肉功能之间的关联时，我们惊人地发现，既定的身体虚弱综合测量指标与脑病理学有关。导致肌肉功能障碍、步态速度减慢和认知衰退的肌肉减少症可能存在强烈的双向关系，这表明老年人认知和运动功能障碍并存，以表征一种以步态缓慢和认知主诉为特征的新综合征，即运动-认知风险综合征（MRC）。
在本综述中，我们想强调记忆主诉与肌肉功能之间的关系，整合认知和身体评估，甚至结合淀粉样蛋白PET研究，以识别有认知和身体衰退高风险的老年患者。
